When the physician leaves the patient

OBJECTIVE: To identify independent predictors of patients’ satisfaction with transfer of their care from a departing to a new resident physician. DESIGN: A self-administered questionnaire completed by consecutive patients following up after transfer of their care, and by a randomly selected 50% of patients not returning within three months after transfer. SETTING: An internal medicine clinic in a teaching hospital. PATIENTS: Questionnaires were completed by 376 patients: 237 returning to clinic and 139 (91%) of 152 randomly selected patients who had not returned. Mean age of the patients was 65 years, 52% were men, and they had come to the clinic for a median of four years. RESULTS: 57% of the patients were satisfied with the transfer process, 25% were neutral, and 18% expressed frank dissatisfaction. Of nine variables significantly associated with satisfaction by univariate analysis, stepwise multiple regression identified five independent predictors. Personal notification of the patient by the departing physician was the most powerful determinant, explaining 41% of the variability in satisfaction. Other predictors were whether patients believed their physicians had done everything possible to facilitate transfer, whether the departing physician had provided opportunity for discussion of the transfer, whether this discussion was considered sufficient, and patients’ impressions of the institution. CONCLUSIONS: Most of the predictors identified can be influenced by physician behavior, suggesting that physicians should personally notify patients of their departure and provide an opportunity for discussion. This could significantly improve patient satisfaction with the transfer process and, as previous studies suggest, translate into greater compliance with medications and follow-up. Received from the Departments of Medicine, Walter Reed Army Medical Center, Washington, DC, and the Uniformed Services University of the Health Sciences, Bethesda, Maryland. Presented in abstract form at the Mid-Atlantic Region Society of General Internal Medicine Meeting, Bethesda, Maryland, February 28, 1992; and at the American College of Physicians Annual Session, Washington, DC, April 1, 1993. The opinions or assertions contained herein are the private views of the authors and are not to be considered as official or as reflecting the view of the Department of the Army or the Department of Defense.