title: The impact of psychosomatic co-morbidity on discordance with respect to reasons for encounter in general practice.
abstract: OBJECTIVE
  Concordance between general practitioners (GPs) and patients is an essential requirement for treatment success and patient satisfaction in general practice. The objectives of this were to estimate the total amount of discordance with respect to reason for encounter (RFE) during consultation in German general practices, and to explore the influence of psychosomatic co-morbidity of the patients in case of discordance.
  
  
  METHODS
  1101 consecutive patients completed a questionnaire, including questions about the RFE and the Patient Health Questionnaire (PHQ). RFEs, as stated by the patients and diagnosed by the GPs were matched according to a predefined index. Factors that may influence the level of discordance between patients' RFE and GPs' RFE were analysed.
  
  
  RESULTS
  Amount of concordance was 74.9%, incomplete concordance 11.2%, discordance in different physical RFEs was 9.1%, and discordance when GPs diagnosed psychosomatic illness while patients presented physical complaints was found in 2.5%. The number of RFE (OR 3.03; 95%CI 2.48-3.69; P<.001), depression (OR 2.27; 95%CI 1.51-3.41), anxiety (OR 1.78; 95%CI 1.03-3.10) and somatisation syndrome (OR 2.20; 95%CI 1.50-3.22) significantly predicted incomplete concordance and discordance, respectively. The number of RFE was significantly associated with depression (OR 1.32; 95%CI 1.09-1.61) and somatoform syndrome (OR 1.45; 95%CI 1.21-1.74).
  
  
  CONCLUSIONS
  The considerable amount of discordance and incomplete concordance can partly be explained by the psychosomatic co-morbidity of the patients. If it is seen as a fundamental right of patients to be adequately understood, more efforts are necessary to improve patient centredness. Further studies have to evaluate if improvement of identification of psychosomatic co-morbidity might reduce discordance.
authors.affiliation: Institute of General Practice, Klinikum rechts der Isar, Technische Universität München, Germany. antonius.schneider@tum.de
authors.forename: Antonius
authors.initials: A
authors.lastname: Schneider
authors.forename: Eva
authors.initials: E
authors.lastname: Wartner
authors.forename: Isabelle
authors.initials: I
authors.lastname: Schumann
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Hörlein
authors.forename: Peter
authors.initials: P
authors.lastname: Henningsen
authors.forename: Klaus
authors.initials: K
authors.lastname: Linde
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006801:Humans; D055809:Illness Behavior; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011602:Psychophysiologic Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires