Rheumatologists are frequently required to evaluate the functional disability of their patients for employers, disability attorneys, insurance companies and government agencies. The evaluations are used to determine eligibility for disability payments, employment accommodations, or for certificates of need for durable medical equipment and assistive devices like wheelchairs.
An article in the July issues of the Journal of Rheumatology found that rheumatologists frequently estimate a patients' level of disability higher than the patients do. The rheumatologists at the University of South Florida College of Medicine evaluated 223 patients during regularly scheduled visits using the Stanford Health Assessment Questionnaire (HAD-QI). The questionnaire was also completed individually by the patients. The HAD-QI covers eight activities of daily living: dressing, rising, eating, hygiene, walking, reach, grip, and outside activity. The physicians consistently rated their patients' difficulty in completing these activities higher than the patients did, especially for patients with advanced disease. In total, they overestimated functional disability in 69% of the 223 patients. Physicians were more accurate in evaluating the physical limitations of patients with more mild disease activity.
While the study did not give clear reasons for the discrepancy between patient self-reporting and physician evaluation, the researchers theorized that the difference might be caused by empathy or the patients' ability to adapt to physical limitations in order to complete ADLs and other tasks. Visible joint deformity is associated with functional disability, but patients very often find ways to adapt, making them less disabled than doctors can discern in a short routine visit. The researchers also mentioned that the typical physical exam and medical history may be inadequate to really determine functional disability. They stressed the importance of using a standardized evaluation, like the HAQ-DI and to incorporate input from physical and occupational therapists. PTs and OTs are specifically trained to evaluate physical function and the performance of ADLs, work and leisure tasks and to help patients regain function or find appropriate means of adapting activities to maximize function.
Have you ever experienced a disconnect between how you perceive your own physical abilities and disabilities and your physician's perceptions? How did you resolve it?
How have you learned to adapt to physical limitations? Do you have any helpful hints or advice for others?
