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; Thomas L. Delbanco, MD
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.
David R. Calkins, Lisa V. Rubenstein, Paul D. Cleary, Allyson R. Davies, Alan M. Jette, Arlene Fink, et al. Failure of Physicians To Recognize Functional Disability in Ambulatory Patients. Ann Intern Med. 1991;114:451–454. doi: 10.7326/0003-4819-114-6-451
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Published: Ann Intern Med. 1991;114(6):451-454.
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