title: Communicating diagnostic certainty of psychogenic nonepileptic seizures - a national study of provider documentation.
abstract: Management of psychogenic nonepileptic seizures (PNES) requires collaboration among and between health care professionals. Although criteria are established for diagnosis of PNES, miscommunication between neurologists, primary care providers, and mental health professionals may occur if the clinical impression is not clearly articulated. We extracted progress notes from the Department of Veterans Affairs (VA) electronic health record (EHR) nationally to study veterans who were evaluated for PNES. Of the 750 patients being worked up for PNES, the majority of patients did not meet criteria for PNES (64.6%). Of those who were thought to suffer from PNES, 147 (19.6%) met International League Against Epilepsy (ILAE) criteria for documented PNES, 14 (1.9%) for clinically established PNES, and 104 (13.9%) for probable or possible PNES. Neurologists tended to use ambiguous language, such as "thought to be" or "suggestive of" to describe their impressions of patients overall, even those with definitive PNES. Ambiguous language may lead to miscommunication across providers and inappropriate health care.
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA; Yale University, Department of Neurology, USA; Yale University, Department of Psychiatry, USA. Electronic address: hamada.hamid@yale.edu.
authors.forename: Hamada H
authors.initials: HH
authors.lastname: Altalib
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.
authors.forename: Khalid
authors.initials: K
authors.lastname: Elzamzamy
authors.affiliation: South Texas VA Healthcare System, USA; University of Texas Health Science Center, Department of Biostatistics and Epidemiology, USA.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Pugh
authors.affiliation: Yale University, Department of Psychiatry, USA.
authors.forename: Javier Ballester
authors.initials: JB
authors.lastname: Gonzalez
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA; Yale University, Department of Emergency Medicine, USA.
authors.forename: Kei-Hoi
authors.initials: KH
authors.lastname: Cheung
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.
authors.forename: Brenda T
authors.initials: BT
authors.lastname: Fenton
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA; Yale University, Department of Neurology, USA; Yale University, Department of Psychiatry, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA; Yale University, Department of Emergency Medicine, USA.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Brandt
authors.affiliation: Brown University, Departments of Psychiatry and Neurology, USA; Providence VA Medical Center, Department of Psychiatry, USA.
authors.forename: W Curt
authors.initials: WC
authors.lastname: LaFrance
mesh_terms: D003142:Communication; D004282:Documentation; D057286:Electronic Health Records; D006801:Humans; D010348:Patient Care Team; D011602:Psychophysiologic Disorders / Q000175:diagnosis* / Q000523:psychology; D012640:Seizures / Q000175:diagnosis* / Q000523:psychology; D014728:Veterans
keywords: Differential diagnosis; Electronic health records; Epilepsy; Psychogenic nonepileptic seizures