BACKGROUND: The process of giving a patient a diagnosis may cause harm. The adverse effects of labeling, best documented for the diagnosis of hypertension, include increased absenteeism from work and lower earnings, increased depressive symptoms, and reduced quality of life. We tried to determine whether the diagnosis of hypertension affects perceptions about the time required to recover from common acute medical problems.
METHODS: In an academic family practice clinic, equal numbers of patients with and without hypertension were asked to estimate how long it would take them to recover from an upper respiratory tract infection (URI), a urinary tract infection (UTI), and an ankle sprain now and 5 years ago (before the diagnosis of hypertension).
RESULTS: Compared with patients who did not have hypertension, patients with hypertension estimated that it would take them twice as long, on average, to recover from a URI now (11.7 vs 6.0 days, P=.002) and in the past (10 vs 5.5 days, P=.02). These differences persisted after controlling for age, sex, race, and education. No significant differences were found for estimated recovery times for UTI or ankle sprain.
CONCLUSIONS: The diagnosis of hypertension may affect patients’ perceptions of their ability to recover from unrelated acute illnesses. This may have implications for the way physicians choose to present information to patients.
Since the early 1970s, concerns have been raised about the adverse consequences associated with diagnostic labeling. Some of the earliest research examined parental responses to childhood cardiac diagnoses and misdiagnoses.1,2 Subsequent studies extended those findings to the results of newborn screening tests,3,4 preschool developmental screening,5 and sickle cell disease screening.6 The greatest body of published research in this regard involves the diagnosis of hypertension. Haynes and colleagues7 first observed that Canadian steel mill workers found to have hypertension through workplace screening had increased absenteeism from work that persisted for at least 4 years, and Johnston and coworkers8 found that this diagnosis was associated with lower mean annual incomes at 5 years postscreen. Subsequently, researchers have consistently found some patients, after being told that their blood pressures are too high, perceive their overall health to be worse and report more depressive symptoms and lower quality of life.9 In 1 study, even close relatives of patients with hypertension seemed to be adversely affected.10
To our knowledge, no one has looked at the effect of the diagnosis of hypertension on patients’ perceptions of their ability to recover from completely unrelated illnesses, such as infections and injuries. Such information may be important, particularly if labeling may affect health care utilization.
Methods
We recruited 22 patients waiting to see family practice residents and faculty in a family medicine clinic at an academic medical center during the summer of 1995. To participate, patients had to be aged 21 years or older and not mentally retarded, severely depressed, schizophrenic, demented, or acutely ill. We constructed the sample to include 11 patients with diagnosed hypertension within the past 5 years and 11 with no diagnosis of hypertension.
After signing informed consent, each participant was asked questions designed to elicit demographic information, recent experience with upper respiratory tract infection (URI), urinary tract infection (UTI), and ankle sprain; self-rated overall health using a single COOP chart; and estimates of how long it would take for them to recover from a URI, a UTI, and an ankle sprain now and 5 years ago. These conditions were chosen because they have no known pathophysiologic relationship to hypertension and represent 3 different kinds of acute illness: a self-limited viral infection, a bacterial infection that is usually treated with antibiotics, and an acute musculoskeletal injury. Medical records were reviewed for possible confounders, such as cigarette smoking, chronic lung disease, asthma, allergic rhinitis, diabetes, congestive heart failure, and payer source.
We entered the data into a standard statistical software program (Statistix, Analytical Software, Tallahassee, Fla) and used the chi-square test to make comparisons between the hypertensive and nonhypertensive groups with respect to age, sex, race, marital status, educational attainment, and self-rated health. Mean estimated times required to recover from each of the 3 acute conditions, both current and past, were compared using Student t tests.
We considered 6 separate linear regression models with estimated time to resolution for each of the 3 conditions at present and in the past as the dependent variables. Age, sex, race, education, and diagnosis group were initially entered into each model and removed 1 at a time until the best model was obtained in each case. We defined the best model as the one associated with an overall P value <.05 that maximized R2 while minimizing the number of variables with individual P values >.05.