Aligning patient expectations

Demands on the healthcare system and expectations of patients present ongoing challenges for those providing care. Expectations and perspectives of patients can be quite different from their doctors, and gaining greater alignment starts with understanding the patient’s point of view.

Why patients might have a different view

There are many reasons why patients’ expectations may not align with your own, which is why understanding them is so important. Making an effort to do this early will be much simpler than trying to do so later.

Doctors might view good care in terms of clinical outcomes, but for patients this is not the only factor. They may place equal importance on things such as the emotional impact of the experience, or whether they feel cared about. Understanding some of the factors that commonly impact your patient’s experience can help you develop strategies to understand their treatment goals and expectations. These may include:

• Information overload – medicine can be complex and providing too much detail at once can confuse patients who may then feel uncomfortable, insecure or irritated.
• Insufficient information – this could be due to ineffective communication or time constraints in the consultation.
• Conflicting advice – patients often get information from the internet, friends or other healthcare professionals.
• Anxiety – stresses from illness, the healthcare system or other external factors can make the factors above worse.

Determining patients’ expectations

Actively listen to your patient in an unhurried manner and give them the opportunity to share their story. Being aware of their circumstances and concerns can help you understand their expectations. They can be concerned about health outcomes, individual clinicians, or how the healthcare system works. They could have expectations about the length or extent of recovery, your availability to see them or what is covered by Medicare.

Making an effort to build a good rapport with patients may be particularly beneficial to manage the expectations of patients who seem unhappy or nervous.

Addressing unrealistic expectations

Gently reinforce what you consider to be an appropriate expectation of treatment and why, and that your recommendation is in their best interests. It might be helpful to explain where you can’t meet a request due to practice policy or legislated regulations.

Give the patient further information to read and ask them to come back for a second appointment. Depending on the situation, it may be appropriate to recommend the patient seek a second opinion.

Expectations for procedures

Expectations are often identified during the consent process for a procedure or new treatment. Your approach should be one of shared decision making, during which you inform the patient of the options, risks and recommendations, and equally encourage them to discuss with you their concerns, expectations and goals. Both parties need to take responsibility for the decisions and outcomes. Inform your patients of what to expect during and after treatment, and at the end of the discussion ask them if they have any questions.

Some patients will say that they have no questions even when they do because they feel naive, intimidated, rushed or confused. Questions such as, “From the information I have provided today, what will you tell your family when you get home?” can highlight any discrepancy between the patient’s understanding and the information they were provided.

Avant factsheet: Managing patient expectations

This article was originally published in Connect  magazine issue 20.