J Manipulative Physiol Ther 2002 (Jun); 25 (5): 300–305 ~ FULL TEXT
Private practice of chiropractic,
BACKGROUND: There are conflicting views about whether expectation plays a role in patient satisfaction. No studies regarding the importance of patient expectations have been done in the chiropractic field.
OBJECTIVE: To investigate the expectations of new patients consulting a chiropractor and to evaluate differences and similarities in expectations between chiropractors and patients.
DESIGN: A questionnaire survey.
STUDY PARTICIPANTS: Thirty chiropractors and 336 patients from 17 private practices throughout Sweden.
RESULTS: Chiropractors and patients expected the chiropractor to find the problem and explain it to the patients, and they also expected patients to feel better and become free of symptoms. However, the following differences were revealed: patients had lower expectations of the chiropractic treatment than the chiropractors but higher expectations of being given advice and exercises than the chiropractors did. There was also a tendency for the patients to expect to get better faster than the chiropractors expected them to.
CONCLUSION: Although chiropractors and patients had some common goals in relation to the therapeutic encounter, there was also a mismatch in certain areas. It is possible that these differences in expectations could influence the treatment and outcome of the treatment negatively. This reinforces the importance of communication between the chiropractor and the patients. More research is needed to evaluate whether fulfilment of expectations actually has an impact on patient satisfaction.
From the Full-Text Article:
The aim of this study was to explore the expectations that both chiropractors and patients have and how these might influence the therapeutic encounter. Both groups agreed that they expected the chiropractor to find the problem and explain the problem to the patient. My results indicate that it is indeed important to diagnose and explain the nature of the problem to the patient. Chiropractors and patients also agreed that they expected patients to feel better and to be free of their symptoms. This is not surprising since the aim of the treatment surely is that it should have a positive effect.
However, it is interesting to note that patients had lowerexpectations of the treatment than chiropractors (Table 1). This was partly due to the fact that they had a considerably higher “no response” percentage (ie, did not answer the question). This may reflect a greater amount of uncertainty among the patients compared with the chiropractors, which is not surprising since chiropractors usually have more knowledge about chiropractic treatment of low back pain than patients. Chiropractors were also more likely to expect that their treatment could help the patients. This might be explained by the fact that some patients in this study perceived the chiropractic consultation as a last chance after trying several other forms of treatment. These patients may not have believed that their chiropractor would be able to help them but were nonetheless willing to give it a try, whereas the chiropractors were more confident. Whether expectations were realistic or not is, of course, a different question.
It was more important to patients than chiropractors that the patient be given advice and exercises,which is of some concern. This may mean that some chiropractors believe that advice about training and exercises is not within the “chiropractic scope” or not suitable for that particular patient. If a patient expects to get “more” than the chiropractor is willing to provide, there is a high probability that the patient will be dissatisfied.
The biggest difference in this study related to the number of treatments needed for improvements of symptoms. Chiropractors' general view was that improvement would occur after 3 to 5 treatments, whereas patients expected either to get well very quickly or did not have an opinion (Table 6). Although patients in this study had lower expectations in comparison to their chiropractors, their expectations were still high. The fact that patients had high expectations that the treatment would be effective has been confirmed in previous studies. [14, 15] Another explanation for this could be that patients believed that the pain in their backs was of mechanical origin (ie, a bone out of place that the chiropractor would put back), whereas the chiropractor viewed the symptoms and treatment as a more complex process. This difference could result in disagreement during the course of treatment, with patients expecting to do well and chiropractors being seen as incompetent, or the condition being seen as very serious if more treatments were needed or recommended. This reinforces the importance of communicating with the patients and listening to their needs, which is emphasized in most patient satisfaction research. [2, 9, 11]
Thirty-three participating patients in this study filled in the questionnaire“in situ.” However, according to the chiropracticreceptionists, some patients did not want to participate in the study even though they fit the inclusion criteria. I do not know how many there were, their reasons for not wanting to participate, or whether these patients would have had different expectations compared with the patients who did participate in the study.
The strengths of this study were that we had a relatively large number of patients (n = 336) and specific inclusion criteria for participation. The instrument was also thoroughly validated through a series of pilot-studies.  By using receptionists in the various clinics as collectors of the data material, we attempted to avoid bias.
This study attempted to compare patients' expectations with those of their chiropractors. Although chiropractors and patients had some common goals in relation to the therapeutic encounter, there was also a mismatch in certain areas for some of the study subjects. It is possible that these differences in expectations could influence the treatment and the outcome of the treatment negatively. This reinforces the importance of communication between the chiropractor and the patients. More research is needed in the area of understanding patients and how that understanding can have an effect on the outcome of the chiropractor-patient encounter.