title: Paired interviews of shared experiences around chronic low back pain: classic mismatch between patients and their doctors.
abstract: BACKGROUND
  current treatments for chronic low back pain (LBP) appear to be inadequate and there are growing calls for new approaches. This study explores the paired interviews of shared experiences among chronic LBP patients and their physicians with the ultimate goal of improving doctor-patient communication and clinical outcomes.
  
  
  METHODS
  in-depth interviews of a purposeful sample of paired chronic LBP patients and their doctors were conducted, transcribed and analysed using a multistep iterative process. Interview pairs were examined for important themes and major areas of convergence and divergence/mismatch.
  
  
  RESULTS
  patients' stories focused on their suffering from severe and disabling LBP while conveying a high level of reliance on their family physicians. Physicians described many challenges in treating this patient population. Patient and doctor stories were convergent regarding the severity/seriousness of illness, the lack of effective treatments and the existence of many barriers to care. Notable areas of mismatch: biomedical/biomechanical versus biopsychosocial (BPS) models of illness, treatment expectations/goals of reducing pain versus improving function and the importance of a definitive diagnosis.
  
  
  CONCLUSIONS
  patient and physician stories revealed shared themes and convergences, as well as significant discordance and mismatch. Family physicians, trained in and adherent to the BPS model, may have great difficulty when matched with biomechanically oriented patients. Re-conceptualizing doctors and LBP patients as a single teachable dyad may be useful. Clinical application of paired interviews of shared experiences may be useful in bridging communication and paradigmatic gaps, reducing mismatch and developing shared treatment plans.
authors.affiliation: Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Allegretti
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Borkan
authors.forename: Shmuel
authors.initials: S
authors.lastname: Reis
authors.forename: Frances
authors.initials: F
authors.lastname: Griffiths
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002908:Chronic Disease / Q000628:therapy; D003142:Communication; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D018802:Patient-Centered Care; D010361:Patients / Q000523:psychology; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology