Purpose of the medical encounter: identification and influence on process and outcome in 200 encounters in a model family practice center.

This study concerned two questions: Why does the patient come to the physician? And, how does patient-physician agreement as to the primary purpose affect the process and outcome of the medical encounter? Separate interviews of patients and physicians following 200 medical encounters revealed a preponderance of visits for continuing care, a paucity of visits for social and emotional problems, and a number of visits in which "concern" as the patient's primary purpose was misperceived by the physician. There was no statistically significant relationship when agreement (or lack of agreement) between patient and physician as to the purpose of the encounter was compared with patient age and sex, number of previous visits of the patient to the physician, and subsequent patient-physician agreement as to the diagnosis, prognosis, therapy, and satisfaction. There was also no statistically significant relationship when patient-physician concordance as to visit purpose was compared with education level of the patient or with physician perception of the patient's intended compliance. In both concordance and non-concordance groups, physicians underestimated both patient satisfaction with the encounters and intended compliance.