Differences between out-patients with physical disease and those with medically unexplained symptoms with respect to patient satisfaction, emotional distress and illness perception

Objectives. This study aimed to assess whether patients with medically unexplained symptoms (MUS) attending cardiology and neurology out-patient clinics were less satisfied with their consultation than patients whose presenting symptoms were explained by an organic diagnosis. The multidimensional nature of satisfaction and its relationships with emotional distress and illness perception were also assessed within the two groups. Design and setting. A prospective cohort study was carried out at a large inner city teaching hospital. Participants. New attenders at cardiology and neurology out-patient clinics participated in the study. Measures. The Satisfaction Questionnaire, the Hospital Anxiety and Depression Scale (HADS), the Health Anxiety Questionnaire (HAQ) and the Illness Perception Questionnaire (IPQ) were used in the study. Results. There were no overall significant differences in satisfaction between organic and MUS patients. Factor analysis yielded four factors: satisfaction with information, satisfaction with style of doctor-patient interaction, satisfaction with clinic environment, and satisfaction with patient's health. Levels of internal consistency were good, with Cronbach's alphas between .74 and .95 for the four subscales. Conclusion. When considering patients with MUS, these findings emphasize the need to examine healthcare satisfaction from a detailed and multidimensional perspective. Relationships between satisfaction dimensions, clinic specialties and measures of psychological well-being and of illness perception show interesting patterns. These findings raise both theoretical and service delivery questions concerning communication strategies.