 | Symptoms
documented in the medical records |
Incorrect
Sources
of information for detecting symptoms include:
- the subject;
- the physician or
other health care professionals involved in treating or investigating
the subject; and
- review of medical
records.
Symptoms are
often not consistently or comprehensively asked about in clinical
care, thus leading to underdetection. Justice et al found that
symptoms reported by patients had a stronger relationship to prognosis
than those noted by their treating physicians (Justice
et al., 2001a).
What is documented
in medical records represents an even greater underestimate because
clinicians not only need to inquire about symptoms but also take
the time to formally record them in their notes. Objective information
(like laboratory tests or physical examination findings) is more
likely to be documented in medical records than the panoply of
symptoms a patient may report.
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