Internist judgments of chronic low back pain

Objective. To examine the consistency of internist judgments about low back pain; to examine the influence of different clinical factors on those judgments. Design. 2 x 4 mixed between- and within-subjects analog experiment. Setting. Academic health sciences center, school of medicine; department of internal medicine. Participants. Forty-eight internal medicine physicians. Interventions. Vignettes describing hypothetical chronic low back pain patient varied by patient pain level (low versus high) and clinical information type (history versus physical examination versus functional disability versus medical diagnostics). Outcome Measures. Clinical judgments regarding patient medical, psychological, and disability status; referral, treatment, and test ordering options. Results. Within-physician consistency was very high, while between-physician consistency was very low. Medical diagnostics had the only consistent influence on judgments. Patient pain level had no effect. Physical examination and functional information had little or no effect. Conclusions. While there is little agreement among internists regarding judgments of low back pain, individual physicians hold consistently to their opinions. These findings suggest that management of low back pain may be idiosyncratic, potentially compromising patient care.