A physiatrist's view of response shift.
OBJECTIVE
This article will discuss the influence of response shift on clinical care of patients and the impact it has on care decisions from the perspective of a physiatrist.


METHODS
The case series presented in this article is from a compilation of clinical observations made over the course of 25 years as a physician specializing in Physical Medicine and Rehabilitation.


RESULTS
Four clinical vignettes describe how changes in health status can affect different persons and their treating clinicians. Each scenario reflects how different biopsychosocial circumstances can influence a response shift because of changes in internal standards, values, and/or conceptualization.


CONCLUSIONS
As a concept based on health-related research, response shift still remains somewhat a clinical enigma. The clinical vignettes used in this article outline the complexity of clinically understanding the nature of response shift.
van Rijn
Theo
T
Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. tvanrijn@interchange.ubc.ca
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D006233:Persons with Disabilities / Q000523:psychology* / Q000534:rehabilitation; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D010551:Personality / Q000235:genetics; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012944:Social Support