Doctor-patient concordance and patient initiative during episodes of low back pain

Doctor-patient concordance and patient initiative were examined in a prospe ctive network interview study, with telephone follow-up, of a cohort of 100 patients presenting with low back pain to their family physician. The aver age overall rate of concordance was 60% (95% CI = 53 to 66), with the highe st rates for radiographic imaging studies and sick leave. No correlation wa s found between concordance and patient parameters. Subjects initiated an a verage of two (95% CI = 1.7 to 2.3) diagnostic or therapeutic procedures, t he most common of which were for medications (40%), followed by bed rest (2 6%) and back school (22%). One out of every six subjects initiated a referr al to a complementary therapist. Positive correlation was found between pat ient initiatives and pain severity (P = 0.022) and disability (P = 0.02). T here was a negative correlation between the subjects' initiatives and their belief that the physician understood the cause of their pain and its influ ence on their life (P = 0.02). Overall, those patients who described more p ain or disability sought more types of diagnostic and therapeutic measures, while those who felt they had been understood sought less.