Original article
Perceptions of physicians and patients with organic and functional gastrointestinal diagnoses

https://doi.org/10.1016/S1542-3565(03)00319-7Get rights and content

Abstract

Background & Aims: We studied patient after-hours telephone calls to gastrointestinal (GI) fellows at a university program to determine requests made, physicians’ responses, and perceptions of patients and physicians to these requests. Methods: During a 4-month period, 4 GI fellows taking call were asked about reasons for patient-initiated after-hours telephone calls, actions taken, and their perceptions about the nature of the request, the illness impact, and their role in the care administered. Patients were telephoned within 1 week and asked the same questions about their perceptions of the call. Results: Patients (N = 102) made 103 telephone calls, averaging 8.7 minutes, for symptoms (56%), procedure-related concerns (19%), and medications (18%). Physicians usually referred the patient to the clinic or emergency room (40%) or provided discussion and reassurance (36%). Patients’ perceptions differed from physicians’ perceptions: patients believed their problems to be more severe and more disabling and requests were more reasonable than perceived by the physician. Furthermore, their interactions with physicians (physician helpfulness, satisfaction with the recommendation, and likeability of the physician) were more positive than believed by physicians. Physicians believed phone calls from patients with functional disorders were less serious and less reasonable, that these patients were less disabled, and also that these patients were less liked than patients with an organic diagnosis. Conclusions: In this study, physicians carried a lower perception of the importance of telephone requests, the impact of the disorder, and their perceived helpfulness to patients than did patients making these requests. Physician perceptions were significantly lower for all these factors for patients with functional GI diagnoses. Additional studies are needed to understand the reasons for differing perceptions between physicians and patients.

Section snippets

Study sample

Patient-initiated night and weekend telephone calls made to 4 first-year gastroenterology fellows on rotating call at a university-based fellowship program between November 1999 and February 2000 were evaluated by questionnaire. All calls received during weekdays after 5:00 pm and before 8:00 am and on weekends from 5:00 pm Friday to 8:00 am Monday were eligible. Although most calls were recorded, an unknown number of calls received in the early morning hours were not.

Study administration

All first-year

Clinical and demographic features

Of 104 questionnaires that were matched between patients and fellows, 1 fellow questionnaire was incomplete, leaving 103 assessable questionnaires. All 4 fellows were Caucasian men aged in their early 30s. Of patients, 69% were women, 65% (N = 66) had an organic diagnosis, and 35% (N = 36) had a functional diagnosis. One patient telephoned on 2 occasions. There was a greater proportion of women with functional diagnoses (86% women with functional vs. 58% women with organic diagnoses; P <

Discussion

As the Western health care system seeks to streamline the cost and efficiency of patient care, use of telephone communication may gain increasing importance. To date, there are only a small number of studies relating to the nature of after-hours telephone calls and attitudes and behaviors of physicians accepting them. A limited number of studies from primary care practices indicated that about one quarter of primary care communications are through the telephone1 and relate primarily to

Acknowledgements

The authors thank Albena Halpert, M.D., for helpful comments.

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