Satisfaction with and effectiveness of medical care in relation to anxiety and depression. Patient and physician ratings compared.

This study examined 1) patient ratings of satisfaction with and effectiveness of medical care, and 2) physician ratings of treatment effectiveness, taking into account personal characteristics, health and mental health of 75 clinic attenders who scored below a cutoff on a screening questionnaire for hypochondriasis. Patients above the cutoff on this instrument, and a random sample of all those below the cutoff, then returned at a later date to undergo a research battery consisting of self-report questionnaires, and structured and semistructured interviews, including the Diagnostic Interview Schedule (DIS). About three-fourths of the patients were very satisfied with their medical care, and over half considered the medical care they received effective. Patients and physicians did not concur on the effectiveness of care (r = 0.029, p = 0.81; Kappa = 0.025). Depression was negatively correlated with satisfaction with medical care, r = -0.42, p = 0.0001; anxiety negatively correlated with perceived effectiveness of care, r = -0.41, p = 0.003. Physician rating of effectiveness of care correlated with physician rating of depression, age, and gender (more effective for older and male), (R2 = 0.27, p = 0.0388). We conclude that the lack of agreement between patients and physicians on effectiveness of care suggests the need for better communication. The finding that a depressive diagnosis is associated with dissatisfaction suggests more generally that psychiatric disorder may be an important determinant of patient satisfaction with medical care.