Reports from the Field
Primary Care
Docs don’t need more time, just awareness of patient clues’
Patients often provide two or three emotional clues during their physician visits regarding anxiety about their medical condition or psychological or social concerns that too often physicians miss. A recent study of primary care physicians and surgeons shows that when doctors do respond to their patients’ concerns, visits tend to be shorter, not longer. In other words, physicians can better respond to patient concerns even in the context of busy clinical practices.
Researchers analyzed audiotapes of 116 randomly selected routine office visits to 54 primary care physicians and 62 surgeons in community-based practices in 1994. They examined the frequency, nature, and content of patient clues during visits and physician responses to clues. They found that patients gave their doctors one or more clues during 52% of the primary care visits and 53% of the surgery visits, with a mean of 2.6 clues per visit in primary care and 1.9 in surgery.
Roughly 80% of the patient-initiated clues in primary care settings were related to psychological or social concerns in their lives, including aging, loss of a family member, and major life changes. More than half of the clues in surgical settings were also emotional in nature, with 70% related to patients’ anxiety about their medical condition.
Researchers found that physicians responded positively to patient emotions in only 38% of cases in surgical settings and 21% in primary care. More frequently, physicians missed opportunities to adequately address patients’ feelings. This is significant, they note, because many clinical studies suggest outcomes are better when physicians address patients’ emotional concerns as well as their medical problems.
[See: Levinson W, Gorawara-Bhat R, Lamb J. A study of patient clues and physician responses in primary care and surgical settings. JAMA 2000; 284(8):1021-1027.]
PCPs don’t take sleep seriously enough
Most primary care physicians don’t ask patients questions about their sleep patterns even though lack of sleep is an important factor in many health problems, according to a recent survey from the National Sleep Foundation (NSF) in Washington, DC.
"The paradox happening in doctors’ offices can be dangerous to patients’ health," says Richard L. Gelula, executive director of the NSF. "While our survey finds that primary care physicians believe that sleep is important to personal health and should be an essential part of a regular checkup, they do not feel they can take the time to discuss it."
The telephone survey of 300 primary care physicians was conducted May 15 through July 7, 2000. Findings include:
- Nearly 70% of primary care physicians said they should raise issues about sleep with their patients.
- Roughly 80% said they are not as knowledgeable about sleep problems as they should be.
- More than 80% said availability of effective treatments and simple diagnostic tools would encourage them to prioritize sleep issues with their patients.
- More than 95% said the discussion is only likely to occur if the patient initiates it.
- Roughly 70% said discussing sleep issues takes time away from other medical problems.
Gelula speculates that physicians may be waiting for their patients to address sleep problems because they think the problems are less prevalent than American consumers report. Physicians said about 16% of their patients suffer from sleep disorders and 14% suffer from insomnia. However, the NSF 2000 Sleep In America poll found that 62% of adults surveyed experienced a sleep problem at least several times a week in the past year, and 58% reported symptoms of insomnia.
The NSF has prepared a simple guide, "Sleep Talk with Your Physician," to make it easier for patients to initiate sleep discussions with their primary care physicians. The guide is available on the NSF web site at www.sleepfoundation.org.
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