Twenty Questions, Part 2

Last month, I told you how my handy DAS-ometer has given me a new, and standardized, look at RA. This month, I want to share my first experience with a new metric: the Health Assessment Questionnaire or HAQ.

For my first patient to get HAQed, I wanted to choose one carefully, especially in a teaching clinic where I could show the added value of a patient-reported outcome. I did not want to be disappointed in my first outing and, like my colleague who wanted to stick a fork in the Disease Activity Score (DAS), join the utensil brigade and stick a fork in the HAQ.

Enter the Subject

A few weeks ago, one of the house officers rotating on service came to me in my clinic office, a small room with an examining table and a desk with a computer for the EMR. He succinctly presented his case, a particularly challenging therapeutic decision. The patient was in his 50s and had had RA for five years. The DAS was 3-something, but the man was struggling, feeling unable to perform the tasks required of him on his job. In today’s parlance, he had minimal disease activity. In my mind, a biological could be of value for him and I wanted to do an HAQ to help me decide.

I do not keep paper HAQs in my clinic and instead have a small handheld computer. This silvery little box is a combined DASometer and HAQometer but, unfortunately, the screen is small and the letters are composed of broken lines that make the words hard to see. I decided therefore to read the questions to the patient and punch in the responses myself. In that way, I would participate in the process and, as we went through the questions, the house officer would learn the array of activities queried to assess functionality.

The house officer, a snappy young man aspiring to be a cath jockey, joined me in the examining room with the patient. The patient had a serious, almost worried, expression but his fingers looked straight and fine. When we shook hands, his grip was firm. We chatted briefly and I then did my joint exam, my DAS almost the same as the house officer’s. I then explained the HAQ to the patient and the rationale for the questions.

“These questions tell us precisely about your function and, in that way, we can determine whether you need more treatment.”