title: Patients with greater symptom intensity and more disability are more likely to be surprised by a hand surgeon's advice.
abstract: BACKGROUND
  A clash between a patient's assumptions and a doctor's advice can feel adversarial which might influence satisfaction ratings and compliance with treatment recommendations. A better understanding of sources of patients' bewilderment might lead to improved strategies for conveying counterintuitive information that improve patient comfort and wellbeing.
  
  
  OBJECTIVE
  This study addressed the following questions: (1) Are magnitude of disability, pain intensity, symptoms of depression, or health anxiety associated with a higher level of surprise when a patient is presented with diagnostic information and/or therapeutic recommendations? (2) Does the surgeon accurately perceive the patient's bewilderment? (3) Does the surgeon's perception of patient bewilderment correlate with diagnosis or a patient's magnitude of disability, pain intensity, symptoms of depression, or health anxiety?
  
  
  METHODS
  In this prospective cohort study, we invited new patients who met prespecified criteria during a 3-month period in one hand-surgery practice to enroll; of 93 patients invited, 84 (90%) agreed to participate. Patients reported demographics and completed the short versions of the DASH questionnaire (QuickDASH), the Patient Health Questionnaire, the Pain Self-Efficacy Questionnaire, and the Short Health Anxiety Inventory; rated their pain intensity; and rated the degree to which the information given by the surgeon was unexpected or surprising on an 11-point ordinal scale. The surgeon also rated his impression of the patient's surprise on an 11-point ordinal scale.
  
  
  RESULTS
  Only greater symptom intensity and magnitude of disability (QuickDASH) correlated with greater unexpected information when rated by the patient (ß = 0.058; p < 0.001). There was a correlation between patient surprise and the surgeon's perception of the patient's surprise (r = 0.58; p < 0.001). Greater surgeon-perceived patient surprise correlated with nonspecific illness (p = 0.007; ß = 3.0).
  
  
  CONCLUSIONS
  Patients with greater symptom intensity and magnitude of disability, and perhaps also patients with nonspecific diagnoses, are more likely to be surprised by a hand surgeon's advice. Future research might address the ability of previsit preparation (using decision aids or other alternative means of education) to ameliorate the discordance between patient assumptions and hand surgeon advice.
authors.affiliation: Hand Surgery Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Joost A
authors.initials: JA
authors.lastname: Strooker
authors.forename: Sjoerd P F T
authors.initials: SP
authors.lastname: Nota
authors.forename: Michiel G J S
authors.initials: MG
authors.lastname: Hageman
authors.forename: David C
authors.initials: DC
authors.lastname: Ring
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D003376:Counseling; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities; D005260:Female; D006225:Hand / Q000601:surgery; D006230:Hand Injuries / Q000523:psychology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009985:Orthopedics; D010147:Pain Measurement; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011446:Prospective Studies; D055815:Young Adult