Validity of physician self-report in tracking patient education objectives

Patient education objectives are included as a strategy in every health promotion area addressed in Healthy People 2000. The likelihood of accomplishing these objectives is linked to the accuracy of the baseline estimates of practice. These estimates have most usually relied upon patient and physician reports. However, the accuracy of these reports has been infrequently studied. We analyzed audiotapes of interactions among 377 adult chronic disease patients and 38 physicians in a variety of practice settings to estimate the accuracy of their reports. Our findings indicate that neither doctors nor patients provide a consistently accurate reflection of health promotion discussions, nor do they appear to agree with one another very much as to what was discussed. Smoking and diet were reported quite accurately by both doctors and patients, whereas discussions regarding physical activity, alcohol, and stress were less so. Further, our findings suggest that underreport may pose an even greater threat to accurate estimates of physician practice than overreports.