Family Practice Vol. 18, No. 2, 174-180
© Oxford University Press 2001
Decision-making in the consultation |
Health from the patient's point of view. How does it relate to the physician's judgement?
Research Centre in General Medicine, Borgmästarvillan, Karolinska Hospital Stockholm, and
a Institute for Social Work, University of Stockholm, Sweden.
Objectives. The purpose of this study was to evaluate the relationship of self-rated health to a measure of physical status, based on a professional rating of the individual's health from a strictly physical point of view.
Methods. A random selection of 407 people over the age of 20 from the north-western catchment area of greater Stockholm were invited in 1995 to a physical examination, including a self-report questionnaire with questions about self-rated health, lifestyle, psychosocial factors and quality of life. A measure of physical health on a 5-point graded scale was constructed using the information from the records of the physical examination as a base.
Results. Self-rated health and the professional ratings of health coincided in ~60% of the cases. There were a relatively large number of cases where the ratings were contradictory. The correlation between the scales was 0.45. Comparison between the two ratings with respect to association with potential determinants showed that physical factors naturally explained most of the variances in physical health, whereas social and mental well-being and somatic conditions (women) were the most important explanatory variables for self-rated health. Irrespective of whether they had ‘favourable’ or ‘unfavourable’ health, those with ‘poor’ self-rated health also had perceived lower social and mental well-being, less appreciation, more somatic conditions (women) and worse coping abilities (men).
Conclusions. With mental, psychosocial and social problems becoming more pronounced in sickness patterns for primary care patients, self-rated health could be a helpful device, especially when time resources for consultations are short. This measure could also give a more global view of the patient's situation when effectivity and rationality can be a threat to a holistic view of the patient.
Keywords. Physician's rating of health, psychosocial factors, self-rated health.
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