How illness presents: a study of patient behavior

Area of Science:

• Medical Sociology
• General Practice
• Health Communication

Background:

• McWhinney's 1972 patient behavior classification offers a framework for understanding patient visit reasons.
• Assessing the reliability of this classification is crucial for its clinical application.

Purpose of the Study:

• To evaluate the reliability of McWhinney's seven-category patient behavior classification schema.
• To compare investigator assessments with cooperating physician assessments of patient behavior.

Main Methods:

• A reliability study comparing investigator and physician classifications of patient behavior.
• Analysis of 389 patient visits over six months from a random sample of women.
• Classification of patient behaviors into McWhinney's schema, noting signal behavior and frank presentation of psychosocial problems.

Main Results:

• Seventy-five percent agreement was achieved between investigators and physicians in classifying patient behavior.
• Signal behavior accounted for 14% of visits; frank psychosocial problem presentation occurred in 22%.
• Patient behavior distribution varied by visit initiation (patient vs. doctor) and participating physician.

Conclusions:

• McWhinney's classification schema demonstrates moderate reliability (75% agreement).
• Physician characteristics significantly influence patient communication styles regarding psychosocial issues, more so than patient characteristics.
• Findings suggest tailoring communication strategies based on physician influence on patient disclosure.