An interpreter or investigator between a patient and a piece of paper or a silvery little box is a major confounding thing. First, most patients want to please their doc and “Pisetsky (or Sokka)-reported outcomes” tend to be significantly better than real PROs. Second, the doc is always busy, such as in your example case, and a patient is forced to provide responses under pressure while you are “ready to push the button.” In fact, PROs save time for the clinician if administered correctly: the patient completes the form while waiting to see a health professional who starts the visit by “eyeballing” the questionnaire to provide an immediate overview of patient’s health status and concerns at that time, ready to be recognized and discussed.
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“People are different and outcome measures need to capture all of this wonderful variety,” wrote Dr. Pisetsky. PROs such as the HAQ/MDHAQ, pain, global assessment, fatigue, morning stiffness, self-report joint counts, and so on, are presented as scores, but levels of the scores don’t automatically lead to certain clinical decisions, just as we don’t treat CRP or ESR levels, but use the information in developing a treatment plan. Being open to widen a traditional bio-medical model of treating diseases helps me understand that in, chronic conditions, PROs—if administered correctly—may be part of an important process to help communication between a patient and a health professional and may lead to a better patient adherence to medications and improved long-term outcomes.
My dear friend Dr. Pisetsky, you really messed up with your patient. Maybe you should try again with the correct method and then write a new story, delighted of the value of PROs!
Tuulikki Sokka, MD, PhD
Jyväskylä Central Hospital, Finland