Abstract
We report on the development and validation of an instrument to assess discordance between physicians and their patients on evaluations of health-related information: the Patient–Physician Discordance Scale (PPDS). The 10-item questionnaire is designed to be employed across chronic diseases and can be used in clinical practice and research. It measures the extent of patient–physician discordance on five aspects of the patient'ls health status and five aspects of the office visit. A prospective study with 200 outpatients with inflammatory bowel disease and their treating physicians revealed that the 10-item discordance scores had good construct validity and satisfactory convergent validity. Overall discordance and the three subscales, discordance on symptoms and treatment, well-being, and communication and satisfaction, identified by factor analysis, had acceptable internal consistency. Patient and physician ratings demonstrated moderate-to-high concurrent validity. Study limitations and directions for future research with PPDS are discussed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Anastasi, A. (1976). Validity: Basic concepts. In Psychological Testing, Macmillan, New York, pp. 134–161.
Bass, M. J., Buck, C., Turner, L., Dickie, G., Pratt, G., and Robinson, H. C. (1986). The physician's actions and the outcome of illness in family practice. J. Fam. Pract. 23: 43–47.
Berkanovic, E., Hurwicz, M.L., and Lachenbruch, P. A. (1995). Concordant and discrepant views of patients' physical functioning. Arthritis Care Res. 8: 95–101.
Black, N., Petticrew, M., Ginzler, M., Flood, A., Smith, J., Williams, G., Davies, J., Doll, H., and McPherson, K. (1991). Do doctors and patients agree? Int. J. Technol. Assess. Health Care 7: 533–544.
Boland, B. J., Scheitel, S. M., Wollan, P. C., and Silverstein, M. D. (1998). Patient–physician agreement on reasons for ambulatory general medical examinations. Mayo Clin. Proc. 73: 109–117.
Botoman, V. A., Bonner, G. F., and Botoman, D. A. (1998). Management of inflammatory bowel disease. Am. Fam. Phys. 57: 57–68.
Carr, A. J., and Donovan, J. L. (1998). Why doctors and patients disagree. Brit. J. Rheumatol. 37: 1–6.
Chesney, A. P., Brown, K. A., Poe, C. W., and Gary, H. E. (1983). Physician–patient agreement on symptoms as a predictor of retention in outpatient care. Hosp. Community Psychiatry 34: 737–739.
Colton, T. (1974). Statistics in Medicine, Little, Brown, Boston.
Connelly, J. E., Philbrick, J. T., Smith, G. R., Jr., Kaiser, D. L., and Wymer, A. (1989). Health perceptions of primary care patients and the influence on health care utilization. Med. Care 27: S99–S109.
Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika 16: 297–334.
Cronbach, L. J., and Meehl, P. E. (1955). Construct validity in psychological tests. Psychol. Bull. 52: 281–302.
Derogatis, L. R. (1994). SCL-90–R. Symptom Checklist-90–R. Administration, Scoring, and Procedures Manual, National Computer Systems, Minneapolis.
Dobkin, P. L., De Civita, M., Abrahamowicz, M., Bernatsky, S., Schultz, J., Sewitch, M., and Baron, M. (2003). Patient–physician discordance in fibromyalgia. J. Rheumatol.
Eisenberg, L. (1992). Treating depression and anxiety in primary care. Closing the gap between knowledge and practice. N. Engl. J. Med. 326: 1080–1084.
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science 196: 129–136.
Fagerberg, C. R., Kragstrup, J., Stovering, H., and Rasmussen, N. K. (1999). How well do patient and general practitioner agree about the content of consultations? Scand. J. Prim. Health Care 17: 149–152.
Feldman, E. J. (1994). Medical treatment of inflammatory bowel disease: Patient concerns. In Kirsner, J. B., and Shorter, R. G. (Eds.), Inflammatory Bowel Disease—From Bench to Bedside, Williams and Wilkins, Baltimore. pp 445–450.
Freidin, R. B., Goldman, L., and Cecil, R. R. (1980). Patient–physician concordance in problem identification in the primary care setting. Ann. Intern. Med. 93: 490–493.
Gladman, D. D., Goldsmith, C. H., Urowitz, M. B., Bacon, P., Fortin, P., Ginzler, E., Gordon, C., Hanly, J. G., Isenberg, D. A., Petri, M., Nived, O., Snaith, M., and Sturfelt, G. (2000). The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index for Systemic Lupus Erythematosus International Comparison. J. Rheumatol. 27: 373–376.
Goldman, L., Freidin, R., Cook, F., Eigner, J., and Grich, P. (1982). A multivariate approach to the prediction of no-show behavior in a primary care center. Arch. Intern. Med. 142: 563–567.
Greenbloom, S. L., Steinhart, A. H., and Greenberg, G. R. (1998). Combination of ciprofloxacin and metronidazole for active Crohn's disease. Can. J. Gastroenterol. 12: 53–56.
Hanauer, S. B., and Baert, F. J. (1995). The management of ulcerative colitis. Annu. Rev. Med. 46: 497–505.
Harvey, R. F., and Bradshaw, J. M. (1980). A simple index of Crohn's disease activity. Lancet 1: 514–514.
Himmel, W., Lippert-Urbanke, E., and Kochen, M. M. (1997). Are patients more satisfied when they receive a prescription? The effect of patient expectations in general practice. Scand. J. Prim. Health Care 15: 118–122.
Jennrich, R. I., and Schluchter, M. D. (1986). Unbalanced repeated-measures models with structured covariance matrices. Biometrics 42: 805–820.
Kirmayer, L. J., Robbins, J. M., Dworkind, M., and Yaffe, M. J. (1993). Somatization and the recognition of depression and anxiety in primary care. Am. J. Psychiatry 150: 734–741.
Kopec, J. A., Esdaile, J. M., Abrahamowicz, M., Abenhaim, L., Wood-Dauphinee, S., Lamping, D. L., and Williams, J. I. (1996). The Quebec Back Pain Disability Scale: Conceptualization and development. J. Clin. Epidemiol. 49: 151–161.
Kwoh, C. K., O'Connor, G. T., Regan-Smith, M. G., Olmstead, E. M., Brown, L. A., Burnett, J. B., Hochman, R. F., King, K., and Morgan, G. J. (1992). Concordance between clinician and patient assessment of physical and mental status. J. Rheumatol. 19: 1031–1037.
Lehmann, M., Chamiot-Prieur, C., Mesnard, B., Halphen, M., Messing, B., Rambaud, J. C., Gendre, J. P., Columbel, J. F., and Modigliani, R. (1996). Methotrexate for the treatment of refractory Crohn's disease. Aliment. Pharmacol. Ther. 10: 309–314.
Lieberman, J. R., Dorey, F., Shekelle, P., Schumacher, L., Thomas, B. J., Kilgus, D. J., and Fineman, G. A. (1996). Differences between patients' and physicians' evaluations of outcome after total hip arthroplasty. J. Bone Joint Surg. 78: 835–838.
Mahmud, N., McDonald, G. S., Kelleherm D., and Weirm D. G. (1996). Microalbuminuria correlates with intestinal histopathological grading in patients with inflammatory bowel disease. Gut. 38: 99–103.
Maly, R. C., Leake, B., Frank, J. C., DiMatteo, and M. R., Reuben. (2002). Implementation of consultative geriatric recommendations: The role of patient–primary care physician concordance. JAGS. 50:1372–1380.
McDowell, I., and Newell, C. (1987). Measuring Health. A Guide to Rating Scales and Questionnaires, Oxford University Press, New York, pp. 3–342.
Murden, R. A., and Kreger, C. G. (1999). Patient–physician agreement on reasons for outpatient visits. Mayo Clin. Proc. 74: 105–106.
Neville, C., Clarke, A. E., Joseph, L., Belisle, P., Ferland, D., and Fortin, P. R. (2000). Learning from discordance in patient and physician global assessments of systemic lupus erythematosus disease activity. J. Rheumatol. 27: 675–678.
Potts, M. K., and Silverman, S. L. (1990). The importance of aspects of treatment for fibromyalgia (fibrositis). Differences between patient and physician views. Arthritis Care Res. 3: 11–18.
Robertson, D. A. F., Ray, J., Diamond, I., and Edwards, J. G. (1989). Personality profile and affective state of patients with inflammatory bowel disease. Gut 30:623–626.
Rothwell, P. M., McDowell, Z., Wong, C. K., and Dorman, P. J. (1997). Doctors and patients don't agree: Cross-sectional study of patients' and doctors' perceptions and assessments of disability in multiple sclerosis. BMJ 314: 1580–1583.
Scott, J., and Huskisson, E. C. (1976). Graphic representation of pain. Pain 2: 175–184.
Starfield, B., Steinwachs, D., Morris, I., Bause, G., Siebert, S., and Westin, C. (1979). Patient–doctor agreement about problems needing follow-up visit. JAMA 242: 344–346.
Starfield, B., Wray, C., Hess, K., Gross, R., Birk, P. S., and D'Lugoff, B. C. (1981). The influence of patient-practitioner agreement on outcome of care. Am. J. Public Health 71: 127–131.
Stewart, M. A., McWhinney, I. R., and Buck, C. W. (1979). The doctor/patient relationship and its effect upon outcome. J. R. Coll. Gen. Pract. 29: 77–82.
Streiner, D. L., and Norman, G. R. (1995). Health Measurement Scales. A Practical Guide to Their Development and Use, Oxford University Press, New York, pp. 1–230.
Szasz, T. S., and Hollender, M. H. (1956). A contribution to the philosophy of medicine. The basic models of the doctor-patient relationship. Arch. Intern. Med. 97: 585–592.
Tabachnick, B. G., and Fidell, L. S. (1989). Principal components and factor analysis. In Rothman, J. L., and MacElree, E. (Eds.), Using Multivariate Statistics, Harper Collins, New York, pp. 597–677.
Taylor, R. B., Burdette, J. A., Camp, L., and Edwards, J. (1980). Purpose of the medical encounter: Identification and influence on process and outcome in 200 encounters in a model family practice center. J. Fam. Pract. 10: 495–500.
Temple, W., Toews, J., Fidler, H., Lockyer, J. M., Taenzer, P., and Parboosing, E. J. (1998). Concordance in communication between surgeon and patient. Can. J. Surg. 41: 445.
Thomas, S. H., Borczuk, P., Shackelford, J., Ostrander, J., Silver, D., Evans, M., and Stein, J. (1999). Patient and physician agreement on abdominal pain severity and need for opioid analgesia. Am. J. Emerg. Med. 17: 586–590.
Wartman, S. A., Morlock, L. L., Malitz, F. E., and Palm, E. (1983). Impact of divergent evaluations by physicians and patients of patient complaints. Public Health Rep. 98: 141–145.
Wyshak, G., and Barsky, A. (1994). Relationship between patient self ratings and physician ratings of general health. depression and anxiety. Arch. Tam. Med. 3: 419–424.
Wyshak, G., and Barsky, A. (1995). Satisfaction with and effectiveness of medical care in relation to anxiety and depression. Patient and physician ratings compared. Gen. Hosp. Psychiatry 17: 108–114.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sewitch, M.J., Abrahamowicz, M., Dobkin, P.L. et al. Measuring Differences Between Patients' and Physicians' Health Perceptions: The Patient–Physician Discordance Scale. J Behav Med 26, 245–264 (2003). https://doi.org/10.1023/A:1023412604715
Issue Date:
DOI: https://doi.org/10.1023/A:1023412604715