Concordant and discrepant views of patients' physical functioning

Abstract

Objective. Although considerable research has been done on patient-physician interaction, few studies have examined discrepancies between patients and physicians in their assessments of the patient's physical functioning. One recent study reports such discrepancies between rheumatologists and 41 % of their rheumatoid arthritis patients. This article reports data replicating that study and examining the relationships between such discrepancies and a number of other variables.Methods. This is a longitudinal study of 158 patients with rheumatoid arthritis who were interviewed 4 times over a 2-year period and who reported their levels of physical functioning on the Arthritis Impact Measurement Scales. At the time of the fourth interview, the rheumatologists rated each patient's physical functioning on the revised criteria published by the American College of Rheumatology.Results. Rheumatologists' assessments of their patients' physical functioning were discrepant with the patient's assessment for 35% of these patients. Twentyseven patients were rated as worse than they rated themselves and 28 were rated as better. There were no differences between the concordant and the two discrepant groups in demographic or health status characteristics. Conclusions. Taken together, these data imply that it is important for physicians to verify their perceptions with the patient and that it is important for patients to verify that the physician understands them correctly.Key words. Physical functioning; Rheumatoid arthritis; Patient-Physician interaction.Although there have been a number of studies of patient-physician interaction and its implications for a variety of outcomes, few studies have looked at discrepancies between physicians and their patients in estimates of the patient's physical functioning. This issue is especially important in the rheumatic diseases, where functional limitations may be the most problematic long-term symptoms with which the patient must struggle. Indeed, much of the patient education directed at arthritis patients is intended to maximize physical functioning. For example, most of the The Arthritis Helpbook (11, is devoted to teaching patients how to improve their physical functioning.Given the centrality of long-term physical limitations in the rheumatic diseases, there are at least two reasons to examine discrepancies between physicians and patients in their estimates of the patient's physical functioning. First, a recent overview of new developments in patient education for persons with rheumatic diseases (2) indicates there is substantial attention currently being paid to improving the patient education skills of physicians. However, there are a number of studies suggesting that physicians and patients differ in their perceptions of patients' health status, health behaviors, and health attitudes (3-5). Indeed, in a study of 42 physicians practicing in hospitalbased outpatient units and 76 physicians practicing in the community, the physical limitations of patients was underestimated 75% of the ti...

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