Failure of physicians to recognize functional disability in ambulatory patients

Ann Intern Med. 1991 Mar 15;114(6):451-4. doi: 10.7326/0003-4819-114-6-451.


Objective: To assess the ability of internists to identify functional disabilities reported by their patients.

Design: Comparison of responses by physicians and a random sample of their patients to a 12-item questionnaire about physical and social function.

Setting: A hospital-based internal medicine group practice in Boston, Massachusetts, and selected office-based internal medicine practices in Los Angeles, California.

Subjects: Five staff physicians, three general internal medicine fellows, and 34 internal medicine residents in the hospital-based practice and 178 of their patients. Seventy-six physicians in the office-based practices and 230 of their patients.

Measurements and main results: Physicians underestimated or failed to recognize 66% of disabilities reported by patients. Patient-reported disabilities were underestimated or unrecognized more often in the hospital-based practice than in the office-based practices (75% compared with 60%, P less than 0.05). Physicians overstated functional impairment in 21% of paired responses in which patients reported no disability.

Conclusions: Physicians often underestimate or fail to recognize functional disabilities that are reported by their patients. They overstate functional impairment to a lesser degree. Because these discrepancies may adversely affect patient care and well-being, medical educators and clinicians should pay more attention to the assessment of patient function.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living*
  • Adult
  • Aged
  • Aged, 80 and over
  • Diagnostic Errors*
  • Disabled Persons*
  • Female
  • Humans
  • Internal Medicine*
  • Male
  • Middle Aged
  • Statistics as Topic
  • Surveys and Questionnaires