title: Psychological factors predict unexpected diagnoses.
abstract: BACKGROUND
  Unexpected diagnoses and treatment recommendations can be awkward for both hand specialist and patient. We tested the hypothesis that psychological factors predict an unexpected hand specialist diagnosis after referral from a primary care provider (PCP) for management of an atraumatic hand condition.
  
  
  METHODS
  One hundred and thirty patients referred to a hand surgeon by their PCP were asked to complete measures of symptoms of depression, catastrophic thinking, hypochondriacal attitudes and beliefs, and disability prior to the visit. Patients indicated their impression of the diagnosis and treatment recommendations. The hand specialist recorded a diagnosis and treatment recommendations after the visit.
  
  
  RESULTS
  Patients receiving unexpected diagnoses had more psychological symptoms than patients receiving expected diagnoses. In logistic regression analysis, symptoms of depression were the sole predictor of an unexpected diagnosis. Patients receiving unexpected treatment recommendations had greater catastrophic thinking and hypochondriacal attitudes and beliefs than patients receiving expected treatment recommendations. In logistic regression analysis, catastrophic thinking was the sole predictor of unexpected treatment recommendations.
  
  
  CONCLUSIONS
  Given that unexpected hand diagnoses or treatment recommendations are both inherently awkward and associated with greater symptoms of depression, catastrophic thinking, and hypochondriacal beliefs, a practiced, thoughtful, and empathetic communication strategy may improve patient satisfaction and health outcomes.
authors.affiliation: Harvard Medical School, Boston, MA USA ; Benson Henry Institute for Mind Body Medicine, Behavioral Medicine Service, Massachusetts General Hospital, One Bowdoin Square, Boston, MA 02114 USA.
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Vranceanu
authors.forename: David
authors.initials: D
authors.lastname: Ring
keywords: Catastrophic thinking; Depression; Hand illness; Unexpected diagnosis