Psoriatic arthritis patient V physician

[Fred]

Who's the better judge to know how a psoriatic patient is feeling? Is it the patient or the physician? This study set out to try and work it out. What do you think, do you know better than your physician? (I know I do I have the bloody psoriatic arthritis they don't.)

Quote:

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Objective:
To assess the extent and determinants of discordance in scoring between patient global assessment (PtGA) and physician global assessment (PhGA) in patients with psoriatic arthritis (PsA).

Methods:
A cross-sectional and longitudinal analysis of data was conducted in patients attending a large PsA clinic. The difference between PtGA and PhGA (each measured on a scale of 0–10, with 0 indicating best status and 10 indicating worst status) reflected the discrepancy between the PtGA and PhGA of joint and skin activity and could take values from −10 (higher rating of disease activity by the patient) to 10 (higher rating of disease activity by the physician). Multivariate regression identified variables that contributed significantly to each of the outcomes. The proportion of variability of each outcome explained by each predictor was expressed by the partial R2.

Results:
A total of 565 patients were included in the analysis. Patients tended to score their disease worse than their physicians, with greater discordance for the joints than for the skin (mean ± SD 1.68 ± 2.41 PtGA–PhGA difference for joints, and 0.77 ± 2.66 for skin). Fatigue accounted for 21% of the variation in the difference between PtGA and PhGA for joints. Pain (inline image = 9%) and disability by Short Form 36 health survey (inline image = 1.2%) were also important factors, each of which led to higher patient rating; whereas increased tender joint count (inline image = 16%) and swollen joint count (inline image = 1.4%) resulted in a higher physician rating of arthritis.

Conclusion:
Fatigue, pain, disability, and tender and swollen joint counts were the most important factors contributing to discrepancy between patient and physician assessment of joint activity.

Source: NO LINKS ALLOWED

Funded by: The Arthritis Society, Canadian Institutes of Health Research, Krembil Foundation, Canadian Institutes of Health Research Fellowship, Canadian Institutes of Health Research Clinical Research Initiative Fellowship

[jiml]

Of course it's the patient that knows best how they are feeling. The physician can only go by what he is told by the patient , and unless the physician actually suffers with the pain how can he be a better judge of how you feel..
I think most doctors have a limited time to assess you and they make judgements on a relatively brief meeting. And think they have a difficult job trying to determine the extent of pain which is an impossible task

[Kat]

Pain is relative to the tolerance of the individual as well. They could take 500+ other people and have a totally different perspective. I hate the pain chart the doctors have here (what level is your pain on a scale of 1-10) I understand that it is their way of trying to see how much you personally are feeling pain but for me I have three numbers (other than 0) 1 - I'm here in your office aren't I? 5- ouch it really really hurts and 10 (which I've never used) is just shoot me.

I do agree that doctors who do not suffer or have ever suffered from an illness can't possibly know what it "feels" like.

[Caroline]

It seems the physicians are leaving from what they can see. If you have a swollen joint, it will probably hurt.

Of course it is very difficult to find out what a patient is really feeling, due to the differences in personality. What for the one is hurting, for the other is only a slight inconvenience.