Assessing symptoms before hysterectomy: Is the medical record accurate?

OBJECTIVE: Our purpose was to evaluate the agreement between the documentat ion of symptoms leading to hysterectomy and the assessment of those symptom s by the patient. STUDY DESIGN: A retrospective study was performed of 497 women in southern California who had hysterectomies. Sensitivity, specificity, and kappa stat istics were calculated for the medical records and were compared with patie nt interviews for the presence and severity of symptoms. RESULTS: The medical record was 93% sensitive and 61% specific for identify ing bleeding and 79% sensitive and 55% specific for identifying pain. Overa ll agreement between physician records and patient interviews was moderate for bleeding (kappa, 0.56-0.58), fair for pain (kappa, 0.29-0.34), and poor for impairment as a result of bleeding or pain (kappa, 0.0-0.14). CONCLUSIONS: Physician overestimation of symptoms could lead to overuse of hysterectomy, whereas underestimation could result In underuse. Our results suggest that both underestimation and overestimation occur for patients wi th abnormal bleeding, pain, or both. If physicians accurately assess sympto ms but fail to document them, examinations of appropriateness will be fault y unless patients are interviewed.