Failure of physicians to recognize functional disability in ambulatory patients.
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.
Calkins
D R
DR
Department of Medicine, Beth Israel Hospital, Boston, MA 02215.
Rubenstein
L V
LV
Cleary
P D
PD
Davies
A R
AR
Jette
A M
AM
Fink
A
A
Kosecoff
J
J
Young
R T
RT
Brook
R H
RH
Delbanco
T L
TL
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