The identity crisis of osteoarthritis in general practice: a qualitative study using video-stimulated recall

Purpose Patients and doctors report marked disenchantment with primary care consultation experiences relating to osteoarthritis. This study aimed to observe and analyse interactions between General Practitioners (GPs) and patients presenting with osteoarthritis (OA), in order to identify how to improve care for OA.

Methods An observational study was conducted in General Practices in the UK using video recorded real-life consultations of unselected patients and their GPs. Post-consultation interviews were conducted using video-stimulated recall, Both consultations and interviews analysed thematically.

Results Three key themes were identified in analysis of 19 OA consultations and the matched GP and patient interviews: complexity; dissonance and prioritisation. OA arises in the consultation in complex contexts of multimorbidity and multiple, often not explicit, patient agendas. Dissonance between patient and doctor was frequently observed and reported; this occurred when symptoms of OA were normalised as part of everyday life and when patients were reassured when not seeking reassurance. GPs used ‘wear and tear’ or no term in preference to ‘osteoarthritis’. GPs subconsciously made assumptions that patients did not prioritise OA and that symptoms raised late in the consultation were not troublesome.

Conclusions The lack of a clear illness profile results in confusion between patients and doctors about what OA is and its priority in the context of multimorbidity. This study highlights generic communication issues regarding negative consequences of reassurance and the importance of validation of symptoms and raises new arguments for tackling OA’s identity crisis by developing a clearer medical language with which to explain OA.