To the Editor:

In “Why I Fired My Family Doctor” (January 1999), one reason for the patient's dissatisfaction was that the doctor clearly did not manage patient expectations. The patient had multiple complaints and was frustrated because the physician did not set clear boundaries and goals for the office visit.

A physical should include the gathering of information, an exam, and a discussion of prevention and health maintenance issues. It is not the time for treating problems. If a patient has pressing health concerns, however, I offer to handle those problems first and postpone the complete physical until a subsequent visit. Usually, patients appreciate this compromise.

Physicians must ensure that patients have reasonable expectations for the office visit. If too many objectives are crammed into one visit, patients are dissatisfied and health maintenance goals are not achieved.