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Clinical Decisionmaking

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Physicians exhibit certain practice behaviors when treating patients who are in pain

Patient pain appears to substantially alter a primary care doctors' practice behaviors during the medical visit. With these patients, primary care doctors tend to focus on technical tasks, such as taking the medical history, performing a physical exam or procedures, and discussing diagnostic and therapeutic strategies. They devote less visit time to disease prevention and other activities designed to encourage the patients' active participation in their own health care, according to a study supported by the Agency for Healthcare Research and Quality (HS06167).

As part of a larger study examining physician practice styles and associated patient outcomes, Klea D. Bertakis, M.D., M.P.H., of the University of California, Davis, and her colleagues randomized 509 new adult patients at a university medical center to see primary care physicians. Before the videotaped visits, the researchers measured self-reported patient pain with the Visual Analog Pain Scale (0 for no pain to 70 and higher for high pain) and the pain scale of the Medical Outcomes Study Short Form-36 (MOS SF-36), and they obtained sociodemographic information from the patients. The researchers did not provide this information to the physicians. Observers recorded the occurrence of each of six physician practice behaviors during the medical visit: technical, health behavior, addiction, patient activation, preventive services, and counseling.

Physicians spent nearly 3 percent more of the visit (compared with an average visit) on the technical aspects of medical care for patients in high pain, after controlling for sociodemographic factors that can influence physician practice behavior, such as age and race. Similarly, physicians spent about 0.5 percent less than the time spent in an average visit on patient activation and preventive services. In contrast, in medical encounters with patients having little or no pain, physicians spent 3 percent less time on technical behaviors than the average visit and nearly 1 percent more than the average time on patient activation and preventive services.

See "Patient pain: Its influence on primary care physician-patient interaction," by Dr. Bertakis, Rahman Azari, Ph.D., and Edward J. Callahan, Ph.D., in the February 2003 Family Medicine 35(2), pp. 119-123.

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