Patients' own predictions of health found accurate

March 21, 1991|By Daniel Goleman | Daniel Goleman,New York Times News Service

People's answer to the simple question, "Is your health excellent, good, fair or poor?" is a better predictor of who will live or die over the next decade than even a rigorous physical examination, according to new findings.

Even if physical examinations show they are in comparable health, a study shows, older people who say their health is "poor" are seven times more likely to die in the next 12 years than those who say their health is "excellent."

The findings are from a study of more than 2,800 men and women 65 years old and older. The same effect has been found in other studies with people of all ages.

Experts said there were several possible ways that a person's feelings might be a good indicator of his or her underlying physical health.

And none of them interpreted the results to mean that people should not get physical examinations. But, at the very least, they said, the findings indicate that physicians should listen more carefully to their patients' own evaluations of their health.

Patients who complain of symptoms that medical tests cannot verify should not be dismissed as hypochondriacs, said Dr. Ellen Idler, a sociologist at Rutgers University who was an author of the study.

"They may be picking up something very meaningful, even if they get a clean bill of health in a physical," Dr. Idler said.

Dr. Idler conducted the study with Dr. Stanislav Kasl of Yale Medical School. Their findings are reported in the current issue of The Journal of Gerontology.

People's own evaluations of how healthy they were proved to be more accurate predictors of who among them would die than did such objective measures as their medical symptoms and known health risk factors such as whether they smoked.

People who said they smoked, for example, were twice as likely to die within the next 12 years as those who never smoked.

The study "confirms something many physicians have suspected for years," said Dr. Daniel Blazer, acting chairman of the Psychiatry Department at Duke University.

"We've all seen times when patients prove to have a better sense of what's happening with their health than you can determine by objective measures."

Dr. Idler's conclusions are supported by a review of five other large studies, all of which asked people to evaluate their own health and then tracked down the same people several years later. The studies involved more than 23,000 people, ages 16 to 94.

In each study, the answers people gave to questions about how they felt were found to be strong predictors of who lived and who died as long as 17 years later. Dr. Idler's analysis of these studies will be reported later this year in The International Review of Health Psychology.

For reasons that are not clear, "men's self-perceptions of their health are slightly better than women's as predictors," Dr. Idler said. She found that the strongest correlation was among middle-aged men, those 45 to 64.

Indeed, Dr. Idler found that almost no results from a thorough physical examination were related to how long a person lived over the next 12 years. One notable exception was for circulatory disorders such as hypertension.

"We were astonished to find that physicians' exams didn't predict mortality," Dr. Idler said. "These were excellent, in-depth physicals with extensive lab tests."

Dr. Idler and other researchers are at a loss to say just why people's own evaluations are stronger predictors of their long-term health.

One possibility is that when people sum up how healthy they are, they may take into account many factors, such as the health histories of their relatives, the life span of their parents and grandparents and their own health habits.

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