Incongruence between self-reported symptoms and objective evidence of respiratory disease among construction workers

In clinical settings, self-reported symptoms and objective evidence of disease may be poorly correlated. In the present study, symptoms and objective evidence of pulmonary disease were compared in a community sample of construction workers with occupational exposure to asbestos. Symptoms of dyspnea and cough were assessed by a standardized questionnaire. The clinical examination included a chest X-ray, pulmonary function testing (PFT), and a physical examination. Both symptoms and objective clinical findings were strongly related to years in these trades. However, less than 1% of workers reported symptoms in the absence of any clinical evidence of disease. A similar low percentage of workers denied any symptoms yet produced clear evidence of pulmonary disease on clinical examination. Results were interpreted in terms of the variety of factors which have been associated with patients' readiness, and conversely, reluctance to report symptoms. The comparatively low frequency of incongruence between symptoms and objective clinical findings in this study suggests over emphasis of malingering by other authors. Health care might be improved if more attention is given by clinicians and researchers to patients who fail to report symptoms in the presence of disease.