The influence of physician practice behaviors on patient satisfaction.

BACKGROUND: Previous research on the relationship between physician behavior and patient satisfaction has not always used standardized terminology and instruments to measure physician behavior. The Davis Observation Code (DOC) provides a reliable and valid means of analyzing clinically relevant units of physician behavior. The units of behavior can then be related to patient satisfaction. METHODS: One hundred new patients randomly assigned to receive care from primary care residents at a university medical center outpatient facility were evaluated. Before seeing their physicians, patients completed a previsit questionnaire to determine their general level of satisfaction with health care. During the visit, the encounter was videotaped and physician behavior characterized using DOC. After the appointment, patients completed a visit-specific satisfaction questionnaire. Multiple regression analysis was used to model the visit-specific satisfaction variables in terms of DOC measurements. RESULTS: Total visit-specific satisfaction was positively related to previsit satisfaction (P < or = .05) and to time spent on health education (P < or = .001), physical examination (P < or = .05), and discussion of treatment effects (P < or = .01). There was a negative relationship with time spent on history taking (P < or = .01). Slightly more than 25% of the variability in satisfaction was explained by these five variables (R2 = .26). The general, humaneness, and quality/competence subscales of visit-specific satisfaction were also positively related to health education, physical examination, and treatment effects and negatively related to history taking. CONCLUSIONS: Patients are most satisfied with medical visits in which they talk about their specific therapeutic interventions, are examined, and receive health education. Extended general discussion of medical history is negatively related to satisfaction.

Comparison of dietary intake of urban and rural elderly patients in family practice centers.

To compare dietary intake of urban and rural patients, we interviewed 50 patients over age 64 at each of two family practice centers, one urban and one rural, using the 24-hour dietary recall method for nutrient comparison. A deficiency of calcium was evident in the intake of both elderly populations, but other specific deficiencies were evident in the rural group. We discuss the need for dietary evaluation and intervention in the elderly, with emphasis on the rural population, and offer specific strategies for application by primary care physicians.

Relationship between high school student smoking and recognition of cigarette advertisements.

We report the results of a study examining the level of advertisement recognition and tobacco experimentation in a group of U.S. high school students. Students who smoked as few as one cigarette per week were found to identify a preferred cigarette brand. One brand of cigarettes accounted for 76% of all preferred brands. A dose-response relationship was found between smoking level and cigarette advertisement recognition, with regular smokers recognizing 61.6% of advertisements, compared with only 33.2% for nonsmokers. These data have potential implications for youth smoking prevention programs. Future research is needed to explain this association and to establish whether cigarette advertising and adolescent smoking are causally related.

Perceptions of fever among adults in a family practice setting.

Febrile illnesses are common clinical problems for the family physician. A questionnaire study was conducted of 100 adult patients in a family practice clinic to gain understanding of their knowledge about fever and its management. Many misconceptions were documented among adult patients about their own fevers and those of children for whom they cared. Misconceptions included the conviction that fever is more dangerous in children than in adults and a distorted concern about bodily damage from fever. Patients demonstrated a poor understanding of normal body temperature, minimum and maximum febrile temperatures, and minimum temperatures warranting antipyresis. Though many owned thermometers, they indicated improper usage and demonstrated inaccurate temperature-reading technique. Questionnaire responses indicated that health care providers had done poorly in educating patients about fever, its consequences, and its proper treatment.