PRACTICE PARTNER
Asking patients “What are you expecting I can do?” is
useful but broad. The number of dimensions requires
deeper investigation. For instance, a UK literature review of how patient expectations are measured looked at
expectations around: reducing problems or symptoms;
being treating with dignity; the doctor’s knowledge;
reassurance; health advice; information about the cause/
management of a condition; and the opportunity to
discuss problems. That was just a partial list.
You can’t always meet every patient expectation. That’s
not the goal. Some expectations will be medically
impossible and others, like a demand for unwarranted
medication, won’t be in the patient’s best
interests.
However, by listening to expectations,
you can respond in the most sensitive
way, tailor the message (if not the care),
and confirm you’re on the same page
around next steps. That’s all part of
patient-centred care.
pear in the consultation, and determine any correlation
between the ICE components and prescription rates.
The doctors were asked to record expressions of ideas,
concerns, and expectations, whether generated by the
patient or elicited by the doctor. All three ICE components were raised in only 20% of the 613 consultations.
In 17% of cases, ICE wasn’t voiced at all, so doctors
were working without this information. One of the
three ICE questions was addressed in 38.5% of cases,
and two of the questions in 24.4% of cases.
The study found that when the ICE components were
discussed, medication was prescribed less often. One
assumption was that systematic disclosure of a patient’s
real expectations and concerns could lead to other
courses of action.
At the very least, gaining this information paints a fuller
picture, and helps to forge the most productive doctorpatient relationship. As the study’s authors wrote, “Identifying and eliciting ICE components are key competencies related
You can’t always meet
to shared decision-making.”
every patient expectation.
That’s not the goal.
Patients will always have a range of hopes and demands
around health outcomes or processes. It gets complex.
But doctors deliver the best care when they understand,
respect and help manage patient expectations.
It’s about attunement, not agreem