Low back pain can be difficult to diagnose, leaving patients frustrated and confused after medical visits. To evaluate the importance of reasons for seeking care in patients with back pain, and to compare this to physicians' assumptions about these patients' reasons. Prospective survey study carried out at two Academic Spine Centers. 419 patients with back pain upon initial presentation to a spine clinic, and 198 physicians; all volunteered to complete a survey. Variance in mean values between patient and physician responders with significance determined by non-overlapping 95% confidence intervals. Patients were asked to "rate each of the following with regard to their importance to you" (answering between 0 "not important" to 4 "extremely important"): improvement in level of pain, improvement in ability to perform daily tasks, explanation of what is causing your problem, thorough physical examination, diagnostic testing, medication, physical therapy, surgery. Physicians were asked to rate each of these "with regard to their importance to your patients." Patients indicated the following items were the most important (mean values): explanation of what is causing your problem (3.27), improvement in level of pain (3.48) and improvement in ability to perform daily tasks (3.31). Patients attributed the least importance and lowest scores to: surgery (1.07) and medication (1.89). Comparing the mean values to each item by patient and physician responders revealed statistically significant differences in certain items. Specifically, physicians underestimated the importance of an explanation of what is causing the problem (2.78 ± 0.119 vs. 3.28 ± 0.098, 95% CI) and overvalued diagnostic tests (2.64 ± 0.120 vs. 2.30 ± 0.147, 95% CI), medications (2.38 ± 0.118 vs. 1.89 ± 0.143, 95% CI) and surgery (1.60 ± 0.126 vs 1.07 ± 0.140, 95% CI). Patients did not place as much importance on diagnostic tests, medications and surgery as the physicians assumed. Physicians understand that back pain patients want improvement in both pain and function, but they underestimate the importance of an explanation for the pain.