Agreement between medical expert assessments in social medicine

BACKGROUND AND AIMS: Medical specialists in social medicine play an important role in description of work-related health problems of the individual citizen in the Municipalities, yet knowledge of the consistency in their medical assessment remains poor. However, we expect good agreement between medical specialists' descriptions of health and work ability. The present paper aims to evaluate inter-rater differences between assessments issued by medical specialists in social medicine on health-related work ability in patients with musculoskeletal diseases and some lighter psychiatric diseases. METHODS: A total of 11 medical specialists in social medicine from four departments across Denmark each described eight subjects' health and health-related disability upon request from the municipal authorities. The resultant 88 written medical expert assessments were evaluated and scored independently by two medical specialists in social medicine with respect to functional impairment/health-related work ability as intact, slightly reduced, much reduced, or extremely reduced. Kappa analysis described the inter-rater agreements. RESULTS: The combined Kappa value for work ability was 0.33 (slight agreement). In the category "extremely reduced" work ability the Kappa value was 0.61 (good agreement), but mostly this result was due to one subject. One department had better intra-departmental agreement than the other departments. Agreement on the level of work ability was poorer in subjects with psychiatric diseases. Conclusions: The assessments from medical specialists in social medicine on work ability and thereby occupational possibilities show much variation. The results of the present study demonstrate that there is much room for improving agreement on these assessments.