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Tuesday, 19 October 2004

This presentation is part of: Poster Session - Clinical Strategies; Judgment and Decison Making

DO PHYSICIANS RECALIBRATE PATIENTS' PAIN FOR FUNCTIONAL REASONS?

Laetitia Marquié1, Eric Raufaste, PhD1, Dominique Lauque, MD, PhD2, Claudette Mariné, PhD1, and Paul Clay Sorum, MD, PhD3. (1) Centre National de Recherche Scientifique, Université Toulouse-II, Laboratoire Travail et Cognition, Toulouse, France, (2) Centre Hospitalier Universitaire Purpan, Service d'Accueil des Urgences, Toulouse, France, (3) Albany Medical College, Departments of Medicine and Pediatrics, Latham, NY

Background: Physicians give systematically lower ratings of patients' pain than do the patients themselves. We found (Pain 2003;102:289-96) that emergency department (ED) physicians in Toulouse, France, were influenced by "non-functional" factors like their own gender. We hypothesized that physicians' recalibration of patients' pain is due also to "functional" factors, namely, the physical signs of pain and the apparent pathology responsible for the pain.

Methods: 52 ED physicians in Toulouse (26 males and 26 females) evaluated 45 scenarios of hypothetical patients with abdominal pain. The scenarios consisted of all combinations of 5 levels of the patient's own pain rating (0, 2, 5, 7 and 10 on a 0-10 scale), 3 levels of physical manifestations of pain, and 3 configurations of cues about the severity of the abdominal pathology. The physicians rated patients' pain on a 0-10 visual analog scale; indicated the most likely diagnosis on the basis of the information about history, physical exam, and white blood cell count; and, after completing the scenarios, indicated the expected range of pain ratings for each possible cause of abdominal pain.

Results: Physicians tended to assign middle ratings to patients' pain, thus giving increasingly higher ratings than did the paper patients as the patients' ratings declined below 5 and increasingly lower ratings as the patients' ratings increased above 5. Multiple linear regression found that the extent of this recalibration of the patient's pain was predicted by the patient's pain rating (ß = -0.67; p< .001), the manifestations of pain (ß =0.43; p< .001), the cues about severity of pathology (ß = 0.13; p< .001), and the minimum expected level of pain for the most likely pathology (ß = 0.09; p< .001).

Conclusions: ED physicians in Toulouse used the patient's appearance and signs of abdominal pathology to adjust the patient's own assessment of pain. "Miscalibration" of patients' pain is, therefore, not merely a result of bias and mistrust of patients; it can be functional.


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