- Patients and clinicians often perceive patient wellness differently, highlighting a need for clear patient-provider communication about patient wellness efforts, found a study published in the Journal of the American Board of Family Medicine.
Patient self-ratings of health (SRH) and physician ratings of patient health (PRPH) are typically tied to health outcomes, explained the Ohio-based research team.
“An individual's response to the question, ‘In general, how would you rate your overall health?’ has intrigued health researchers for decades and is consistently associated with future mortality, morbidity, and healthcare costs,” the researchers said.
“However, relatively little research has examined the relationship of SRH with more clinical indicators of health, including physician ratings of patient health (PRPHs).”
The researchers conducted a survey of over 500 patients and 33 primary care physicians at four family medicine practices. Patients and physicians rated patient health on a five-point scale, offering justifications for their scores and suggestions for wellness improvement.
Patient and physician ratings matched exactly 38 percent of the time, the researchers found. When there was not an exact match, physicians were equally as likely to rate the patients higher or lower than the patients perceived themselves.
When SRH was lower than PRPH, it was due to variables such as body mass index, having seen a provider previously, older age, and higher co-morbidity score. This may be because patients who rated their health as fair or poor were hyper-focused on their medical concerns, the researchers offered.
“These types of findings may be partially explained by patients, like those in our study, who focus primarily on medical problems when they rated their health fair or poor,” the team said.
Differences in SRH and PRPH are likely due to contrasting patient and clinician priorities. Physicians typically focused on disease presence and health metrics when rating patients, whereas patients usually focused on how they felt and their own quality of life.
Although these priorities differ, the researchers said neither should be devalued.
“In medicine, wellness is often considered the absence or prevention of disease, but other concepts within wellness, such as happiness and contentment, may be equally or more important to patients,” the team asserted.
The context for wellness ratings also diverged, the research team found.
Justifications for wellness ratings only matched 25 percent of the time, the researchers reported, and wellness improvement suggestions only matched 24 percent of the time. Both findings were independent of whether patients and providers agreed on a health status rating.
Ultimately, these conflicting views highlight a need for primary care physicians and patients to have more transparent communication and engage in shared decision-making.
Primary care physicians are the main drivers behind patient wellness and behavior change, the researchers said. These clinicians have been tasked with working with patients to determine how to best accomplish this task.
However, all too often providers decide how patients should improve their health based not on what patients prefer, but on what the provider deems most appropriate. These results suggest that providers need to work together with patients to determine the best path forward.
“Our findings show that physicians and patients are only in agreement about the ‘most important thing to change’ about 24 percent of the time,” the researchers explained. “Not taking the time to elicit patients' opinions may prove counterproductive for this important component of primary care practice.”
Going forward, healthcare professionals must focus on leveraging stronger patient-provider communication strategies. Having conversations that are transparent and include the patient as a member of the care team will help physicians work with patients to guide wellness improvement activities.
“Exploration of individual physician-patient dyads provides evidence that physicians cannot assume they know how patients perceive their own health, nor what is most important to patients to improve their health,” the researchers concluded. “Open and ongoing communication between physicians and patients, as recommended in motivational interviewing, remains key to patient-centered primary care.”