For patients with diabetes, doctors have to address multiple complex conditions in a brief office visit. Most of these patients have around three to four other chronic conditions that may interfere with their self-management of the disease. These other conditions, commonly referred to as “co-morbidities,” include serious problems such as chronic pain and depression, and can be especially disruptive.

Therefore, it is very important that doctors and patients have a shared understanding of the various health conditions that affect patients dealing with diabetes. A new study suggests that while doctors and patients agree on the most important health conditions affecting patients with multiple co-morbidities, this agreement is lower for patients with poor health status or those with other non-health related competing demands.

The study asked 1,169 diabetic patients to rank their most important health concerns. It also asked their 92 primary care doctors to rank the most important conditions likely to affect that patient’s health outcomes. An agreement score was calculated to compare the patient’s priorities with that of their doctors.

In 72% of the patient-doctor pairs, the top health concern for the patient was also in his doctors’ list of three conditions likely to affect that patient’s health outcomes. More specifically, 16% of the pairs had three matching concerns, 55% had two, 25% had had one and only 4% had none.

While both patients and doctors ranked diabetes and hypertension most frequently, 38% of physicians ranked hypertension as one of their most important concerns for their diabetic patients, while only 18% of those patients ranked hypertension among their most important concern. The one concerning finding was that patients were more likely than providers to prioritize symptomatic conditions such as pain, depression, and breathing problems. Also, the patient-doctor agreement score was lower when a patient reported having poor health status or non-health competing demands.

According to lead author, Dr. Donna Zulman of the University of Michigan Medical School and the Ann Arbor Veterans Affairs, “if a patient and their doctor do not agree on which health problems should be prioritized, it will be more difficult for them to come up with an effective treatment plan together.” She adds that “we know from previous studies that conditions like pain can interfere with a person’s ability to manage his or her diabetes. […] So putting these types of symptomatic problems on the back-burner might lead to worse outcomes in diabetes and other chronic diseases.”