Patients With Greater Symptom Intensity and More Disability are More Likely to be Surprised by a Hand Surgeon’s Advice

Background A clash between a patient’s assumptions and a doctor’s advice can feel adversarial which might influence satisfaction ratings and compliance with treatment recommendations. A better understanding of sources of patients’ bewilderment might lead to improved strategies for conveying counterintuitive information that improve patient comfort and wellbeing. Questions/purposes This study addressed the following questions: (1) Are magnitude of disability, pain intensity, symptoms of depression, or health anxiety associated with a higher level of surprise when a patient is presented with diagnostic information and/or therapeutic recommendations? (2) Does the surgeon accurately perceive the patient’s bewilderment? (3) Does the surgeon’s perception of patient bewilderment correlate with diagnosis or a patient’s magnitude of disability, pain intensity, symptoms of depression, or health anxiety? Patients and Methods In this prospective cohort study, we invited new patients who met prespecified criteria during a 3-month period in one hand-surgery practice to enroll; of 93 patients invited, 84 (90%) agreed to participate. Patients reported demographics and completed the short versions of the DASH questionnaire ( Quick DASH), the Patient Health Questionnaire, the Pain Self-Efficacy Questionnaire, and the Short Health Anxiety Inventory; rated their pain intensity; and rated the degree to which the information given by the surgeon was unexpected or surprising on an 11-point ordinal scale. The surgeon also rated his impression of the patient’s surprise on an 11-point ordinal scale. Results Only greater symptom intensity and magnitude of disability ( Quick DASH) correlated with greater unexpected information when rated by the patient (ß = 0.058; p