Substantial differences in perception of disease severity between post COVID-19 patients internists & psychiatrists or psychologists…, 2023, Ruzicka+

Substantial differences in perception of disease severity between post COVID-19 patients, internists, and psychiatrists or psychologists: the Health Perception Gap and its clinical implications
Ruzicka, Michael; Ibarra Fonseca, Gerardo Jesus; Sachenbacher, Simone; Heimkes, Fides; Grosse-Wentrup, Fabienne; Wunderlich, Nora; Benesch, Christopher; Pernpruner, Anna; Valdinoci, Elisabeth; Rueb, Mike; Uebleis, Aline Olivia; Karch, Susanne; Bogner, Johannes; Mayerle, Julia; von Bergwelt-Baildon, Michael; Subklewe, Marion; Heindl, Bernhard; Stubbe, Hans Christian; Adorjan, Kristina

Patient-reported outcome measures (PROMs) such as the Numeric Pain Rating Scale (NPRS) or Likert scales addressing various domains of health are important tools to assess disease severity in Post COVID-19 (PC) patients. By design, they are subjective in nature and prone to bias.

Our findings reveal substantial differences in the perception of disease severity between patients (PAT), their attending internists (INT) and psychiatrists/psychologists (PSY). Patients rated almost all aspects of their health worse than INT or PSY. Most of the differences were statistically highly significant. The presence of fatigue and mood disorders correlated negatively with health perception. The physical health section of the WHO Quality of Life Assessment (WHOQoL-BREF) and Karnofsky index correlated positively with overall and mental health ratings by PAT and INT. Health ratings by neither PAT, PSY nor INT were associated with the number of abnormal findings in diagnostic procedures. This study highlights how strongly perceptions of disease severity diverge between PC patients and attending medical staff. Imprecise communication, different experiences regarding health and disease, and confounding psychological factors may explain these observations.

Discrepancies in disease perception threaten patient-physician relationships and pose strong confounders in clinical studies. Established scores (e.g., WHOQoL-BREF, Karnofsky index) may represent an approach to overcome these discrepancies.

Physicians and psychologists noting harsh differences between a patient’s and their own perception of the patient’s health should apply screening tools for mood disorders (i.e., PHQ-9, WHOQoL-BREF), psychosomatic symptom burden (SSD-12, FCV-19) and consider further psychological evaluation. An interdisciplinary approach to PC patients remains imperative.

Link | PDF (European Archives of Psychiatry and Clinical Neuroscience)

 

(Received 2 Jul 2023, prior to publication of eg Distinguishing features of Long COVID identified through immune profiling)

 

And yet in Healthcare employment as a risk factor for functional neurological disorder: A case–control study (2023, European Journal of Neurology) we have —

 

I think the fact that they call chronic fatigue syndrome a psychiatric condition tells us all we need to know. Not to mention that their internists apparently thought more than half of the patients in the study, who were at an LC clinic, had excellent or good physical health.

 

We need a rebuttal of this article done by someone like Leonard Jason. They would get similar findings--that doctors rate LC patients' health much better than the patients themselves. But they would explain it as due to doctors' ignorance.

 

Could also have a rebuttal from - you know - actual physicians with long Covid.

ETA: or perhaps they might read Long covid: the doctors’ lives destroyed by an illness they caught while doing their jobs (2023, BMJ)

 

It would be an interesting rebuttal because the results are meaningful, but the interpretation for why doctors rate patients' health better is terrible.

 

Perhaps they should apply those screening tools and consider further psychological evaluation on themselves. I'm sure it's very common for doctors--and really anyone other than the patient--to immediately think "I know what fatigue feels like. Just get over it lazybones." So, if there's a discrepancy between how the patient rates their symptoms and how the doctor does, the doctor should re-evaluate their own biases and judgement.

Do psychiatrists/psychologists apply the findings from psychiatrist/psychologist research papers on themselves? Do they cherrypick the ones they apply to themselves? There are so many contradictory theories, so they can't apply them all, so what method do they use to select theories?