I was chatting with a friend this week who had painful joints due to osteoarthritis and like many people she chose not to visit her General Practitioner because she thought that they would only tell her that osteoarthritis is a normal part of ageing. Is this actually what happens in consultations between GPs and their patients?

Well to find out the authors of a recent narrative review undertook a comparison of patient experiences of the osteoarthritis consultation with GP attitudes and beliefs to OA.

Here’s what they did

They undertook a systematic literature search using several electronic databases and identified 552 papers. They included papers where particpants were over 45 years old and had a diagnosis of OA or clinical syndrome of chronic joint pain. Critical appraisal of the studies was informed by CASP tools. Emergent themes were identified from the extracted findings and GP and patient perspectives compared within each theme.

Here’s what they found

They identified 22 relevant papers undertaken mainly in the UK, North America, Europe and Austalasia. Four themes emerged

• diagnosis – delay in diagnosis is frequently reported and finally patients relief in their symptoms being recognised as legitimate.
• explanations – avoidance of the term osteoarthritis in favour of ‘ wear and tear
• management of the condition – pain management and fear of disability appears to be a priority for patients, although a number of barriers to effective management have been identified e.g. making lifestyle changes such as exercise and weight loss. Patient report hat care is often reactive rather than proactive.
• the doctor-patient relationship – both patients and doctors report negative talk in the consultation, including that OA is to be expected, has an inevitable decline and there is little that can be done about it. Patients reporting a lack of feeling their symptoms were legitimised.

The authors concluded

The nature of negative talk and discussions around management within the consultation have emerged as areas for future research. The findings are limited by generic limitations of interview research. Further understanding of the OA consultation alternative methodology such as direct observation may be necessary.

The Musculoskeletal Elf’s view

This is an interesting and well undertaken review and gives insight into the attitudes and beliefs of both patients and GPs in relation to osteoarthritis. These type of evidence does not lend itslef to a quantitive  systematic review and thus a narrative review of this kind is an approriate methodological option.

The authors seleceted studies published in English and thus this may not represent the views of paients or GPs or healthcare systems globally. However there were 22 studies included from a variety of countries and healthcare systems. The authors also suggest alternative methodological approaches to investigating this issue such as observing the consultation, and matching patient and doctor behaviours and reactions.

What do you think?

• Q. When would you give a diagnosis of osteoarthrits to the patient?
• Q. Is this different to your medical diagnosis in your case notes?
• Q. Do you use any recognised diagnostic criteria for osetoarthrtis?
• Q. Do you use the term osteoarthritis or ‘wear and tear’ in discussions with patients about their symptoms?
• Q. Do you discuss prognosis in a positive way? If so how?
• Q. What symptom amangement advice do you give?

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Links

• Paskins et al.: Comparison of patient experiences of the osteoarthritis consultation with GP attitudes and beliefs to OA: a narrative review. BMC Family Practice 2014 15:46.
• CASP Critical Appraisal Skills Programme