Date of Award

January 2021

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Daniel Federman

Abstract

Little is known about patient preference regarding the physical exam in non-urgent primary care settings, particularly in relationship to race, age, and other demographic factors. The objective of this study is to determine the influence of demographic factors on patients' expectations of the physical exam, the actual components of the physical examination performed during a non-urgent visit, and which components of the physical exam were actually done.

In this study, 452 surveys were administered in the waiting room of a VA primary care clinic in West Haven, CT. The response rate was 92.5% (n = 417). For 15 of 16 maneuvers on the survey, more respondents believed a reasonable provider should conduct it than received it at their annual physical exam; for 7 of them (breast, axillary, rectal, pelvic, total body skin exam, electrocardiogram, and stress test), over twice as many respondents believed they should be done than received them. There was an association between a patient’s perception of their primary care provider and the number of maneuvers recalled at their annual exam (p <0.001), and a gap in the number of maneuvers expected from a reasonable provider by non-white and white patients (p <0.001).

Our study found that patient perception of their primary care provider is strongly associated with the number of maneuvers recalled during an annual physical. Furthermore, the number of maneuvers expected by a patient is influenced by race, with non-white patients desiring more. This suggests the need for further research on the role of race in expectations of healthcare providers.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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