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Failure of Physicians To Recognize Functional Disability in Ambulatory Patients
- David R. Calkins, MD, MPP;
- Lisa V. Rubenstein, MD;
- Paul D. Cleary, PhD;
- Allyson R. Davies, PhD;
- Alan M. Jette, PhD;
- Arlene Fink, PhD;
- Jacqueline Kosecoff, PhD;
- Roy T. Young, MD;
- Robert H. Brook, MD; and
- Thomas L. Delbanco, MD
Abstract
Objective: To assess the ability of internists to identify functional disabilities reported by their patients.
Design: Comparison of responses by physicians and a random sample of their patients to a 12-item questionnaire about physical and social function.
Setting: A hospital-based internal medicine group practice in Boston, Massachusetts, and selected office-based internal medicine practices in Los Angeles, California.
Subjects: Five staff physicians, three general internal medicine fellows, and 34 internal medicine residents in the hospital-based practice and 178 of their patients. Seventy-six physicians in the office-based practices and 230 of their patients.
Measurements and Main Results: Physicians underestimated or failed to recognize 66% of disabilities reported by patients. Patient-reported disabilities were underestimated or unrecognized more often in the hospital-based practice than in the office-based practices (75% compared with 60%, P < 0.05). Physicians overstated functional impairment in 21% of paired responses in which patients reported no disability.
Conclusions: Physicians often underestimate or fail to recognize functional disabilities that are reported by their patients. They overstate functional impairment to a lesser degree. Because these discrepancies may adversely affect patient care and well-being, medical educators and clinicians should pay more attention to the assessment of patient function.
Article and Author Information
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From the Beth Israel Hospital and Harvard Medical School, Boston, Massachusetts; and the University of California, Los Angeles, Center for Health Sciences, Los Angeles, California. For current author addresses, see end of text.
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Grant Support: By The Robert Wood Johnson Foundation, Princeton, New Jersey. The views expressed in this article are those of the authors and not necessarily those of the Foundation.
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Requests for Reprints: David R. Calkins, MD, MPP, Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Hospital, 330 Brookline Avenue, Boston, MA 02215.
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Current Author Addresses: Drs. Calkins and Delbanco: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Hospital, 330 Brookline Avenue, Boston, MA 02215.
Drs. Rubenstein, Young, and Brook: Department of Medicine, UCLA Center for Health Sciences, Los Angeles, CA 90024.
Dr. Cleary: Department of Health Care Policy, Harvard Medical School, 25 Shattuck Street, Parcel B, 1st Floor, Boston, MA 02115.
Dr. Davies: Department of Quality Assessment, New England Medical Center, NEMC 100, 750 Washington Street, Boston, MA 02111.
Dr. Jette: New England Research Institute, 9 Galen Street, Watertown, MA 02172.
Dr. Fink: 1562 Casale Road, Pacific Palisades, CA 90272.
Dr. Kosecoff: Value Health Sciences, Inc., 1448 15th Street #202, Santa Monica, CA 90404.
- © 1991 American College of Physicians
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