Patient-physician concordance in problem identification in the primary care setting.

We analyzed how often patients and physicians identified the same principal problem for 439 return primary care visits. Agreement between the patient and physician, called concordance, was scored as complete when both cited a problem in the same organ-system (208 visits; 47%); as partial when the patient cited a problem that was anywhere but first on the physician's problem list but both parties agreed on the biological or psychosocial nature of the principal problem (114 visits; 26%); or as absent (117 visits; 27%). Concordance scores were significantly lower when physicians identified a principal psychosocial problem or when patients identified a principal problem related to psychosocial issues, preventive medicine, the musculoskeletal system, or accidents. Because physicians in the Primary Care Internal Medicine Training Program were significantly more likely to identify principal psychosocial problems, their concordance scores were significantly lower than those of standard internal medicine track physicians.