An Identity Crisis in Osteoarthritis

The lack of patient-doctor communication about osteoarthritis symptoms leaves patients in quandary about their condition, according to a small UK study based on the observations of conversations between doctors and patients.

Published in the November/December 2015 issue of the Annals of Family Medicine, the study is based on 19 videotaped consultations that took place in seven general practice offices with 15 physicians in the United Kingdom between August 2012 – August 2013.

Even though it is the most common cause of musculoskeletal pain in older people and it is the fastest increasing cause of disability in the world, there appears to be confusion amongst general practitioners in defining osteoarthritis and in determining how serious it is relative to other comorbidities, wrote Zoe Paskins, Ph.D., of Keele University, Staffordshire, and colleagues.

Paskins wrote that it is still common for patients to struggle with getting proper medical treatment for osteoarthritis for a number of reasons. Patients don’t consult with their primary care practitioner about osteoarthritis as often as they do for other conditions. And, there appears to be a gap between the recommended care and the care that patients receive.

The authors narrowed down communication problems to three categories:  complexity, dissonance and prioritization.

In terms of complexity, osteoarthritis often comes up within the context of the patient having multiple morbidities, with the doctor often focusing on the condition that is the greatest threat to the patient’s health.

“The diagnosis of osteoarthritis therefore became a diagnosis of exclusion, after other conditions, particularly after rheumatoid arthritis, had been ruled out. The patient could then interpret the lack of diagnostic specificity as “nothing showing” and “nothing being done,” the authors wrote.

​Dissonance was a common trait observed in the study, particularly when the physician dismissed osteoarthritis symptoms as the “normal wear and tear” as part of the aging process - a vague term that seemed to confuse patients. “Patients who were seeking clear diagnostic information, not reassurance, described feeling that their concerns were not validated when the GP downplayed or normalized symptoms or otherwise provided reassurance. GPs were observed to use talk implying that OA is normal as a strategy to reassure, facilitate acceptance, or conclude the consultation,” the researchers wrote.

“Both patients and doctors report ‘negative talk’ in consultation concerning osteoarthritis, namely that osteoarthritis is to be expected, that it involves an inevitable decline, and that little can be done about it,” the authors wrote.

​And finally, there was appears to be some confusion between doctor and patients in terms of how to priorities a diagnosis of osteoarthritis. Some physicians assumed that patients did not consider osteoarthritis a priority.

Physicians often spent more time explaining what osteoarthritis is not, rather than explain what it is. And, they downplayed the significance of symptoms with terms such as “early onset” or talking down the significance of radiology reports. “General practitioners also described the need to play down osteoarthritis to avoid encouraging the patient to adopt the ‘sick role,’” the authors wrote.

“The obvious next step would be to work with patients and doctors to create GP training and patient information packages and to test their efficacy in improving the consultation experience,” the authors wrote.

References:

Zoe Paskins, Tom Sanders, et. al. "The Identity Crisis of Osteoarthritis in General Practice: A Qualitative Study Using Video-Stimulated Recall," Annals of Family Medicine. November/December 2015;13:537-544. doi: 10.1370/afm.1866.