Patient-physician agreement about medical diagnoses and cardiovascular risk factors in the ambulatory general medical examination.
OBJECTIVE
To describe the spectrum of medical diagnoses and cardiovascular risk factors identified by physicians during the comprehensive medical examination in ambulatory patients, to assess how accurately patients report the health problems identified by their physicians, and to determine the characteristics associated with patient and physician agreement.


METHODS
We conducted a prospective study of ambulatory patients at Mayo Clinic Rochester. All 64 internists in the general internal medicine divisions who perform comprehensive medical examinations were invited to enroll 10 adult patients each; 57 physicians and 566 eligible patients participated. Complete physician and patient information on diagnosed health problems was available for 458 patient visits (81%). Diagnosed health problems were collected from both the patients and the physicians by questionnaire after the examination and classified into medical diagnoses and cardiovascular risk factors.


RESULTS
Of the diagnosed health problems, 63% involved four organ system categories: (1) nutritional, endocrine, or metabolic (20%); (2) cardiovascular (18%); (3) musculoskeletal (13%); and (4) digestive (12%). Patients failed to report 68% of all health problems and 54% of the most important health problems diagnosed by the physician. Major health problems, new diagnoses, and distant residence were associated with the highest level of patient-physician agreement for diagnosed health problems.


CONCLUSIONS
Because patients failed to report more than half of their most important health problems identified by their physicians, practitioners might consider giving problem lists or summary letters to patients to improve and reinforce communication and management of health problems.
Scheitel
S M
SM
Division of Community Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.
Boland
B J
BJ
Wollan
P C
PC
Silverstein
M D
MD
D000553:Ambulatory Care; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control*; D006304:Health Status; D006801:Humans; D008487:Medical History Taking; D010349:Patient Compliance; D010808:Physical Examination; D011320:Primary Health Care; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires