Patient-practitioner perceptions: Can chiropractors assume congruence?

Abstract

Background: Advances in mind-body medicine have resulted in the realization that beliefs can modulate pathophysiologic processes. Because symbolic interaction affects health status, perceptions and the congruence between the perceptions of chiropractors and their patients become a relevant clinical consideration. Objective: A case study to explore the congruence of health-relevant perceptions of chiropractors and their patients was undertaken. Method: This Australian case study was undertaken to explore the concurrence of patient-practitioner perceptions with respect to the patient's stress levels, the importance of injury as a causative factor in the presenting symptom and the responsibility the patient should take “in getting themselves well.” Purposive sampling of practitioners and convenience sampling of patients was undertaken. Data were collected by means of a patient questionnaire and a practitioner questionnaire and interview. Data were analyzed to determine the congruence of patient-practitioner perceptions within each of 173 consultations. Results: A total of 9 practitioners and 173 patients participated. Within each patient-practitioner dyad, congruence of perceptions was <50% in each of 3 dimensions examined. Most patients believed they should take a high level of responsibility for “getting well.” Discussion: Although the results of a case study cannot be extrapolated to the chiropractic patient population, this study does suggest that it may be prudent for chiropractors to ascertain the extent to which their patients share their perceptions of the presenting clinical problem. “Thinking hats” are proposed as a helpful perception management tool. Conclusion: This exploratory study suggests that practitioners should not assume that their patients share their perceptions. Given that each patient-practitioner encounter is unique, it may be prudent for chiropractors to actively ascertain the patient's opinions. A patient's perception of his or her responsibility for “getting well” should be harnessed in developing management plans with high compliance. (J Manipulative Physiol Ther 2000;23:409–13)