URGENCY OF MEDICAL-CARE - CONTRASTING PERCEPTIONS OF HIV-POSITIVE PATIENTS AND PHYSICIANS

Background: To assess the agreement between patients and physicians ab out the appropriate time to seek medical attention for symptom complex es commonly encountered in human immunodeficiency virus (HIV) disease, identifying potential suboptimal utilization of health care services. Methods: A questionnaire consisting of 25 clinical problems commonly encountered in the ambulatory care of patients with HIV infection was developed to survey opinions regarding the most appropriate time to se ek medical attention. Participants included 70 anonymous HIV-positive patients attending a health department's early intervention clinic and 104 physicians recruited at academic conferences in 1992. Results: Cl inically and statistically (P<.05 after Bonferroni correction) signifi cant disagreement between physicians and HIV-positive patients regardi ng perceived urgency to seek medical care was found in 22 of the 49 po ssible responses. In seven of these scenarios, patients perceived grea ter urgency to seek care than physicians, especially for relatively di screte complaints, such as oral lesions, lymphadenopathy, and Kaposi's sarcoma. Conversely, in 15 scenarios, physicians were more concerned than patients, especially for serious complaints, such as those associ ated with meningitis, retinitis, sinusitis, pneumonia, infectious diar rhea, and urinary tract infection. Conclusions: Substantial difference s regarding the urgency to seek care exist between physicians and HIV- positive patients. Patients focused on the physical aspects of their d isease and had difficulty appreciating important symptom complexes ass ociated with serious but potentially reversible conditions. A need exi sts for health professionals to educate patients about the appropriate urgency to seek care for a number of common symptom complexes.