Dan Wu1, Tai Pong Lam1, Kwok Fai Lam2, Xu Dong Zhou3, Kai Sing Sun1. 1. Department of Family Medicine and Primary Care, Faculty of Medicine, The University of Hong Kong, Hong Kong, China. 2. Department of Statistics and Actuarial Science, Faculty of Science, The University of Hong Kong, Hong Kong, China. 3. Institute of Social Medicine, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China.
Abstract
OBJECTIVE: Physicians' prescribing patterns may be influenced by how they perceive their patients' expectations of medical care. This study explored doctors' perceptions of patient expectations of medical care. DESIGN: Qualitative interviews and a cross-sectional survey (September 2014-September 2015). SETTING: Primary- and tertiary-care facilities in Zhejiang province, China. PARTICIPANTS: Primary care practitioners (PCPs) and hospital specialists. MAIN OUTCOMES: Perceived patients' expectations. RESULTS: Seven focus groups and 21 individuals were interviewed. Questionnaires were completed by 460 PCPs and 651 specialists (response rate: 78%). About 36.8% of doctors reported generating profit for the facility at which they practiced as a foremost consideration. Participants perceived patients as holding high expectations of clinical performance and use of medical products. Respondents perceived that their patients expected either drug prescriptions (48.2%) or intravenous (IV) therapy (45.2%). Perceived patient expectations of an arrangement of tests and consultation fee refunds if no prescriptions were made were reported by 29.7 and 22.7%, respectively. Doctors reported feeling undervalued and disrespected when patients requested consultation fee refunds. Compared to those who did not report a need for profit-making, doctors who did were significantly more likely to perceive that their patients expected medication-based treatments (AOR = 1.62, P < 0.001), IV therapy (AOR = 1.32, P = 0.037), the arrangement of tests (AOR = 2.06, P < 0.001), and consultation fee refunds when no prescriptions were made (AOR = 1.92, P < 0.001). CONCLUSIONS: Most doctors believed that patients had high expectations. Workplace profit-orientation demonstrated a strong association with doctors' perceptions.
OBJECTIVE: Physicians' prescribing patterns may be influenced by how they perceive their patients' expectations of medical care. This study explored doctors' perceptions of patient expectations of medical care. DESIGN: Qualitative interviews and a cross-sectional survey (September 2014-September 2015). SETTING: Primary- and tertiary-care facilities in Zhejiang province, China. PARTICIPANTS: Primary care practitioners (PCPs) and hospital specialists. MAIN OUTCOMES: Perceived patients' expectations. RESULTS: Seven focus groups and 21 individuals were interviewed. Questionnaires were completed by 460 PCPs and 651 specialists (response rate: 78%). About 36.8% of doctors reported generating profit for the facility at which they practiced as a foremost consideration. Participants perceived patients as holding high expectations of clinical performance and use of medical products. Respondents perceived that their patients expected either drug prescriptions (48.2%) or intravenous (IV) therapy (45.2%). Perceived patient expectations of an arrangement of tests and consultation fee refunds if no prescriptions were made were reported by 29.7 and 22.7%, respectively. Doctors reported feeling undervalued and disrespected when patients requested consultation fee refunds. Compared to those who did not report a need for profit-making, doctors who did were significantly more likely to perceive that their patients expected medication-based treatments (AOR = 1.62, P < 0.001), IV therapy (AOR = 1.32, P = 0.037), the arrangement of tests (AOR = 2.06, P < 0.001), and consultation fee refunds when no prescriptions were made (AOR = 1.92, P < 0.001). CONCLUSIONS: Most doctors believed that patients had high expectations. Workplace profit-orientation demonstrated a strong association with doctors' perceptions.