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Predictors of Physician-Patient Agreement on Symptom Etiology in Primary Care

From the Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts (J.G.); Department of Psychology, University of Massachusetts, Amherst, Massachusetts (R.H.).

Address correspondence and reprint requests to Joseph Greer, PhD, Massachusetts General Hospital, WACC 812, 15 Parkman Street, Boston, MA 02114. E-mail: jgreer2{at}partners.org

Objective: Primary care patients often report medically unexplained symptoms and may disagree with their physicians about the nature of their presenting complaints. The goals of this study were to explore the level of physician-patient agreement on symptom etiology and to identify predictors of disagreement.

Methods: Primary care patients (n = 175) and their physicians rated the extent to which patients' presenting symptoms represented a medical versus a psychological problem. Patients also completed surveys regarding their demographic characteristics, level of psychological distress, health status, recent stress, history of mental health treatment, and reason for office visit.

Results: Physicians and patients agreed on the etiology of symptoms in approximately 59% of the cases. Patient sex, history of mental health treatment, and reason for office visit significantly predicted agreement on symptom etiology. Physicians perceived patients with whom they disagreed about symptom etiology as less cooperative.

Conclusion: Physician-patient agreement on symptom etiology is low and relates to several patient psychosocial and demographic factors. Identifying the variables associated with disagreement may help to improve communication and patient outcomes in primary care.

Key Words: primary care • physician-patient agreement or concordance • psychological distress

Abbreviations: SCL-90-R = Symptom Checklist 90-Revised; GSI = Global Severity Index; CEQ = Clinical Encounter Questionnaire.