Lack of congruence in the ratings of patients' health status by patients and their physicians

Purpose. The purpose of this study was to examine if physician assessments of their patients' health status after the medical encounter are comparable to their patients' self-assessment of their own health. Methods. Consecuti ve patients with musculoskeletal diseases were recruited when they attended 1 of the rheumatology outpatient clinics selected for the study. Five phys icians participated in the study, 4 based at an academic center and I in th e community. Patients were interviewed after seeing the physician; they com pleted health status questionnaires (mHAQ and SF-12) and rated their pain, worry about disease, and overall health status on visual analog scales. Sta ndard gamble techniques were used to obtain patient utilities in relation t o their health status, "gambling" on the probability of obtaining perfect h ealth from an intervention with varying risks of death. After the medical e ncounter, physicians were asked to rate their patients' health status with similar instruments and with standard gamble elicitation techniques, blinde d to the patients' responses. Results. A total of 105 patents participated in the study; 70% were female; mean age was 54 +/- 16 years; 64% had a conn ective tissue disease, most commonly rheumatoid arthritis; and the other di seases in this group included soft tissue rheumatism, osteoarthritis, or lo w back pain. Statistically significant differences were observed between pa tient and physician ratings for pain, overall health, and standard gamble. On average, physicians rated their patients' health status higher than the patents themselves and were less willing to gamble on the risk of death ver sus perfect health. Intraclass correlation coefficients (ICC) were low: 0.4 2 for pain, 0.11 for worry, 0.11 for overall health, and 0.04 for standard gamble utilities. Similar findings were observed when subgroup analysis was performed for individual physicians and for patients with connective tissu e diseases. No specific patient characteristic consistently related to incr eased divergence in the ratings. Conclusions. These findings suggest that t he communication between physicians and their patients at the time of the m edical encounter needs to be enhanced. An understanding of their patents' h ealth perceptions may assist physicians in suggesting appropriate intervent ions, taking into account their patients' benefit-risk preferences.