Primary Care Research

Diagnosis of pain by primary care doctors is influenced by pain severity, patient sex, and physician practice style

Appropriate pain control may speed patients' recovery and improve their quality of life and productivity. Yet, pain is frequently unrecognized and undertreated by physicians. The diagnosis of pain by primary care doctors is influenced by the severity of patient pain, the patient's sex, and the physician's practice style, according to a study supported by the Agency for Healthcare Research and Quality (HS06167).

Klea D. Bertakis, M.D., M.P.H., of the University of California, Davis, and her colleagues interviewed 509 patients who were randomized to care by one of 105 physicians. The researchers asked patients about their level of pain and then videotaped their initial physician visit to correlate patient and physician characteristics with pain diagnosis. Patients were interviewed a second time following the visit to assess their satisfaction with the visit.

The researchers used the Davis Observation Code to characterize physician practice style, and they reviewed each patient's medical record to assess physician recognition of patient pain. Overall, 18 percent of patients who reported zero to little pain had their pain diagnosed compared with 47 percent of those reporting medium pain and 70 percent of those reporting severe pain. Female patients reported a greater amount of pain than male patients (46.4 vs. 32.3 on a global pain score scale ranging from 0 to 100). When patients were in severe pain, women were more likely than men to have their pain accurately recognized by their physician.

Surprisingly, the correct diagnosis of pain was not significantly related to patient satisfaction. Physician practice styles emphasizing technically oriented activities (for example, history taking, performing a physical exam or other procedures, and planning treatment) and health behavior discussions (for example, about compliance with medication or proper nutrition and exercise) were strongly predictive of the physician diagnosing patient pain.

For more information, see "Patient pain in primary care: Factors that influence physician diagnosis," by Dr. Bertakis, Rahman Azari, Ph.D., and Edward J. Callahan, Ph.D., in the May 2004 Annals of Family Medicine 2(3), pp. 224-230.

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