Rheumatoid Arthritis Is the Only Major Disease in Which the Patient Largely Informs the Doctor
A funny thing happened while we were at a poster session last week at ACR. The Georgia World Congress Center is like three 4-story shopping malls with a couple of theaters and secondary schools thrown in – it’s big. So, we were standing in one of the several exhibit halls looking at posters of abstracts and listening to the researchers discuss their projects. I heard a man say, “With all of these diseases, you go to your doctor to find out how you are. But RA is the only one of the serious diseases where the patient goes to the doctor for the doctor to find out how the patient is.”
Well if you know me, I was pulled in that direction like an electromagnet would grab a screwdriver. But something stopped me. It was Katie Beth, wanting to point out a poster she’d been reading. Here’s what she wanted to show me: Rheumatoid Arthritis (RA) Is the Only One of 8 Diseases for Which a Patient History and Physical Examination (Versus Laboratory Tests and Ancillary Studies) Were Rated as Most Important for Clinical Decisions by >50% in a Physician Survey. Of course it was the same one. Of course it was Dr. Ted Pincus standing there.
Doctors rate patient reported outcome measures highest with RA
Dr. Pincus was part of a team of five researchers (L. McCollum, S. Park, T. Sokka, H. Yazici, T. Pincus ) who surveyed about 600 doctors (half rheumatologists) “concerning the relative importance of 5 sources of information in the clinical encounter—vital signs, patient history, physical examination, laboratory tests, and ancillary studies—in diagnosis and management of 8 chronic diseases: congestive heart failure (CHF), diabetes mellitus, hypercholesterolemia (HC), hypertension (HTN), lymphoma, pulmonary fibrosis (PF), rheumatoid arthritis (RA), and ulcerative colitis (UC).” As I heard Dr. Pincus explaining, “RA was the only disease for which history and physical examination were rated as most important by >50%, including rheumatologists and non-rheumatologists.”
Patient reported outcome measures are more significant than lab tests
Look at their conclusion: “A patient history and physical examination are estimated by physicians to provide a larger proportion of the information for clinical decisions in diagnosis and management of RA than for 7 other chronic diseases. The patient history and physical examination may be regarded as ‘clinician intensive,’ compared to vital signs, laboratory tests, and ancillary studies. This greater physician effort might be recognized in policies for scheduling, reimbursement, and allocation of physician resources by planners, regulators, and payers.”
Imagine: the patients’ physical condition and the patients’ story are more significant with RA than the patient’s lab work or x-rays. Can you see a reason why I say Pincus’ work is important to patients – and doctors? You’ve probably heard me quote Dr. Pincus’ study showing that patient questionnaire scores are as “scientific” as lab tests. In that work, he demonstrated that patient outcome measures are the better predictor of prognosis (via mortality) with RA. He convincingly challenges the rheumatologists who view patient questionnaires as “poor surrogates” of so-called “objective” tests.
Note: You can read this study yourself on page S34 of the abstract pdf at this link. It is number 84.
- The Value of Patient Reported Outcome Measures of Rheumatoid Arthritis
- How Much Does Patient Testimony Matter?
- American College of Rheumatology Annual Meeting 2010
- Would Relying on Patient Generated Data Make a Difference?