Dermatology patients rate disease severity higher than physicians

Key takeaways:

• Physicians tend to focus on visually objective measures of a disease.
• Patients focus on the physical, functional and emotional toll of their disease.

The high discordance of disease severity grading between patients and physicians calls for targeted interventions and more compassionate health care approaches, according to a study.

Discordant severity grading occurs when the evaluation of disease severity differs between patients and physicians.

“Despite its frequent occurrence, this phenomenon is poorly understood,” Valencia Long, MBBS, of the National University Healthcare System in Singapore, and colleagues wrote.

In a cross-sectional study, Long and colleagues investigated the factors associated with this discordance. Out of 1,053 pairs of patients with psoriasis or eczema and physicians, 46.3% of pairs demonstrated discordance.

Patients tended to rate disease severity higher than physicians, with 42.4% of patients rating severity as worse than physicians, 53.8% rating severity the same as physicians, and 3.8% rating severity lower than physicians.

This discordance may occur because physicians tend to focus on visually objective measures while patients focus on the physical, functional and emotional toll of their disease.

Patients were more likely to rate their severity higher than physicians if they had lower resilience and stability (P < .001), lower self-efficacy (P = .02), increased disease cyclicity (P < .001) and greater expectation of chronicity (P < .001) and if they engaged in negative social comparisons (P < .001).

Patient and physician demographics were not factors in discordance, and the authors said demographics may have been “surrogates for untested cognitive-behavioral factors when found to be statistically significant in previous studies.”

The authors cautioned physicians from attributing discordance to demographics because they are usually nonmodifiable. Instead, physicians should focus on behavioral, cognitive and psychological factors that can be changed with interventions such as cognitive behavioral therapy, education and counseling for stress management.

Physicians can use social media to counter the negative social comparisons that cause this discordance. Additionally, equipping patients with contingency and action plans, healthy coping mechanisms and realistic outlooks can help ease the burden of disease cyclicity.

Lastly, physicians should remember that they may be desensitized to the severity of cases, often dismissing mild cases as trivial, due to their daily exposure. However, to patients, even mild cases can cause great distress.

“It is equally important to acknowledge the crucial contribution of physicians to the phenomenon of discordance, rather than viewing it as a patient problem,” the authors wrote. “It is important that we prioritize patient-focused outcomes and cultivate effective communication habits that allow us to elucidate values that are important to the patient.”