چکیده (انگلیسی):

Background:Symptoms are common in primary care. Besides providing thorough assessment of possible severe
disease, the general practitioner (GP) must ensure good health care to all patients, irrespective of diagnoses. We
aimed to explore patient satisfaction with the provided care and how well expectations in patients were met when
no diagnosis was made during the consultation.
Method:Cross-sectional study based on a questionnaire survey conducted in 2008–2009 among 377 GPs and their
patients in the Central Denmark Region. A total of 2286 patients completed a questionnaire after the consultation
(response rate: 54 %). The questionnaire included four satisfaction items from the EUROPEP instrument and a
question about unmet expectations. For each patient, the GP answered a one-page registration form including
information about the main problem in the consultation, chronic disorders and assessment of prognosis. Statistical
analyses were adjusted for patient characteristics and GP clustering.
Results:A higher proportion of patients reported illness worry (20 vs. 17 %,p-value: 0.005), unmet expectations
(17 vs. 13 %, p-value: 0.019) and dissatisfaction with their GP after the consultation when no diagnosis was made.
Dissatisfaction was primarily related to the medical examination (adjusted OR 1.30; 95 % CI: 1.06–1.60) and GP
explanations (adjusted OR 1.40; 95 % CI: 1.14–1.71). Exploratory analyses revealed an association between dissatisfaction
with examination and the GP assessment that symptoms were unrelated to biomedical disease. This association was
found both in patients with ‘symptoms only’ and patients given a specific diagnosis.
Conclusion:GPs are challenged by patients presenting symptoms that do not fit the patterns of biomedical
diagnoses. The current study demonstrates more illness worry, unmet expectations and dissatisfaction with the
consultation in these patients compared to patients receiving a diagnosis. This trend is true for all patients assessed as
having‘symptoms only’ at the end of a consultation and not only for the minority group with‘medically unexplained
symptoms’. As primary care is the frontline of the health-care system, symptoms are managed as the main problem in
almost one in three consultations. It is about time that we take the same professional approach to symptoms as we
have done for years to biomedical disease.