Predictors of physician-patient agreement on symptom etiology in primary care.
OBJECTIVE
Primary care patients often report medically unexplained symptoms and may disagree with their physicians about the nature of their presenting complaints. The goals of this study were to explore the level of physician-patient agreement on symptom etiology and to identify predictors of disagreement.


METHODS
Primary care patients (n = 175) and their physicians rated the extent to which patients' presenting symptoms represented a medical versus a psychological problem. Patients also completed surveys regarding their demographic characteristics, level of psychological distress, health status, recent stress, history of mental health treatment, and reason for office visit.


RESULTS
Physicians and patients agreed on the etiology of symptoms in approximately 59% of the cases. Patient sex, history of mental health treatment, and reason for office visit significantly predicted agreement on symptom etiology. Physicians perceived patients with whom they disagreed about symptom etiology as less cooperative.


CONCLUSIONS
Physician-patient agreement on symptom etiology is low and relates to several patient psychosocial and demographic factors. Identifying the variables associated with disagreement may help to improve communication and patient outcomes in primary care.
Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA. jgreer2@partners.org
Joseph
J
Greer
Richard
R
Halgin
D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D004194:Disease / Q000209:etiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care; D014505:Urban Population