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31-07-2011 | General practice | Article

Physicians, patients disagree on oral mucosal disease severity


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MedWire News: Patients with oral mucosal conditions and their physicians often do not agree on the severity of symptoms, research shows.

There was low agreement on disease severity regardless of whether both symptoms and clinical signs were present, report Francesca Sampogna (Malmö University, Sweden) and colleagues in the Journal of the American Academy of Dermatology.

For patients with dermatologic conditions, the lowest satisfaction with care is often in patients who rate their quality of life worse than the severity of disease assessed by the physician.

To assess the amount of agreement in symptom assessment between patients and healthcare providers, 206 patients were recruited from an oral healthcare unit. The severity of the oral mucosal conditions was evaluated by the physician and patients using a global severity assessment scale.

Concordance between physician and patient assessment of symptoms ranged from 42% to 57%.

Overall, 14% of patients considered to have mild or very mild symptoms by their physician self-reported their condition as severe or very severe. By contrast, physicians rated their patient's condition as severe or very severe in 30% of patients who considered their symptoms mild or very mild.

The agreement was highest for patients with symptoms and clinical evidence of disease, while symptom severity was misjudged most frequently by physicians treating patients who did not have both clinical evidence and symptoms.

Physicians were more likely to underestimate the severity of symptoms in patients with alexithymia, a difficulty in identifying and expressing feelings that is associated with higher rates of depression, than in patients without this condition (43% vs 25%). Psychological disorders were also associated with an increased risk for underestimating disease impact (44% vs 25%).

Physicians also underestimated disease severity in individuals with aphthous stomatitis, burning mouth syndrome, and bacterial or fungal diseases, but overestimated disease severity in patients with pemphigus.

"These results suggest that the concept of 'disease severity' is different from the point of view of patients and of physicians," write the researchers.

They add that the overall burden of disease, including symptomatic, psychologic, and social aspects of disease, influenced the patients' perception of their condition.

As a result, patients' severity of disease is interpreted by wider measures than the physician, suggest Sampogna and colleagues.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By MedWire Reporters

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