title: Failure of physicians to recognize functional disability in ambulatory patients.
abstract: OBJECTIVE
  To assess the ability of internists to identify functional disabilities reported by their patients.
  
  
  METHODS
  Comparison of responses by physicians and a random sample of their patients to a 12-item questionnaire about physical and social function.
  
  
  METHODS
  A hospital-based internal medicine group practice in Boston, Massachusetts, and selected office-based internal medicine practices in Los Angeles, California.
  
  
  METHODS
  Five staff physicians, three general internal medicine fellows, and 34 internal medicine residents in the hospital-based practice and 178 of their patients. Seventy-six physicians in the office-based practices and 230 of their patients.
  
  
  RESULTS
  Physicians underestimated or failed to recognize 66% of disabilities reported by patients. Patient-reported disabilities were underestimated or unrecognized more often in the hospital-based practice than in the office-based practices (75% compared with 60%, P less than 0.05). Physicians overstated functional impairment in 21% of paired responses in which patients reported no disability.
  
  
  CONCLUSIONS
  Physicians often underestimate or fail to recognize functional disabilities that are reported by their patients. They overstate functional impairment to a lesser degree. Because these discrepancies may adversely affect patient care and well-being, medical educators and clinicians should pay more attention to the assessment of patient function.
authors.affiliation: Department of Medicine, Beth Israel Hospital, Boston, MA 02215.
authors.forename: D R
authors.initials: DR
authors.lastname: Calkins
authors.forename: L V
authors.initials: LV
authors.lastname: Rubenstein
authors.forename: P D
authors.initials: PD
authors.lastname: Cleary
authors.forename: A R
authors.initials: AR
authors.lastname: Davies
authors.forename: A M
authors.initials: AM
authors.lastname: Jette
authors.forename: A
authors.initials: A
authors.lastname: Fink
authors.forename: J
authors.initials: J
authors.lastname: Kosecoff
authors.forename: R T
authors.initials: RT
authors.lastname: Young
authors.forename: R H
authors.initials: RH
authors.lastname: Brook
authors.forename: T L
authors.initials: TL
authors.lastname: Delbanco
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003951:Diagnostic Errors; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D013223:Statistics as Topic; D011795:Surveys and Questionnaires