The decision to see the physician: a clinical investigation

To study why people decide to see a physician, 150 consecutive patient-initiated visits to a university family medicine center were evaluated prospectively. Physician and patient agreed about the reason for the decision to see a physician in 40 percent of encounters. Correlation was stronger for visits for health maintenance and weaker when patients were told to come, had psychosocial reasons, or experienced an event triggering their decision. An empirically based taxonomy of eight reasons for the decision to see a physician is presented: symptom existence causing pain (eg, cystitis), symptom existence causing anxiety (eg, child with fever), symptom persistence causing pain (eg, pharyngitis), symptom persistence causing anxiety (eg, skin rash), health maintenance visit, psychosocial reason, told to come, trigger event. Patients with psychosocial reasons presented ostensibly with symptom existence, symptom persistence, or health maintenance needs. Patients who were told to come were either unwilling to seek care or unable to interpret their symptoms appropriately. Two thirds of patients decided themselves to see a physician; one third consulted someone else; no one used books or the media to help decide.