Correspondence of patient word choice with psychologic factors in patients with upper extremity illness.
BACKGROUND
Studies of patients with back pain, cancer, and in a general medical practice note that the use of certain phrases by a patient when communicating with their health provider can indicate greater disability and distress than expected for patients with a given disorder. However, it is unclear whether such phrases apply to patients with hand and arm disorders.


OBJECTIVE
We assessed whether specific patient phrases are associated with symptoms, disability, and psychologic factors in patients with hand and arm disorders.


METHODS
We recorded and coded 61 interviews of new patients. Specific expressions of patients were listed and categorized into six phrase categories: "I can't", "Find it and fix it", "Something is wrong", "It's serious", "Deemphasis (hoping)", and "Protective mindset". Patients completed questionnaires for arm-specific disability (DASH), depression (Patient Health Questionnaire [PHQ-9]), pain catastrophizing (Pain Catastrophizing Scale [PCS]), and heightened illness concern (Whiteley Index).


RESULTS
Patients who endorsed phrases in the category "I can't" had higher scores on the PCS, Whiteley, DASH, and pain; they also had longer visits. Patients expressing "Something is wrong" had higher scores for the PCS, pain, and duration of visit. Patients using "It's serious" had a higher score for pain. Finally, patients using "Protective mindset" had lower PHQ-9 scores and younger age.


CONCLUSIONS
Patient word choice may indicate underlying distress or ineffective coping strategies that represent important opportunities for empathy and support, including evidence-based cognitive and behavioral interventions.


METHODS
Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.
Arjan G J
AG
Bot
Ana-Maria
AM
Vranceanu
James H
JH
Herndon
David C
DC
Ring
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D003142:Communication; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000523:psychology*; D010146:Pain / Q000523:psychology; D010817:Physician-Patient Relations; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D009626:Terminology as Topic; D034941:Upper Extremity; D055815:Young Adult