How illness presents: a study of patient behavior.

In 1972 McWhinney presented a classification of patient behavior which provided the physician with a framework in which to describe his assessment of the reason for the patient's visit. The present paper assesses the reliability of this classification schema involving seven categories of patient behavior comparing the assessments of the investigators with those of the cooperating physicians. There was agreement in 75 percent of the cases. For a random sample of women, 389 visits over a six-month period were classified. Signal behavior was noted in 14 percent of all visits and psychosocial problems were presented frankly in another 22 percent. The distribution of patient behaviors differed for patient and doctor-initiated visits and differed among the five participating physicians. Characteristics of the doctor, rather than those of the patient, had the greater influence on the degree to which patients used frank presentation rather than signal behavior to provoke discussion of psychosocial problems.