Patient-physician concordance and discordance in gynecology: Do physicians identify patients' reasons for visit and do patients understand physicians' actions?

摘要

Objective: To assess physician-patient concordance on reasons for consultation and actions taken during consultation in five different gynecological practices, and to investigate patient and physician factors influencing discordance in reporting. Methods: 1667 post-encounter questionnaires completed by patients and physicians were compared in terms of reasons for consultation and actions taken during consultation. Patient-physician concordance was assessed using kappa statistics. Multivariable regression analyses served to identify determinants of discordance. Results: A moderate to high level of patient-physician concordance on reasons for consultation and actions taken during the consultation was found. Discordance regarding reasons for consultation was associated with patient and practice characteristics, discordance regarding actions taken during the consultation only with practice characteristics. Counseling emerged as a particular source of patient-physician discordance. Conclusion: In gynecological practices, discordance depends on the reason or action assessed, but is particularly pronounced when it comes to counseling. The influence of physician characteristics on patient-physician concordance needs more attention in research. Practice implications: Gynecologists need to establish a mutual understanding with their patients about the reason of the consultation and the actions taken in the consultation, in particular with regard to counseling.