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.
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Calkins DR, Rubenstein LV, Cleary PD, Davies AR, Jette AM, Fink A, 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.
Education and Training, Hospital Medicine.
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