The Patient

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Adherence by the patient to the proposed treatment and the understanding of his or her health condition can be considered as the essential aspects of medical practice.

Reification and the consciousness of the patient.

Investigation of satisfaction in the doctor's office is one of the ways that can be used to improve these aspects. Some circumstances can be pointed to as being related to the patient's satisfaction: access to health services, outpatient service organization, treatment duration, doctor's competence and the patient's perception of it, clarity of information given by the doctor, doctor's behavior and patient's expectation.

On the other hand, some factors do not seem to be linked to the patient's satisfaction, such as: type of payment, patient's clarity of communication, doctor's personality and patient's social and demographic characteristics or health condition. Some reports have shown up different aspects of this relationship: when patients had objective consultations physical examination and history strictly focused on the problem presented by the patient some of them appeared more satisfied.

On the other hand, other patients were more comfortable when part of the consultation was spent in talking about trivial matters, including a " friendly" attitude by the doctor.

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Some authors suggest there are at least three main subjects to be addressed: i the quality of attendance, ii the access to the doctor, iii the personal relationship with him or her. When using questionnaires to investigate this field, precision in the use of words is expected, so as not to give rise to contradictions. Also, the inclusion of open remarks may worsen data retrieval, but may even be essential for some results.

The use of a five point scale very poor, bad, regular, good, excellent may be best for capturing patients' opinions in this type of investigation. In this study, medical students took field observations of doctor-patient interactions during outpatient appointments. The students assumed the role of observer that participates and did a questionnaire intended to measure the doctor's attitudes to the patient, as well as the patient's expectations related to the appointment.

The adoption of this questionnaire was proposed as complementary to the practice of free ethnographic annotation. They were allowed to follow a Resident during his or her clinical assignment, for four hours per week, with patients' permission and in the knowledge they were students, and also subject to the Resident's willingness to receive them. We used a questionnaire with questions graded using a five point scale very poor, bad, regular, good, excellent , some questions with yes or no answers and the retrieval of demographic data. The study protocol and questionnaire received approval from the Hospital Ethics Committee Board.

The patients were interviewed before the medical appointment, at the documentation desk, and invited to participate in the study, allowing one student to be inside the doctor's office. All patients were adults Five questions were asked of the patient at this time. In the physician's office, another student took up the role of observer and was able to take notes regarding the medical consultation, including 6 items for the patient and 14 for the physician's attitudes.

Immediately after leaving the consultation office, the patient was interviewed again by a third student with three additional questions pertinent to the results of the consultation. More specifically, the student had access to a chart with the doctor's orientation and asked the patient to repeat this to the best of their recall. The times spent waiting for the consultation and in it were recorded.

The Patient - Patient-Centered Outcomes Research

In order not to lengthen the time spent by the patient during the scheduled visit to the hospital, the total filling-in time for the questionnaire was recorded, resulting in less than five minutes spent before the appointment and five minutes right after it. Statistical methods. The data collected were analyzed using descriptive statistics, linear regression and the t-test, by means of a statistical software package, Sigma Stat for Windows Version 2.

The inquiries about the understanding of the orientation given by the doctor, the understanding of his or her letter by the patient and the patient's satisfaction with the appointment were considered as dependent variables. Data were reported as means and standard deviations, and probability levels of less than 0. Notwithstanding this, patients who were able to read these orientations also could repeat it during the recall test by students. The patient satisfaction was higher after the consultation. The total number of patients that allowed their appointments to be monitored by the students was Some data were missed out, mainly regarding the time spent in the consultation 67 missing data items and the satisfaction before the appointment 44 missing.

Some patients did not comment on their educational level 58 missing. The doctor's orientation and letter and patient satisfaction did not show any significant correlation with all the other aspects of medical appointment.


There was no related significance as to whether the doctor gives personal attention, allows the patient to interpret his or her own problems, or prepares for the physical examination. They did not comment on the results of physical examinations, although when necessary they carefully explained laboratory tests, the medicines they suggested for patients to take, and they used a vocabulary appropriate to the patients' understanding Table 2.

As expected, the patients did not show willingness in receiving prescriptions or laboratory tests, and they readily received appropriate explanations regarding their clinical declarations in the consultation Table 3. Patients showed themselves to be happier right after the appointment Figure 1.

Enthusiasm was different before 2. This study has pointed out the low readiness among doctors to give written orientation and the difficulties in understanding it, related to the letter format. Nevertheless, the satisfaction was higher after the medical appointment, even with a waiting time of almost two hours. It is important to emphasize the special features of this observation made by students who were perhaps not used to clinical practice, which could be a good point. Also, this was a narrow field represented by only one period per week in one hospital, which could be a negative point.

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Doctors habitually have a more negative view of the consultation than the patients, including aspects of the ability to assess patients, to offer explanations and advice on treatment and to allow them to express their feelings during the consultation process. When doctors try to detach their patients from this ability, confusion is likely and breakdowns in communication can occur. Both are crucial to any successful healthcare performance.

The finding in this report that our doctors do not give written explanations can be related to the supposed low educational level of these patients, most of whom only attended elementary school. However, given the previously reported impression of deeper negative feelings from physicians to patients, it is possible to consider this practice as being related to physicians' impressions of low capacity among patients.

Patients comply better with the proposed therapy when they understand the doctor's instruction. Since doctors were uneasy about writing them down, changing this habit would allow a better chance of improving the patient compliance with their care and therapies even more.

Patients who ask questions about medications are seen in a positive light, rated as more interested in their own physical status. The attending physicians during this study were first-year Residents. Teaching and attending patients are important aspects of creating role models of excellency for physician profiles. Low willingness by physicians or a tendency not to greet patients should be considered as possibly resulting in a feedback of low expectations for the next or forthcoming scheduled visits.

On the other hand, physicians' careful attention to the explanation of laboratory tests and medicines, added to an ability to seek out adequate vocabulary, are all well developed techniques that help patients to become attuned to the proposed therapies. Another aspect evoked by the students who participated was their upraised interest in the medicine course during the accomplishment of this project.

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The needs in medical education are not always clear, and sometimes students fall back into some idleness, as the course tackles uninteresting subjects. Although improving students' interest was not the intention in this project, but rather it sought to facilitate familiarity with the scientific method and a capacity for writing such reports, their interest for different themes did improve during this experience, even biochemistry and anatomy.

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Since this was not the scope of the investigation, and we only have the reports of ten students out of almost two hundred, we are currently testing this approach with the new class at the USP School of Medicine FMUSP. Giving patients the possibility of talking after the appointment made them aware of some "consumer rights" as pointed out by some.

The time spent waiting for the doctor to arrive or call the patients into the office was by far the most criticized aspect.

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Although the outpatient schedule considers the patient to be at the hospital at least half an hour before the appointment, the waiting time turned out to be far longer than expected, even by the Residents. We do not know what the main reason for this is, but it seems to be a deep-rooted problem for the hospital appointment books. Understanding Health Insurance. Choosing a Health Plan. Tips for Interacting with Your Insurer. Tips for Interacting with Your Physician.

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