Predictors of differences in symptom perception of older patients and their doctors.

BACKGROUND Doctors and their older patients do not necessarily agree on what health problem ought to be treated. Discordance influences diagnostic procedures, patient satisfaction and treatment outcome negatively. OBJECTIVE The purpose of the present study was to determine the psychosocial factors influencing differences in symptom reports of patients and physicians. METHODS A cohort study was carried out in a medical out-patient clinic. A total 141 women and 213 men agreed to give symptom reports while waiting for their doctor's appointment and allowed their treating physician to evaluate symptoms afterwards. RESULTS Disagreement between patients and physicians on which symptoms triggered the visit appeared in one-third of the cases. This was more likely the longer symptoms existed, the less intensely patients experienced their symptom and the more restricted they felt because of the symptom. Psychosocial factors did not have a significant influence. CONCLUSIONS Independently of psychosocial variables, the different illness concepts of patients and their treating physician influence the subject of the consultation. Doctors and patients were most likely to agree when patients reported their symptoms as being of recent onset and being intense. Symptom intensity and the associated degree of restriction seem to reflect two different conceptual dimensions of symptom evaluation.