title: The Identity Crisis of Osteoarthritis in General Practice: A Qualitative Study Using Video-Stimulated Recall.
abstract: OBJECTIVE
  Patients and doctors report marked disenchantment with primary care consultation experiences relating to osteoarthritis. This study aimed to observe and analyze interactions between general practitioners (GPs) and patients presenting with osteoarthritis (OA) to identify how to improve care for OA.
  
  
  METHODS
  We conducted an observational study in general practices in the United Kingdom using video-recorded real-life consultations of unselected patients and their GPs. Postconsultation interviews were conducted using video-stimulated recall. Both consultations and interviews were analyzed thematically.
  
  
  RESULTS
  Three key themes were identified in an analysis of 19 OA consultations and the matched GP and patient interviews: complexity, dissonance, and prioritization. The topic of osteoarthritis arises in the consultation in complex contexts of multimorbidity and multiple, often not explicit, patient agendas. Dissonance between patient and doctor was frequently observed and reported; this occurred when GPs normalized symptoms of OA as part of life and reassured patients who were not seeking reassurance. GPs used wear and tear in preference to osteoarthritis or didn't name the condition at all. GPs subconsciously made assumptions that patients did not consider OA a priority and that symptoms raised late in the consultation were not troublesome.
  
  
  CONCLUSIONS
  The lack of a clear illness profile results in confusion between patients and doctors about what OA is and its priority in the context of multimorbidity. This study highlights generic communication issues regarding the potential negative consequences of unsought reassurance and the importance of validation of symptoms and raises new arguments for tackling OA's identity crisis by developing a clearer medical language with which to explain OA.
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, United Kingdom z.paskins@keele.ac.uk.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Paskins
authors.affiliation: Section of Public Health, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Tom
authors.initials: T
authors.lastname: Sanders
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, United Kingdom.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Croft
authors.affiliation: School of Medicine, Keele University, Staffordshire, United Kingdrom.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Hassell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D005260:Female; D058006:General Practice; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D010003:Osteoarthritis / Q000523:psychology*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012017:Referral and Consultation; D006113:United Kingdom; D014741:Video Recording
keywords: arthralgia; clinic visits; diagnosis; multiple morbidities; osteoarthritis; physician-patient relations; primary care; prognosis