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Patient-Physician Fit: An Exploratory Study of a Multidimensional Instrument

Department of Medical Education (mc 591), 808 S. Wood St., 986 CME, University of Illinois at Chicago, Chicago, IL 60612 alansz{at}uic.edu

Memoona Hasnain, MD, PhD, MHPE

Department of Family Medicine, University of Illinois at Chicago

Arnold R. Eiser, MD

Department of Medical Education, Mercy Catholic Medical Center and Drexel University College of Medicine, Philadelphia, Pennsylvania

Elizabeth Lincoln, MD

Yale University, New Haven, Connecticut

Arthur S. Elstein, PhD

Department of Medical Education, University of Illinois at Chicago

Background. Patients face difficulty selecting physicians because they have little knowledge of how physicians’ behaviors fit with their own preferences. Objective. To develop scales of patient and physician behavior preferences and determine whether patient-physician fit is associated with patient satisfaction. Design. Two cross-sectional surveys of patients and providers. Setting. Ambulatory clinics at a university medical center. Participants. Eight general internists, 14 family physicians, and 193 patients. Measurements. Two instruments were developed to measure 6 preferences for physician behaviors: 1) considering nonmedical aspects of the patient’s life, 2) familiarity with herbal medicine, 3) physician decision making, 4) providing information, 5) considering the patient’s religion, and 6) treating what the patient perceives as his or her problem. Patients reported how they would prefer physicians to behave, and physicians reported how they preferred to behave. Patients also rated satisfaction with their physician. Results. Post hoc tests found that as a group, patients scored higher than physicians in preference for the physician to provide information and lower in preference for considering nonmedical aspects of the patient’s life and religious beliefs. As hypothesized, preference differences accounted for significant variance in satisfaction in overall tests (19% in the family medicine patients and 25% in internal medicine patients). Greater satisfaction was associated with fit between patient and physician preferences for physician decision making (in the internal medicine patients) and with fit in providing information and consideration of religion (in family medicine patients) Conclusions. Patients often prefer behaviors other than how their physicians prefer to behave. Preference fit is associated with enhanced patient satisfaction. Physicians should attend to whether patients want religion and other nonmedical aspects of their lives considered. Health plans may wish to provide tools to help patients choose physicians by fit

Key Words: preferences • satisfaction • patient-physician relationship

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