Discordance between self-evaluated health and doctor-evaluated health in relation to general health promotion

Objective - To describe the occurrence of "health realists'', "health pessimists'' and "health optimists'' in a non-patient population by identifying cases of concordance and discordance between doctor-evaluated health and self-evaluated health and to describe the distribution of selected life-style-related physiological risk factors among these health-groups. Design - Comparative study. Setting - Primary health care. Subjects - 456 middle-aged persons registered with a general practitioner (GP) were after a general health screening invited to a health discussion. Prior to the health screening the participants had assigned their health status to one of five categories ranging from "very poor'' to "excellent''. After the health discussion the GP rated the participants' general health status on a visual analogue scale. On basis of this information patients were classified as "health realists'', "health optimists'' and "health pessimists''. Results - 54% of the participants could be classified as "good-health realists'', 14% as "poor-health realists'', 22% as "health optimists'', and 10% as "health pessimists''. "Poor-health realists'' had the greatest accumulation of risk factors, followed by "health optimists'', "health pessimists'' and "good-health realists''. Among the "health pessimists'' there was a significantly higher risk score of future cardiovascular disease and poor physical endurance compared with the "good-health realists''. Conclusion - Discordance between doctor-evaluated health and self-evaluated health was found in 32% of the cases studied. "Health pessimists'' had more risk factors than "good-health realists'' even though the GPs had rated their general health status as good in both cases.