Reassuring patients about normal test results
BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39121.361910.80 (Published 15 February 2007) Cite this as: BMJ 2007;334:325
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We read with interest your leading article and would like to report
the result of a small study we conducted which highlight the effect of
the results of diagnostic tests on patients and the requesting physicians.
Background: The term Rheumatoid Factor (RF) implies a definite link
between its presence or absence in the blood of a patient, with the
presence or absence of rheumatoid arthritis (RA). It is difficult to find
another laboratory test that detects a factor, which bears the same name
as the disease itself.
Despite its poor performance as a diagnostic test in an unselected
population, some primary care physicians (PCP) use the test for RF to rule
in or rule out the diagnosis of RA.
Methods: Two questionnaires,containing closed questions with a choice
of options with some room for open comments (one for PCPs and one for
patients) were designed, piloted amd amended. Ethical committee approval
was obtained.
Results: Out of the 150 questionnaires sent out to PCPs, 107
completed questionnaires were returned.
Overall, the RF test was second only to the ESR as the test of choice in
investigating patients with joint pain.
56.2% said that changing the name of RF it would influence their
diagnosis of RA, 72.4% felt would make explaining the results of test
easier and 51.4 thought that changing the name would induce less anxiety
in patients
Patients fear and assume that they might have RA if they were told
that they have RF in their blood, the majority tended to agree.
Out 150 questionnaires sent to patients, 99 replies were received. Of
those who responded, 50 patients fully completed the questionnaire .
50 patients reported that they had a blood test for RF and all were
told the results. 23 patients said they were told that they had a positive
RF, 19 patients said they were told that negative result and 8 patients
did not know.
Of the patients who were told that had a positive test, 58.3% were
told that they their blood test showed some abnormalities. 25.8% said they
were told that they had rheumatoid in their blood and 32.1% said that they
were told that they had RA
Of the group of patients who had a negative test result, 93% (15/16
who responded to the question) assumed that they did not have RA because
of their negative test.
Of those with a positive test result, 70% (14/20 who responded to the
question) assumed that they have RA.
A significant number of responders, 85 %( 17/20) who were told that
they had positive RF felt anxious and concerned.
Conclusions: The name Rheumatoid Factor, alone, seems to convey many
incorrect messages to patients and PCPs. The name is scientifically
inaccurate and misleading. A suggesion could be to rename it after its
immunological nature i.e. the anti-IgG autoantibody.
There should better education and dissemination of information to
patients and PCPs. leaflets on RA should emphasis that there is no single
test to diagnose or exclude RA.There is effective suppressive therapy and
the disease does not inevitably lead to wheelchair existence, some
patients fear.
A protocol for PCPs explaining guidelines on what laboratory tests to
use in investigating patients presenting with joint pain is recommended.
Competing interests:
None declared
Competing interests: No competing interests
Communication with patients and Good Medical Practise
Reassuring patients of a normal results forms a part of good doctor-
patient communication and partnership as described in GOOD MEDICAL
PRACTISE(2006) quote-
"share with patients, in a way they can understand, the information they
want or need to know about their condition, its likely progression, and
the treatment options available to them, including associated risks and
uncertainties
respond to patients’ questions and keep them informed about the progress
of their care" and doctor-patient
partership quote-
"To fulfil your role in the doctor-patient partnership you must:
be polite, considerate and honest
treat patients with dignity
treat each patient as an individual
respect patients’ privacy and right to confidentiality
support patients in caring for themselves to improve and maintain their
health
encourage patients who have knowledge about their condition to use this
when they are making decisions about their care"
Strict adherence to good medical practise will guide doctors to build a
good relationship with patient and the best outcome in patient's interest
can be acheived effectively.
Competing interests:
None declared
Competing interests: No competing interests