Physician interpretation of illness behavior.

Determining factors in physician recognition of emotional factors in the illness presentation of their patients was examined by stepwise multiple regression analysis, utilizing 18 predictor variables, in a sample of 101 randomly selected internal medicine inpatients. Self-report measures of patients' psychological symptoms failed to explain a significant percentage of the variance in physician assessment of emotional factors in illness. Physician assessment of severity of medical illness, patient satisfaction with present medical care, and age predicted 58 percent of the variance in physician ratings of emotional factors in illness. Physicians attributed greater emotional morbidity to patients judged to have less severe medical illness and to be less satisfied with their care. Using only patient variables as independent predictors, number/frequency of symptoms and race accounted for 16 percent of the variance in physicians' ratings. These results suggest that physician expectations about normative illness behavior, more than mental status characteristics documented by patient self-report measures, determine the recognition of significant emotional factors in illness presentation.