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The name of the test could be the problem!
- Ragai Shaban, Richard Hull. (7 March 2007)
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Communication with patients and Good Medical Practise
- Rohit Sinha (7 March 2007)
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Ragai Shaban, Associate specialist in rheumatology Rheumatology Department,Queen Alexandra Hospital, Portsmouth, Hants.PO6 3LY, Richard Hull.
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We read with interest your leading article and would like to report the result of a small study we conducted which highlight the effect of the results of diagnostic tests on patients and the requesting physicians. Background: The term Rheumatoid Factor (RF) implies a definite link between its presence or absence in the blood of a patient, with the presence or absence of rheumatoid arthritis (RA). It is difficult to find another laboratory test that detects a factor, which bears the same name as the disease itself. Despite its poor performance as a diagnostic test in an unselected population, some primary care physicians (PCP) use the test for RF to rule in or rule out the diagnosis of RA. Methods: Two questionnaires,containing closed questions with a choice of options with some room for open comments (one for PCPs and one for patients) were designed, piloted amd amended. Ethical committee approval was obtained. Results: Out of the 150 questionnaires sent out to PCPs, 107 completed questionnaires were returned. Overall, the RF test was second only to the ESR as the test of choice in investigating patients with joint pain. 56.2% said that changing the name of RF it would influence their diagnosis of RA, 72.4% felt would make explaining the results of test easier and 51.4 thought that changing the name would induce less anxiety in patients Patients fear and assume that they might have RA if they were told that they have RF in their blood, the majority tended to agree. Out 150 questionnaires sent to patients, 99 replies were received. Of those who responded, 50 patients fully completed the questionnaire . 50 patients reported that they had a blood test for RF and all were told the results. 23 patients said they were told that they had a positive RF, 19 patients said they were told that negative result and 8 patients did not know. Of the patients who were told that had a positive test, 58.3% were told that they their blood test showed some abnormalities. 25.8% said they were told that they had rheumatoid in their blood and 32.1% said that they were told that they had RA Of the group of patients who had a negative test result, 93% (15/16 who responded to the question) assumed that they did not have RA because of their negative test. Of those with a positive test result, 70% (14/20 who responded to the question) assumed that they have RA. A significant number of responders, 85 %( 17/20) who were told that they had positive RF felt anxious and concerned. Conclusions: The name Rheumatoid Factor, alone, seems to convey many incorrect messages to patients and PCPs. The name is scientifically inaccurate and misleading. A suggesion could be to rename it after its immunological nature i.e. the anti-IgG autoantibody. There should better education and dissemination of information to patients and PCPs. leaflets on RA should emphasis that there is no single test to diagnose or exclude RA.There is effective suppressive therapy and the disease does not inevitably lead to wheelchair existence, some patients fear. A protocol for PCPs explaining guidelines on what laboratory tests to use in investigating patients presenting with joint pain is recommended. Competing interests: None declared |
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Rohit Sinha, F2 Respiratory Medicine North Tees University Hospital, TS19 8PE
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Reassuring patients of a normal results forms a part of good doctor- patient communication and partnership as described in GOOD MEDICAL PRACTISE(2006) quote- "share with patients, in a way they can understand, the information they want or need to know about their condition, its likely progression, and the treatment options available to them, including associated risks and uncertainties respond to patients’ questions and keep them informed about the progress of their care" and doctor-patient partership quote- "To fulfil your role in the doctor-patient partnership you must: be polite, considerate and honest treat patients with dignity treat each patient as an individual respect patients’ privacy and right to confidentiality support patients in caring for themselves to improve and maintain their health encourage patients who have knowledge about their condition to use this when they are making decisions about their care" Strict adherence to good medical practise will guide doctors to build a good relationship with patient and the best outcome in patient's interest can be acheived effectively. Competing interests: None declared |
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