The predictive value of the presenting complaint

The relationship between the presenting complaint and the principal problem identified during 103 new patient visits was assessed in an academic primary care setting. Complaints and problems were classified by content as somatic, psychosocial, or health maintenance and compared by category. The presenting complaint correctly identified the category in 76 percent of somatic but only 6 percent of psychosocial principal problems (sensitivity of 76 percent and 6 percent, respectively). The likelihood of a same-category principal problem (positive predictive value) ranged from 53 percent for somatic to 100 percent for psychosocial presenting complaints. A specific underlying motivation for the visit other than the presenting complaint was noted by the primary provider in 42 percent of the encounters and was most frequent in those encounters characterized by a lack of concordance between complaint and problem. The presenting complaint introduces the clinical encounter, but its value is limited in specifically identifying the principal problem.