Upper Extremity Specialist Puzzlement and Misdiagnosis Are More Likely When Patients Interpret Rather Than Describe Their Symptoms.

Abstract

Background and objective: Diagnosis of upper limb illness by upper extremity specialists may be more straightforward when patients relate matter-of-fact descriptions more so than interpretation of symptoms, which can be inaccurate and misleading. This study investigated the accuracy of diagnosis when specialists are presented with interpretations compared to descriptions of symptoms.

Methods: Upper extremity specialists reviewed 4-sentence descriptions of symptoms of 7 nontraumatic upper limb diseases in typical American spoken English. Text for the descriptions was sourced from a set of transcripts of audio and video recorded visits: half matter-of-fact descriptions of common symptoms, and half reflecting common misinterpretations of symptoms. The 4 sentences were randomly presented one at a time and the surgeons provided text descriptions of their guess at the diagnosis and rated the likelihood of symptom misinterpretations.

Results: The number of sentences until correct diagnosis was significantly lower for the matter-of-fact descriptions (median 1 vs median "unable to diagnose") compared to the symptom interpretations. For the matter-of-fact descriptions, most surgeons (>80%) correctly guessed the diagnosis on the first sentence. Specialists detected symptom misinterpretation in the scenario language.

Conclusion: These findings suggest that difficulty in diagnosis is associated with patient interpretation rather than description of symptoms. While interpretation of symptoms is an important part of illness, the pathophysiology may be best discerned when patients provide matter-of-fact descriptions rather than interpretation of their symptoms.