Disagreement in Doctor's and Patient's Rating About Medically Unexplained Symptoms and Health Care Use

Abstract

Medically unexplained (somatoform) symptoms (MUS) are highly prevalent in primary care. It remains unclear to what extent patients and their general practitioners (GPs) agree upon the etiology of physical symptoms as well as on the number of visits to the GP. The purpose of this study is to determine patient-physician agreement on reported symptoms. A sample of 103 persons provided information on MUS and health care utilization (HCU) during the previous 12 months. The persons' GPs (n = 103) were asked for the same information. By determining patient-physician agreement on reported symptoms, the sample was subdivided into a concordance group (high agreement: Pt = GP) and two discordance groups (substantial disagreement: Pt > GP, Pt < GP). Patients and their GPs showed substantial disagreement concerning physical symptom reports for the prior 12 months. On means, patients named 3.26 (SD = 3.23; range 0-21) physical complaints of which 71.6% were considered to be medically unexplained (MUS), whereas GPs only determined 1.77 (SD = 1.94; range 0-11) symptoms of which 57.5% were MUS. Substantial patient-physician agreement regarding the number of reported MUS was detected in 29.1% of the cases (Pt = GP). Patients of all groups underestimated their HCU. Since patients' and GPs' reports differ substantially concerning the etiology of symptoms and concerning HCU, both sources of data gathering should be treated carefully in primary care research.