Rheumatological medicine literacy among Middle Eastern populations

Abstract

Background: It has been observed for years that many Middle Eastern patients with autoimmune rheumatic disorders, are more likely to be delayed in seeing a rheumatologist for their symptoms and that the rheumatology services are in general under-utilized by the population.

Aim: To explore if patients with autoimmune rheumatic disorders were truly delayed in seeing rheumatologists and to explore the possible reasons for that delay should any delay be documented.

Subjects and methods: Patients suffering from chronic autoimmune rheumatic disorders were interviewed and were asked to answer a questionnaire that assesses their initial set of actions when they had their first symptoms of disease, how much time they took to see a rheumatologist and their background knowledge about rheumatology as a specialty before and after they saw a rheumatologist.

Results: Seventy-eight patients, 57 (73%) females and 21 (27%) males were included in this study. Their ages ranged from 11 to 72 years with a mean of 38.9 +/- 13 years. Patients' explanations for their initial symptoms were 'evil eye doing', disease, exertion, cold weather and trauma in 44%, 37%, 20%, 16% and 8% respectively. Ninety-six percent of patients had to make a total of 166 consultations first at other specialties before they were finally advised or directed to see a rheumatologist. Non-rheumatologist referrals to rheumatologists happened in only 33% of the time. The duration from the onset of the disease until patients finally came to see a rheumatologist ranged from 0.5 weeks to 432 weeks with a mean of 51 +/- 88 weeks.

Conclusions: General health literacy and knowledge of the rheumatology scope of service is extremely limited among Middle Eastern patients. Most patients with autoimmune rheumatic diseases make their initial consultations at clinics other than rheumatology clinics and non-rheumatologists have been shown to consistently not refer patients with rheumatic diseases to rheumatologists. Wrong diagnosis is attributed to rheumatology symptoms by non-rheumatologists 82% of the time. Level of education of patients, has no impact on their choice of the right specialty to be consulted for their disease symptoms.