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P.J. McCluskey, C.K. Pager; Seeing Eye to Eye: Doctors' Perceptions of Their Patients' Priorities . Invest. Ophthalmol. Vis. Sci. 2003;44(13):769.
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Purpose: The decision for cataract surgery is primarily based on subjective indications known only to the patient. Furthermore, doctors' predictions of their patients preferences is often little better than chance. However, patients rely heavily on their doctors' opinions and are reluctant to make decisions for themselves. Additionally, patient satisfaction – an increasingly important health outcome – is greatly dependant on the degree of doctor-patient understanding. The objective of this study is to compare cataract surgeons' predictions of patient responses to the patients' own responses, for both private and public patients, on 13 factors of importance to patients about to undergo cataract surgery and likely to affect patient satisfaction. Methods: Patients undergoing day-stay cataract surgery at a large private and large public hospital were asked to rate the importance of 13 factors regarding their cataract treatment. All cataract surgeons who regularly treated cataract patients in a large metropolitan city were randomized into public or private groups, and sent the same 13 factors, asking them to rate how important each was to their public or private patients, as appropriate. Results: 81 patients and 77 doctors responded to the survey. Overall, doctors predicted that all items would be more important to private patients than to public patients, when no significant difference in fact existed between patient groups. Doctors correctly identified public patients' priorities, but underestimated the magnitude of overall importance. On the other hand, doctors recognized the magnitude of overall importance to private patients, but misjudged many priorities. Doctors under-estimated the importance to patients of non-surgical characteristics such as seeing the same doctor, caring surgeon, pleasant location for appointments and waiting time for surgery. Conclusions: A lack of understanding between doctor and patient is a primary sources of patient dissatisfaction, and also potentially leads to less accurate clinical decision-making. This study demonstrates significant discordance between patients' priorities when undergoing cataract surgery, and their doctors' perception of those priorities. These difference could be explained by doctors' stereotypes of public patients and insufficient appreciation of non-medical aspects of patient care.
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