Patient Misunderstanding in Arthritis
Major Patient Misunderstanding Found in Numerous Categories:
Various studies have been done to investigate a patients understanding of their disease. Most studies that have examined Arthritis have sought to classify people into social categories in order to form comparisons between the perceptions of various groups of people afflicted with Arthritis and to provide further evidence for the existence of individual illness models. In addition, some of the previous studies of Arthritis further define the variety of sources and experiences from which people derive the meanings that they assign to specific illnesses.
Social Classes:
In a 1973 study, the perceptions of the symptoms and the etiology of 160 patients regarding their Arthritis were examined through a series of structured and unstructured questions. The participants were divided into five different social classes, based upon income, occupation, home values, and levels of education. Numerous differences were found between the responses that subjects of different social classes gave regarding the cause of their Arthritis. Causes such as climate, working conditions, and accident or injury were more commonly named by subjects of “lower social classes.” The study concluded that the reason why these explanations seemed to be more common among subjects of “lower social classes” was because “lower class” workers were exposed to these variables on a more frequent basis than were “upper class” workers. Oppositely, subjects belonging to the “upper classes” attributed the cause of their Arthritis to heredity and age. This study supports the individuality of patient models of illness, and provides an explanation for the variability of patient perceptions.
Cultural Differences:
The culture that a person recognizes is often associated with his or her ethnicity. Both culture and ethnicity act as variables in the construction of one’s individual illness model. In a 1984 study conducted on Arthritis, patients were grouped, according to their ethnicity, into either Spanish-speaking (46 patients) or Caucasian (98 patients) categories. Both patients and their physicians were asked 3 survey questions regarding general Arthritis. Patients were asked to identify things that they believed would improve their Arthritis and things that they believed would worsen their Arthritis. Physicians were asked to describe those things that they thought their patients would identify as being beneficial or harmful to their Arthritis. Differences between the Caucasian and Spanish-speaking groups consisted of differing beliefs regarding the use of diet and massage therapy in the treatment of Arthritis. It was clear that inconsistencies in the treatment beliefs between the two ethnic groups were the result of strong cultural influences for each group. Another key finding in the study that supports the need for improved physician-patient communication is the variance that was found between what patients thought about their disease and what physicians thought that patients knew about their disease. The top two items that patients reported as making their Arthritis worse were exercise or prolonged activity and remaining in one position for an extended period of time. What is so striking about this finding is that out of the 50 physicians that participated in the study, zero identified these two items as plausible perceptions held by their patients with regard to their Arthritis. The study concluded that there was a need for caution and change in the way that physicians educated and interacted with their patients and in the assumptions that physicians made with respect to their patients’ knowledge of disease.
Individual Patient Knowledge:
Several studies have attempted to assess the public’s level of knowledge of Arthritis. The objectives of these previous studies of Arthritis were to promote improved and widespread education of the public on the subject of Arthritis. These studies argued individually that a group of diseases as prevalent as Arthritis warranted such efforts. In one 1983 study, which utilized a telephone survey to collect data, 300 respondents answered questions about their knowledge of the subject of Arthritis.
The study found numerous differences between respondent perceptions of Arthritis when compared to the established medical model of Arthritis at the time. The greatest perceptual differences between the public models of illness and the established medical model for Arthritis, were regarding treatments. For example, 83% and 76% of respondents replied that bee venom and copper bracelets, respectively, were effective methods of treating Arthritis, none of which were or are currently recognized by the established medical model for Arthritis. In a follow-up study that questioned only arthritic patients, fewer inconsistencies were found between the illness models of the arthritic patients and the medical model than were found between the perceptions of Arthritis held by the general public when compared to the medical model. Although this two-part study was conducted in 1983, it is important because it is among the few studies conducted on the general public’s perceptions of Arthritis. The study concluded that the models of illness recognized by the majority of people within the study were inconsistent with what science and medicine was reporting on Arthritis. In addition, the study found that 35% of arthritic patients reported not understanding the explanations that they had been given regarding their Arthritis from their physicians. Though time has vastly improved public access to medical information through the technology of the internet, several more recent studies have demonstrated that major differences still exist between models of illness recognized by the general public and established medical models.
Communication Gaps:
In a 1986 study, patients demonstrated a general lack of knowledge of the medical model of Rheumatoid Arthritis. The majority of the 29 patients interviewed for the study reported that they felt unable to discuss their beliefs and knowledge about their Arthritis with their physicians. The few patients in the study who had actually discussed their illness beliefs with their physicians had received an indifferent and discouraging response. This study reiterated the need for improved communication between physicians and their patients and provided an explanation for inconsistencies that exist between patient illness models and medical model of Arthritis.
In a 1985 study of the treatment strategies of both Rheumatoid Arthritis and Osteoarthritis, only 19 of the 76 respondents had any knowledge of the pathophysiology of Arthritis. The study found that patients who had either more advanced Arthritis or longstanding Arthritis possessed a greater degree of knowledge than did those patients with new onset Arthritis or mild forms of the disease. Furthermore, the study concluded that patient illness models were a product of the treatment process for an illness, and that structured illness models did not exist prior to the initiation of treatment for Arthritis.
The ideal outcome of improved physician-patient communications is for both individuals to have a greater understanding of the meaning that the other assigns to Arthritis. Limiting discussions to only a few aspects of the disease and leaving the remainder to assumption allows for misinterpretation and poor treatment outcomes, which in some cases include unnecessary symptoms. In a 2000 study, 90% of 209 general practitioners reported that in discussions with their patients on the pharmacologic treatment of OA, the physicians provided education to their patients on the risks of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), including the risk of gastrointestinal (GI) side effects. However, of the 510 OA patients in the study, only 51% reported having a discussion with their physicians on the GI side effects of NSAIDs. In addition, when GI discomfort caused by NSAIDs did occur, only 15% of patients attributed their symptoms to their Arthritis medication; the remaining patients blamed rich foods and other causes for their discomfort. Even though 90% of general practitioners stated that they had discussed NSAID use and its possible GI side effects with their patients, the general practitioners in the study reported that they believed as many as 27% of their patients titrated their prescribed medication for their arthritic condition in order to lessen GI side effects and discomfort. A comprehensive discussion of NSAID use including the risks of possible GI discomfort likely would have prevented unnecessary patient discomfort, for those patients who reported that they were not aware of how NSAIDS would affect them. Increased compliance to prescribed Arthritis medication would also likely resulted, had patients known the cause of their GI symptoms and therefore known to report these symptoms to their physician. Although this study only examined physician and patient perceptions of the treatment of Osteoarthritis, it provides insight into situations that exist in medicine, where a lack of communication between physicians and patients can result in unnecessary discomfort and decreased compliance with prescribed medical management.
Patients That Do Not Comply With Their Doctors Instructions:
Compliance with treatment recommendations and the successful outcome of such treatments is a primary therapeutic objective in medicine. Studies of Diabetes Mellitus and Myocardial Infarction have demonstrated patient-initiated modifications in behavior as a result of improved physician-patient communication, leading to improved patient compliance. In a 2001 study, compliance with prescribed therapeutic regimens for Osteoarthritis was investigated in 20 arthritic patients to determine the factors that influence patient decisions to comply with physicians’ recommendations. The study found that the perceptions that patients had of the severity of their symptoms greatly influenced their behavioral decisions. Patients experiencing severe pain and the threat of immobility were more likely to comply with their physician’s recommendations. Perceived causes of Osteoarthritis also impacted patient responses to prescribed treatments. Patients who believed the cause of their disease to be inalterable were less inclined to follow through with prescribed exercise regimens. Inalterable causes identified by patients include age, obesity, and general wear and tear on the body. The study concluded that patient decisions with regard to treatment regimens were reasoned in relation to individually held perceptions of symptoms, the patient’s perceived efficacy of the prescribed treatments, and the desire for patients to incorporate the treatments into their lifestyles.
Do Cultural Differences Matter in How Osteoarthritis Will Affect Me?
Patient Misunderstanding in Osteoarthritis
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