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Satisfaction With Specific and Nonspecific Diagnoses

Published:November 27, 2018DOI:https://doi.org/10.1016/j.jhsa.2018.10.012

      Purpose

      Nonspecific upper extremity illnesses (eg,. wrist pain, forearm pain)—where no objectively verifiable pathology is detectable—are common and usually self-limiting. For some patients, a nonspecific diagnosis can contribute to mistrust and disappointment.

      Methods

      This study tested the primary null hypothesis that there is no difference in mean overall satisfaction between patients given a specific compared with a nonspecific diagnosis. Second, we assessed factors associated with satisfaction and with nonspecific upper extremity diagnosis.

      Results

      There was no significant difference between mean satisfaction with nonspecific and specific diagnoses in bivariate analysis. However, when treated as a categorical variable, 22% of the patients with a nonspecific diagnosis had a satisfaction score of 8 or lower compared with 11% of the patients given a specific diagnosis. First visit and greater pain intensity were significantly associated with a nonspecific diagnosis in bivariate analysis. In the multivariable models, no factors were independently associated with satisfaction or with nonspecific diagnoses.

      Conclusions

      Although nonspecific diagnoses can sometimes be frustrating for both physician and patient, in this small study using a satisfaction measure with a strong ceiling effect, they were no less satisfying to patients on average and corresponded with slightly greater pain intensity than specific diagnoses.

      Clinical relevance

      The degree to which nonspecific diagnoses (perhaps in combination with compassionate care and incremental monitoring) can be part of a satisfying treatment experience merits additional investigation.

      Key words

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      References

        • Kortlever J.T.
        • Janssen S.J.
        • Molleman J.
        • Hageman M.G.
        • Ring D.
        Discrete pathophysiology is uncommon in patients with nonspecific arm pain.
        Arch Bone Jt Surg. 2016; 4: 213-219
        • Miranda H.
        • Viikari-Juntura E.
        • Heistaro S.
        • Heliövaara M.
        • Riihimäki H.
        A population study on differences in the determinants of a specific shoulder disorder versus nonspecific shoulder pain without clinical findings.
        Am J Epidemiol. 2005; 161: 847-855
        • Walker-Bone K.
        • Palmer K.T.
        • Reading I.
        • Coggon D.
        • Cooper C.
        Prevalence and impact of musculoskeletal disorders of the upper limb in the general population.
        Arthritis Care Res (Hoboken). 2004; 51: 642-651
        • Isaac M.L.
        • Paauw D.S.
        Medically unexplained symptoms.
        Med Clin North Am. 2014; 98: 663-672
        • Chabok H.A.
        • Ring D.
        Arm ache.
        Hand (N Y). 2014; 9: 151-155
        • Barsky A.J.
        • Borus J.F.
        Functional somatic syndromes.
        Ann Intern Med. 1999; 130: 910-921
        • Barsky A.J.
        Amplification, somatization, and the somatoform disorders.
        Psychosomatics. 1992; 33: 28-34
        • Garralda M.E.
        Unexplained physical complaints.
        Pediatr Clin North Am. 2011; 58: 803-813
        • Kroenke K.
        • Mangelsdorff A.D.
        Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome.
        Am J Med. 1989; 86: 262-266
        • Katon W.
        • Ries R.K.
        • Kleinman A.
        The prevalence of somatization in primary care.
        Compr Psychiatry. 1984; 25: 208-215
        • Vranceanu A.-M.
        • Safren S.
        • Zhao M.
        • Cowan J.
        • Ring D.
        Disability and psychologic distress in patients with nonspecific and specific arm pain.
        Clin Orthop Relat Res. 2008; 466: 2820-2826
        • Hadjistavropoulos H.D.
        • Hadjistavropoulos T.
        The relevance of health anxiety to chronic pain: research findings and recommendations for assessment and treatment.
        Curr Pain Headache Rep. 2003; 7: 98-104
        • Hadjistavropoulos H.D.
        • Craig K.D.
        • Hadjistavropoulos T.
        Cognitive and behavioral responses to illness information: the role of health anxiety.
        Behav Res Ther. 1998; 36: 149-164
        • Hanssen D.J.C.
        • Lucassen P.L.B.J.
        • Naarding P.
        • de Waal M.W.M.
        • Oude Voshaar R.C.
        Pain characteristics of older persons with medically unexplained symptoms, older persons with medically explained symptoms and older persons with depression.
        Aging Ment Health. 2017; : 1-8
      1. Hubbard RC. Newest vital sign—a health literacy assessment tool. 2011. Available at: https://www.pfizer.com/files/health/nvs_flipbook_english_final.pdf. Accessed November 16, 2018.

        • Parrish R.C.
        • Menendez M.E.
        • Mudgal C.S.
        • Jupiter J.B.
        • Chen N.C.
        • Ring D.
        Patient satisfaction and its relation to perceived visit duration with a hand surgeon.
        J Hand Surg Am. 2016; 41: 257-262.e4
        • Jha A.K.
        • Orav E.J.
        • Zheng J.
        • Epstein A.M.
        Patients’ perception of hospital care in the United States.
        N Engl J Med. 2008; 359: 1921-1931
        • Bijur P.E.
        • Silver W.
        • Gallagher E.J.
        Reliability of the visual analog scale for measurement of acute pain.
        Acad Emerg Med. 2001; 8: 1153-1157
        • Kersten P.
        • White P.J.
        • Tennant A.
        Is the pain visual analogue scale linear and responsive to change? An exploration using Rasch analysis.
        PLoS One. 2014; 9: e99485
        • Weiss B.D.
        Health Literacy and Patient Safety: Help Patients Understand. Manual for Clinicians.
        2nd ed. American Medical Association Foundation and American Medical Association, Chicago2007: 62
        • Menendez M.E.
        • Mudgal C.S.
        • Jupiter J.B.
        • Ring D.
        Health literacy in hand surgery patients: a cross-sectional survey.
        J Hand Surg Am. 2015; 40: 798-804.e2
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research Electronic Data Capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Teunis T.
        • Thornton E.R.
        • Jayakumar P.
        • Ring D.
        Time seeing a hand surgeon is not associated with patient satisfaction.
        Clin Orthop Relat Res. 2015; 473: 2362-2368
        • Menendez M.E.
        • Chen N.C.
        • Mudgal C.S.
        • Jupiter J.B.
        • Ring D.
        Physician empathy as a driver of hand surgery patient satisfaction.
        J Hand Surg Am. 2015; 40: 1860-1865.e2
        • Mellema J.J.
        • O’Connor C.M.
        • Overbeek C.L.
        • Hageman M.G.
        • Ring D.
        The effect of feedback regarding coping strategies and illness behavior on hand surgery patient satisfaction and communication: a randomized controlled trial.
        Hand (N Y). 2015; 10: 503-511
        • Menendez M.E.
        • Loeffler M.
        • Ring D.
        Patient satisfaction in an outpatient hand surgery office: a comparison of English- and Spanish-speaking patients.
        Qual Manag Health Care. 2015; 24: 183-189
        • Vranceanu A.-M.
        • Safren S.A.
        • Cowan J.
        • Ring D.C.
        Health concerns and somatic symptoms explain perceived disability and idiopathic hand and arm pain in an orthopedics surgical practice: a path-analysis model.
        Psychosomatics. 2010; 51: 330-337
        • Ring D.
        • Kadzielski J.
        • Malhotra L.
        • Lee S.G.
        • Jupiter J.B.
        Psychological factors associated with idiopathic arm pain.
        J Bone Joint Surg Am. 2005; 87: 374-380
        • Dzwierzynski W.W.
        • Grunert B.K.
        • Rusch M.D.
        • Zader G.
        • Keller D.
        Psychometric assessment of patients with chronic upper extremity pain attributed to workplace exposure.
        J Hand Surg Am. 1999; 24: 46-52
        • Hoffman B.M.
        • Papas R.K.
        • Chatkoff D.K.
        • Kerns R.D.
        Meta-analysis of psychological interventions for chronic low back pain.
        Health Psychol. 2007; 26: 1-9
        • Vranceanu A.-M.
        • Barsky A.
        • Ring D.
        Psychosocial aspects of disabling musculoskeletal pain.
        J Bone Joint Surg Am. 2009; 91: 2014-2018