Abstract
BackgroundAlthough physician-rated health is emerging as a potentially useful variable in research, with implications in practice, it has not been analyzed. Moreover, one of its most important aspects, namely, concordance with patients’ objective health state, has not been investigated. This study sought to measure concordance between physician-rated health and an objective health measure, and assess both measures’ validity in predicting death.MethodsThe data for the study were drawn from a 1998–1999 survey and subsequent mortality follow-up of residential and nursing homes in Madrid (Spain). Study subjects were 630 residents aged ≥65 years, and their respective facility physicians. Measures included agreement between physicians’ rating of residents’ overall health (good, intermediate or poor) and an objective measure of residents’ health (good, intermediate or poor), based on functional capacity, cognitive status, and number of chronic conditions. Overrating was defined as any case where health, rated as good by a physician, was objectively rated as poor.ResultsWhereas 45 % of physicians and 55 % of residents rated their health as good, only 4 % of such residents had good objective health. Of those who received a physician rating of good/very good health, 39.0 % had poor objective health. There was evidence of clear overrating in 18 % of the population, and clear to moderate overrating in 73 % of the population. In terms of power to predict mortality, the pattern of behavior shown by the objective health measure was good, graded and congruent, and better than that shown by physician-rated health.ConclusionPhysician overrating of the overall health of older persons in residential and nursing homes, would appear to be very high. Although some degree of contextualization by physicians in this setting might be considered reasonable, the degree of overrating in our population seems nevertheless excessive.
Highlights
Physician-rated health is emerging as a potentially useful variable in research, with implications in practice, it has not been analyzed
Giltay et al found that both physician- and self-rated health independently predicted all-cause mortality, albeit with some differences, i.e., while poor selfrated health was associated with cancer mortality, poor physician-rated health was associated with cardiovascular mortality [5]
Todd and Goldman reported that interviewer ratings displayed a better predictive behavior than did physician ratings in the case of older adults in Taiwan [6]
Summary
Physician-rated health is emerging as a potentially useful variable in research, with implications in practice, it has not been analyzed. This study sought to measure concordance between physician-rated health and an objective health measure, and assess both measures’ validity in predicting death. Self-rated health (ascertained via the question, “How would you describe your health: very good, good, fair, poor or very poor?”, or variations of this), is a variable that is widely used and extensively studied, since it provides an easy-to-obtain measure of subjective health, shown to be of great value by innumerable papers [1]. While self-rated health has an inherent value because it is a measure of subjective health, it is highly advisable that physician-rated health be checked against objective measures. Physicians incorporate some legitimate subjectivity and may appreciate subtle aspects not captured by objective indicators, yet their assessment is expected to be based on objective health factors to a greater extent than that of other actors, such as nurses, staff, caregivers, the residents themselves, and family members. Congruence between physicians and their patients’ objective situation tends to be taken for granted and, to our knowledge, has not been systematically explored
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