New patient charts were reviewed before and after the introduction of a self-administered questionnaire, designed to elicit occupational and environmental (OE) information from patients. The Occupational Health Risk Assessment questionnaire (OHRA) was expected to prompt primary care physicians to make further inquiries into OE health issues. Chart reviews determined the amount and type of information detailed in the primary care physicians' notes. Twenty-three percent of completed OHRAs indicated a job-related health problem. Despite a high prevalence of self-reported work-related symptoms and exposures, the mean number of notations regarding OE exposures was less than one item per patient chart. A comparison of mean OE notations per chart before versus after introduction of the OHRA indicated a decline in notations after introduction of the OHRA (1.03 vs 0.72, P = 0.02). We detail the type of OE issues that patients presented to a primary care practice and the resulting information contained in primary care providers' notes. Suggestions are made to improve a self-administered patient questionnaire to better diagnose, prioritize, and formulate treatment plans related to OE issues.
Three different interpretations of these findings are apparent. 1) Physician self-report is a poor tool for the measurement of clinical behavior, and therefore research of physician behavior should not rely solely on self-reported data; 2) physicians' chart recording of their clinical practice is insufficient to reflect actual care; or 3) neither is an accurate measure of actual practice.
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