PHYSICIAN JUDGMENTS OF CHRONIC PAIN PATIENTS

Recent evidence has indicated that physician judgments of patients can be influenced by contextual factors. This study examined three contex tual factors relevant to hypothetical patients with low back pain, usi ng vignettes that were varied in a 2 x 2 x 2 factorial design: level o f reported pain (high vs low), level of supporting medical evidence (h igh vs low), and the valence of the physician-patient interaction (pos itive vs negative). Perceived levels of pain, disability, emotional di stress, and somatic preoccupation were rated by internists after readi ng a vignette. Ratings of pain and disability were lower for patients without supporting medical evidence; ratings of distress, somatic preo ccupation, and disability were greater for patients who exhibited nega tive rather than positive affect; internist ratings of pain were lower than patient ratings among patients reporting high levels of pain, wh ile ratings were inflated for patients with low levels of pain. The re sults suggest that characteristics of both the patient and the situati on may influence medical judgments. (C) 1997 Elsevier Science Ltd.