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Primary care patients often fail to disclose symptoms like anxiety, depression, fatigue, and sexual or relationship problems
Clinical Question
How often do patients fail to disclose their symptoms during a visit to their primary care physician?
Bottom line
Patients often fail to disclose symptoms, including some they may consider to be sensitive, such as anxiety, depression, and sexual or interpersonal problems. It is important that, as primary care physicians, we remain aware of this, look for cues, and make sure patients know that they have permission and a safe space to discuss these issues with us. 3b
Reference
Study design: Cross-sectional
Funding: Government
Setting: Outpatient (primary care)
Synopsis
These researchers approached 252 adults scheduled to visit 1 of 15 English general practitioners (GPs) and asked for permission to videotape the encounter. Ultimately, 190 agreed and were videotaped. Each patient was interviewed before the visit and asked about the main reason for their visit, the presence of any of 11 groups of symptoms in a checklist, and whether they planned to address the symptom with their physician. Symptoms present in at least half included joint pain, back or neck ache, tiredness or a sleep problem, and cough/cold/breathing difficulty. Of the 188 patients who identified a main reason for the consultation, 185 discussed it with their physician. However, among the 139 patients who identified an intention to discuss at least one symptom from the checklist, 43 patients failed to disclose 67 symptoms to their physician during the visit. Symptoms that patients identified on the checklist but most often indicated they did not want to talk to their physician about included stress; worries or sadness; tiredness or sleep problems; problems passing urine; headache; and intimate or personal problems. Among those who expressed an intention to discuss the problem with their physician, they most often did not follow through with a mention of tiredness or sleep problems and intimate or personal problems. The fact that patients and GPs knew that they were part of a study on patient-physician communication means that, if anything, the findings may understate the problem in the real world.
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA
Comments
Impact of study conditions on outcome
I agree with the reviewer that the fact that patients & GPs knew that they were part of a study on patient-physician communication could impact on the results. However, while it was suggested that this might contribute to understatement of the problem (presumably due to doctors / patients being more attentive to their communication with each other than under usual conditions), I could also imagine that knowing one is being videotaped during one's physician visit might add to self-consciousness about discussing more sensitive / intimate issues.
Presence vs. Pad
While I agree that knowing you’re in a study could contribute to patients hesitancy to share more sensitive issues, e.g., sexual, mental health, I don’t think this is the main reason why they feel guarded. It is a sign of the times and how we practice time-based medicine using algorithms and protocols that take away from the art of medicine, the subtle and invisible skill of building rapport & trust with our patients. Who would want to share their most sensitive issues with a hurried physician that is just going to prescribe a medication because they don’t have the time to really listen and come to a plan based on principles of patient centred care. And who can blame physicians given the time pressures of the system! If it was me I would go see a counsellor, psychologist or talk with a trusted friend before telling my physician. Hopefully, we will take these results and reflect on what we can do to facilitate a safe environment where these types of conversations can blossom and take back our role as a trusted care provider that can heal with our presence not just our pad.