Urgency of medical care. Contrasting perceptions of HIV-positive patients and physicians

To assess the agreement between patients and physicians about the appropriate time to seek medical attention for symptom complexes commonly encountered in human immunodeficiency virus (HIV) disease, identifying potential suboptimal utilization of health care services.

A questionnaire consisting of 25 clinical problems commonly encountered in the ambulatory care of patients with HIV infection was developed to survey opinions regarding the most appropriate time to seek medical attention. Participants included 70 anonymous HIV-positive patients attending a health department's early intervention clinic and 104 physicians recruited at academic conferences in 1992.

Clinically and statistically (P < .05 after Bonferroni correction) significant disagreement between physicians and HIV-positive patients regarding perceived urgency to seek medical care was found in 22 of the 49 possible responses. In seven of these scenarios, patients perceived greater urgency to seek care than physicians, especially for relatively discrete complaints, such as oral lesions, lymphadenopathy, and Kaposi's sarcoma. Conversely, in 15 scenarios, physicians were more concerned than patients, especially for serious complaints, such as those associated with meningitis, retinitis, sinusitis, pneumonia, infectious diarrhea, and urinary tract infection.

Substantial differences regarding the urgency to seek care exist between physicians and HIV-positive patients. Patients focused on the physical aspects of their disease and had difficulty appreciating important symptom complexes associated with serious but potentially reversible conditions. A need exists for health professionals to educate patients about the appropriate urgency to seek care for a number of common symptom complexes.