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The Patient's Perspective

Edward L. Schor, MD; Debra J. Lerner, PhD; Sue Malspeis, SM

Arch Intern Med. 1995;155(3):309-314.

Abstract
Background
Ascribing quality to medical care rests in part on the expectation of physician behavior and the content of care. The adoption of functional outcomes of care as legitimate measures of quality will require greater attention to patient-provided assessments of health and add new dimensions to medical practice and quality assessment.

Methods
We conducted a cross-sectional, national population survey of adults to obtain estimates of the frequency with which physicians reportedly inquire about patients' functional health status and emotional well-being, patients' attitudes about such assessments, and the perceived use of data thus obtained in the therapeutic process.

Results
The majority of physicians rarely or never ask about the extent to which patients' health limits their ability to perform everyday activities (64.7% to 78.7%); neither do they inquire about limitations imposed by emotional problems (71.4% to 84.4%). Physicians are more likely to make such inquiries in the presence of chronic illness or diminished health status, or with older patients, although such assessments remain the exception to usual practice and a large portion of functional impairment is undiscovered. More than 60% of respondents want their physicians to assess their functional health status and well-being.

Conclusions
While individuals want their physicians to assess their functional performance and emotional well-being as a part of medical care, by their reports this occurs infrequently. The content of care may be less comprehensive than physicians believe to be the case.

(Arch Intern Med. 1995;155:309-314)

Author Affiliations
From The Health Institute, New England Medical Center, Boston, Mass.

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