Health: perception versus observation

BMJ 2002; 324 doi: http://dx.doi.org/10.1136/bmj.324.7342.860 (Published 13 April 2002) Cite this as: BMJ 2002;324:860

Self reported morbidity has severe limitations and can be extremely misleading

  1. Amartya Sen, master of Trinity College
  1. Master's Lodge, Trinity College, Cambridge CB2 1TQ

    Critical scrutiny of public health care and medical strategy depends, among other things, on how individual states of health and illness are assessed. One of the complications in evaluating health states arises from the fact that a person's own understanding of his or her health may not accord with the appraisal of medical experts. More generally, there is a conceptual contrast between “internal” views of health (based on the patient's own perceptions) and “external” views (based on the observations of doctors or pathologists). Although the two views can certainly be combined (a good practitioner would be interested in both), major tension often exists between evaluations based respectively on the two perspectives.

    The external view has come under considerable criticism recently, particularly from anthropological perspectives, for taking a distanced and less sensitive view of illness and health. 1 2 It has also been argued that public health decisions are quite often inadequately responsive to the patient's own understanding …

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