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Soc Sci Med. 1985;21(2):115-20.

Building an effective doctor-patient relationship: from patient satisfaction to patient participation.


In this paper, the authors argue that patient satisfaction is an insufficient measure of the quality of the doctor-patient relationship. While shown to have a salutary effect on patient anxiety concerning illness and treatment, the only other significant outcome associated with levels of satisfaction is utilization behavior. This is not surprising, the authors argue, since prevailing conceptualizations of patient satisfaction fail to incorporate measures of patient participation in the therapeutic process. Evidence suggests that by encouraging patients to take an active role in their health care physicians can increase the effectiveness of their therapeutic activities. A method for involving patients is through incorporating their preferences into the physician's decision-making processes. An example of physician decision making which incorporates patient preferences is provided.


Patient satisfaction is rejected as a sufficient measure of the quality and effectiveness of the physician patient relationship. Satisfaction appears to be correlated with passive acquiescence to treatment but not with commitment to health promoting behavior. Physicians are urged to involve patients in an informed decision making process by eliciting and including patient preferences in a health program that incorporates an active patient role. The authors suggest a preliminary, "utility value" model of clinical decision analysis to be used in conditions of uncertainty when the outcomes of care may be risky or costly. The model, which requires the physician to elicit the patient's ranking of potential outcomes of treatment options, integrates the probability of an event's occurrence with that event's outcome value.

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