"Our study found that if patients were treated by physicians who they really liked and were very caring, they might not leave the practice even if they were misdiagnosed and, therefore, did not trust the physician. They would, however, be more vigilant and therefore monitor their visits more closely."
Hupcey, Mary Beth Clark, assistant professor of nursing and Christina Hutcheson and Virginia Thompson, recent master's degree recipients, used focus groups to investigate interactions of elderly, community-dwelling outpatients and their primary care physicians. In Hupcey's previous work looking at hospitalized patient and healthcare provider interactions, she found that the most important factor was having expectations for care met.
"This present study supported the earlier work that meeting expectations for care is one of the key issues between patients and providers," Hupcey told attendees at the Scientific Session of the Eastern Nursing Research Society today (March 23) on Penn State's University Park Campus.
Patient's expectations for care fell into three categories: sense of caring, technical proficiency, and an efficient and friendly office environment. Physicians who connected personally with patients, spent a little more time with them or at least appeared to, or office assistants who connected personally achieved good marks for caring. A sense of humor and a call with test results also went a long way to meet expectations. Ordering tests, not necessarily prescribing medications, was an indication of competency. If an examination was rushed or not thorough, then the physician was labeled not technically proficient.
Environmental office factors may influence satisfaction, but were important only if the other aspects of care were sub par. Pleasant receptionists, timely appointments and a pleasant atmosphere were important, but not necessarily major influences on satisfaction. The elderly patients universally disliked voice mail systems or answering machines as alternatives to a human receptionist or operator.
"The environment was not an important factor if the elders were satisfied with the other two categories," says Hupcey. "But if either a sense of caring or technical proficiency was deemed lacking, a negative environment would heighten the dissatisfaction."
The researchers used eight focus groups recruited from senior centers and housing projects. Data collection continued until the responses became repetitive, signaling to the researchers that they had reached saturation – that all points of view had been covered.
"These elderly are very savvy about their medical care, much more than I ever expected them to be," says Hupcey. "Many are willing to leave a practice if they are not satisfied." Although the participants in the study were diverse in education, they knew how to function in the healthcare system. According to Hupcey, they were empowered, bringing lists of questions and a family member to doctors' visits and refusing to leave until their questions were answered. Physicians who limited the number of questions per visit were considered uncaring and this may enhance feelings of unmet expectations. Elders' expectations for care are fairly basic. They want to be treated as individuals by someone who cares about them and who is technically proficient. Environmental factors may influence satisfaction, but may not be essential if the provider's interpersonal and technical skills meet expectations. Health care providers need to treat their elderly patients with respect and take time to address their concerns, the researchers say.