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The Uncertain Consultation and Patient Satisfaction: The Impact of Patients' Illness Perceptions and a Randomized Controlled Trial on the Training of Physicians' Communication Skills

From the Research Clinic for Functional Disorders and Psychosomatics (L.F., P.F., E.O., K.S.C., T.T.) and Research Unit of General Practice (F.O.), Aarhus University Hospital, Aarhus, Denmark; Unit of Psychology, Guy's, King's and St. Thomas', Guy's Campus, London, United Kingdom (J.W.).

Address correspondence and reprint requests to Lisbeth Frostholm, MSc, Research Clinic for Functional Disorders and Psychosomatics, Barthsgade 5.1, Aarhus University Hospital, DK-8200 Aarhus N, Denmark.

Objective: To identify predictors of patient satisfaction among a range of patient and practitioner variables. In particular, to focus on patients' illness perceptions and the impact of a randomized controlled trial on the training of physicians in general communication skills and how to treat patients presenting with poorly defined illness.

Methods: A randomized controlled follow-up study conducted in 28 general practices in Aarhus County, Denmark. Half of the physicians were randomized into an educational program on treatment of patients presenting with medically unexplained symptoms (somatization). One thousand seven hundred eighty-five general practice attenders presenting a new health problem completed questionnaires on illness perceptions, physical functioning, and mental distress before the consultation. After the consultation, a questionnaire including relational and communicative domains of patient satisfaction with the current consultation was completed. The physicians completed a questionnaire for each patient on diagnostics and prognostics. Predictors of patient satisfaction were determined by logistic regression.

Results: A large number of patient and practitioner variables predicted satisfaction in univariate logistic regression models. Results from a multivariate logistic model showed that the illness perceptions "uncertainty" (patient not knowing what is wrong) and "emotional representations" (the complaint making the patient feel worried, depressed, helpless, afraid, hopeless) predicted dissatisfaction at OR (CI) = 1.8 (1.3–2.4), p < .001 and OR (CI) = 1.5 (1–2.3), p = .03 respectively. Trained physicians were associated with dissatisfaction at OR (CI) 0.7 (0.5–1), p = .06 in the multivariate model. Furthermore, uncertain patients consulting a trained physician were less likely to be dissatisfied OR (CI) = 0.6 (0.3–1), p = .04.

Conclusions: A randomized controlled trial on the training of general practitioners' communication skills improved patient satisfaction. Illness perceptions predict satisfaction. In particular, patients feeling uncertain and negatively emotionally involved in their health problem were more inclined to being dissatisfied with the consultation.

Key Words: primary care • patient satisfaction • illness perceptions • communication skills • randomized controlled trial • medically unexplained symptoms • somatization

Abbreviations: IPQ = Illness Perception Questionnaire; PSCQ-7 = Patient Satisfaction Consultation Questionnaire; TERM = the extended reattribution model; SCL = Symptom Check List; SCL-SOM = SCL-90 somatization subscale.

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