Disparities between ophthalmologists and their patients in estimating quality of life

Numerous types of instruments can measure quality of life in a given state of health. This article reviews studies that have measured quality of life of patients and physicians for various types of disease states by using a generic preference-based method known as the time tradeoff method of utility analysis. Of particular interest are comparisons of quality of life estimates between patients and physicians for common ophthalmologic conditions.

In nearly all of the studies identified, the quality of life estimates of patients differed significantly from those of physicians. In studies involving macular disease, cataracts, and numerous other types of medical conditions, physicians generally underestimated the impact of the condition on patients' quality of life. Less of a disparity between patients and physicians has been reported for estimates of quality of life with glaucoma. Differences in quality of life estimates may be related to poor physician-patient communication.

It is important to appreciate the differences in preferences of patients and physicians. Because only patients themselves know their values and needs regarding treatments and outcomes, physicians should routinely elicit patients' preferences and allow them to participate in decision making about treatment. At the societal levels, patients' preferences should help guide decisions including how to allocate finite health care resources. An important tool for this purpose is cost-utility analysis, which incorporates data on patient preferences, along with survival and cost data, to compare the values of competing health care interventions.