RELIABILITY OF SYMPTOM ASSESSMENT IN DYSPEPSIA

Objective: To examine the variation between doctors in their clinical assessment of dyspeptic symptoms. Design: Simulated presentation of th ree dyspeptic symptom complexes to a total of 27 general practitioners , who each interviewed the 'patient' in accord with their own clinical practice. A structured record form was used to record details of the history elicited. Setting: Simulation of a primary care consultation. Results: Although overall agreement in symptom assessment was reasonab le for each of the three symptom complexes, both the accuracy and cons istency of assessment varied considerably for individual symptoms. inc onsistency and inaccuracy in the assessment of epigastric pain were un expectedly large, demonstrating that neither the nature nor severity o f pain were communicated reliably. Conclusion: The findings illustrate the feasibility of quantitative appraisal of patient-doctor communica tion in respect of symptoms and show that there is much variation in t he reliability with which different symptoms are communicated. Difficu lty in characterizing abdominal pain reliably may contribute to the we ll recognized inadequacy of a conventional clinical history in identif ying the cause of a patient's dyspepsia.