Table 4 Physician characteristics that may reduce diagnostic delay for patients with axSpA

Establish trust and good rapport with patients

D23: I think also if a patient actually establishes rapport with the doctor and there’s a good doctor-patient relationship and they are familiar with each other, if something like this does crop up, it is out of the ordinary based on what the doctor knows of the patient.

D23: I think what it really comes down to just trust and open relationship with the doctor and the patient.

D31: Some of my colleagues don’t listen well enough to patients and they miss things. Actively listening to the patient is going to be the most important thing I think any physician -- most important skill that I think any physician can possess, actively listening. Talking less and listening more. Because I always learned when I was a medical student that, you know, your patient is going to give you the diagnosis, all you have to do is listen.

Setting appropriate expectations

D3: But if its somebody who is coming in who has had chronic back pain, has had a lot of work up, has had good intervention, then I think that’s somebody where I’m starting to turn on my radar and thinking, “Okay, is there something else that I’m missing here that’s not just your run in the mill.

D27: I would be seeing them in follow up and noticing that they didn’t resolve typically, and I would probably be -- in my next exam be doing a review of systems again to find those other systems that were involved.

Some physicians attribute back pain to other factors

D10: It’s certainly not on the top three things I think of when somebody comes in and says my back hurts. … I’m not sure if I’m just missing it because I’m not looking for it or is it just relatively rare.

D24: they’re saying well, yeah, but I was in a car accident when I was 18 and I rolled the car and, you know, so my back has been hurting me off and on since I was then -- you know, now that I’m, you know, 35 and I’ve put on some weight and I don’t exercise anymore, my back is hurting.