Article Figures & Data
Tables
- Appendix A.
Six Clusters of Physician Practice Behaviors and the Davis Observation Codes Included in Each Cluster
Codes in Each Cluster Technical Cluster Abbreviated Davis Observation Code (DOC) Definitions Structuring interaction Discussing what is to be accomplished in current interactions History taking Physician inquiring about or patient describing details related to the chief complaint or to previous illnesses Family information Discussing family medical or social history, and/or current family functioning Physical examination Any aspect of physical examination of patient Evaluation feedback Physician telling patient about results of history, physical examination, laboratory work, etc Planning treatment Physician prescribing a medication, diagnostic, or treatment plan Treatment effects Physician inquiring about or patient describing result of ongoing therapeutic intervention Procedure Any treatment or diagnostic procedure done in office Health behavior cluster Compliance Discussing previously requested behavior Health education Physician presenting information regarding health to patient Health promotion Physician asking for change in patient’s behavior in order to increase or promote health Nutrition Any question or discussion about nutrition Exercise Any question or discussion about exercise Addiction Cluster Substance use Any question or discussion of drinking alcohol or use of other substances Smoking behavior Any question about or discussion of smoking or other use of tobacco Patient activation cluster Health knowledge Physician asking or patient spontaneously offering what patient knows or believes about health and disease Patient question Patient asking question Chatting Discussion of topics not related to current visit Preventive service cluster Preventive service Physician discussing, planning, or performing any screening task with disease prevention Counseling cluster Counseling Physician discussing interpersonal relations or current emotional state of patient or patient’s family Patients Pain Score ≤ 10*Zero to Little Pain n (%) Pain Score >10 – ≥70 Medium Pain n (%) Pain Score ≥ 70 Severe Pain n (%) Total n (%) Note: there were 504 patients having both global visual pain analog scale scores and medical record data regarding physician diagnosis of pain in index appointment. * Global Pain Scale 1–100. † Chi-square, P <.0001, significant differences between the 3 groups for the diagnosis of pain. No diagnosis of pain 100 (81.97) 139 (52.85) 36 (30.25) 275 (54.56) Diagnosis of pain† 22 (18.03) 124 (47.15) 83 (69.75) 229 (45.44) Total 122 (100) 263 (100) 119 (100) 504 (100) Patients Pain Score ≤ 10 Zero to Little Pain n (%) Pain Score >10 – ≤70 Medium Pain n (%) Pain Score ≥70 Severe Pain n (%) Total (N = 504) * Chi-square, P =.0059, significant differences between the 3 groups for the diagnosis of pain for women only. † Chi-square, P =.0092, significant differences between the 3 groups for the diagnosis of pain for men only. Women only No diagnosis of pain 46/57 (80.70) 92/168 (54.76) 23/88 (26.14) 161 Women only* Diagnosis of pain 11/57 (19.30) 76/168 (45.24) 65/88 (73.86) 152 Men only No diagnosis of pain 54/65 (83.08) 47/95 (49.47) 13/31 (41.94) 114 Men only† Diagnosis of pain 11/65 (16.92) 48/95 (50.53) 18/31 (58.06) 77 - Table 3.
Standardized Coefficients from Logistic Equations in Which the Diagnosis of Pain by the Physician is Explained by Physician Practice Style for All Patients (N = 500),* Women (n = 310), and Men (n = 190)
Diagnosis of Pain Independent Variables Physician Practice Style Cluster Standardized Coefficients PValues OR (95% CI) OR = odds ratio, CI = confidence interval. *Complete data for all independent variables tested available for 500 patients. All patients Technical 0.3494 <.0001 1.074 (1.071–1.076) Health behavior 0.2276 <.0001 1.066 (1.054–1.079) Women only Technical 0.1349 <.0001 1.028 (1.025–1.032) Preventive service −0.1414 <.001 0.941 (0.909–0.975) Men only Technical 0.4694 <.0001 1.096 (1.092–1.101) Health behavior 0.3153 <.0001 1.093 (1.071–1.116)
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The Article in Brief
It is sometimes difficult for medical professionals to recognize a patient's pain. Pain is more often recognized in patients with severe pain and in female patients. Physicians who focus on the technical aspects of care and on a patient's health behaviors are more likely to diagnose pain.
