Treat the Person or Treat the Paper ? Or, better stated, my love/hate relationship with the Health Assessment Questionnaire (HAQ).
During my last appointment I left wondering who is being treated – me or the HAQ. I realize this is a tool used by many physicians to obtain valuable information from patients. However, I wonder if this form sometimes becomes more the focus of the appointment than I am. Here are a few of my concerns …
Do physicians ever discuss this form with patients? I have been to two rheumatologists. Neither has ever said anything to me about the form, its importance or how it is used in their diagnosis and treatment of a patient.
My first doctor never touched the form. He was always more focused on seeing and thoroughly evaluating the joints along with open dialogue regarding symptoms. My current doctor reviews the HAQ first and then does a quick evaluation of joints. I believe what happens in the exam room is totally based on responses in the HAQ. This is based on my experience during appointments.
Definitions based on ‘whatever it means to you’ do not give a clear understanding of the patient. A few months ago I asked my doctor to define the word “pain” used on the HAQ. His response – “it’s whatever you think it is.” What I discovered is that is the actual direction given with this form – the patient should respond “using their own frame of reference” and “whatever it means to them”.
I have a concern with definitions. Take pain for example. My battle is not so much with pain, but a list of other symptoms. However, if I define pain only as “ouch, I hurt incredibly bad”, then ratings on the form would be lower. Unfortunately, that does not give an accurate assessment of how I’m doing overall because it does not acknowledge all those other symptoms. A low number in the rating and doc thinks I am “OK”, but is that accurate?
What about all the information that is not collected on the form? For example, does a patient use devices or aids to do routine tasks. I can answer a question about walking a distance, but if it does not allow me to say I use a cane when I do this, how is that helpful? The questions on this form simply do not collect enough information to make an complete assessment beneficial to the patient.
What about that long list of ‘other symptoms’ on the form? I admit I have become indifferent about this information because it has never been mentioned or discussed during my appointment. It leaves me feeling it is not relevant.
During that difficult last appointment the only comment the doctor made after viewing the HAQ was ‘so, you have no pain’ followed by a very quick check of some joints. I really have no idea how he could possibly detect anything with my hips, knees, ankles or feet as there was not even a full movement of the joint and he looked at nothing but my hands. I suppose he didn’t notice me hobbling out of the office.
That gets us to the recurring importance of patient involvement. It is not only about filling out a form and getting the patient’s perspective of their symptoms. Discussion during the exam is also critical. Perhaps patients should also be involved in the development of a form since they add a real-life perspective that doctors do not experience. These forms represent only a portion of the information a doctor should be evaluating. Input direct from the patient is critical, but only if that information is unrestricted.
Do you complete a health assessment questionnaire at your appointments? Is it discussed with your doctor? Share your experience and your thoughts.
Don’t forget – February 2 is Rheumatoid Awareness Day !
For details – rheum4us.org