Discrepancy in patient and physician perception of patient's quality of life related to urinary symptoms

Objectives. To investigate the relationship between physician-assessed quality-of-life (QOL) parameters obtained from patient interview and patient self-report of QOL by using the short form of the Urogenital Distress Inventory (UDI-6). Methods. Female patients presenting for the first time at our clinic at two different academic institutions were consecutively evaluated. All patients were asked to fill out the UDI-6 while in the waiting area before their appointment. One additional global QOL question specific to the patient's overall urinary condition was included in the questionnaire. A physician who was unaware of the patient's responses then interviewed all patients. The physicians then filled out the UDI-6 on the basis of their impression of the patient's symptoms from the patient's responses during the medical interview. A statistician unaware of the patient's diagnosis and presenting symptoms compared the physician and patient symptom bother assessments. Results. Seventy-nine patients were analyzed. Statistical analysis with weighted kappas revealed poor concordance between the physician and patient responses. Overall, the physicians at both institutions underestimated the patient's degree of bother 25% to 37% of the time. Conclusions. Reports of outcomes after treatment of urinary incontinence should always include independent patient self-administered questionnaires. Because of interviewer bias, physician assessment of QOL tends to underestimate a patient's bother from urinary symptoms.