Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

When Patients And Doctors Disagree

A 69-year-old woman who swims in my master program came back to the pool after a total knee replacement. I asked her how she was doing. She said she is still in a lot of pain because of her physical therapy. She said that her physical therapist was disappointed that she still was still unable to achieve full flexion of 120 degrees. Why 120 degrees? Did you set that goal I asked her? ”No,” she said, “the therapist did.”

She went on to tell how she already had more range of motion in her knee than she did before the surgery. My friend was quite satisfied with her progress and wanted to stop physical therapy. The pain from the PT was worse than anything she had experienced before the knee replacement. I knew she and her 80-year-old boy friend were going on a cruise and she didn’t want to still be hobbling around.

It turns out that patients and physicians disagree on quite a few things. We hear a lot about patient-centered care. You know, that’s where the provider is supposed to consider the patient’s needs, preferences, and perspective when diagnosing and treating health problems. But medicine is still very provider-centered.

Disagreements between patients and providers like this happen all the time. By way of example, there was a recent study that looked at the issue of physician-patient agreement among patients complaining of low back pain. Researchers found that of the 336 patients, 12 percent disagreed with their physicians’ explanations for the cause of their problem, 9 percent disagreed with the physician’s diagnostic plan (some wanted an MRI), and 13 percent disagreed with the physician’s treatment plan. Overall, 29 percent of patients disagreed with their physician on at least one key aspect of their care.

Providers are in a tough spot in these kinds of situations. They have limited time during the appointment to spend chatting with patients about their thoughts, fears and concerns. It has to be easier to just treat patients knowing that they will be happy with the results down the road. The patient will get over not being “heard.”

Maybe they will and maybe they won’t. But aren’t patients entitled to at least be asked what goals they would like to set for their treatment? Turns out that when patients feel that they and their physicians are in agreement, good things happen. It the case of the low back pain study, patients report much higher levels of satisfaction and measurable improvement in their symptoms at 12 months.

As for my friend, I don’t think she will be going back to her physical therapist again anytime soon. After all, she was back in the pool and going on a cruise with her boyfriend.  She had already met her rehab goal whether the physical therapist knew it or not.

SOURCE: Staiger, T., et al., “BRIEF REPORT: Patient-Physician Agreement as a Predictor of Outcomes in Patients with Back Pain.” Journal of General Internal Medicine. 2005 October; 20(10): 935–937.

*This blog post was originally published at Mind The Gap*


You may also like these posts

Read comments »


Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »