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Physicians can be more responsive to patients' concerns without lengthening visits

Few studies have examined how physicians address patients' concerns, which patients hint at in small comments during their visits. In fact, patients typically provide two to three emotional clues to their doctors regarding anxiety about their medical condition or psychological or social concerns during a medical or surgical visit.

Physicians often miss these opportunities to adequately acknowledge patients' feelings. Yet 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. Thus, these physicians can better respond to patient concerns even in the context of their busy clinical practices, conclude Wendy Levinson, M.D., and her University of Chicago colleagues. The study was supported in part by the Agency for Healthcare Research and Quality (HS07289).

The researchers analyzed audiotapes of 116 randomly selected routine office visits to 54 primary care doctors and 62 surgeons in community-based practices in two States in 1994. They examined the frequency, nature (emotional vs. social), and content of patient clues during visits and physician responses to clues (positive or missed opportunity). They found that patients gave their doctors one or more clues during half of the primary care (52 percent) and surgery (53 percent) visits, with a mean of 2.6 clues per visit in primary care and 1.9 in surgery.

Three-fourths of patient-initiated clues in primary care settings were chiefly related to psychological or social concerns (80 percent) in their lives, such as aging, loss of a family member, and major life changes. Sixty percent of clues in surgical settings were also emotional in nature, with most (70 percent) related to patients' anxieties about their medical condition. Physicians responded positively to patient emotions in only 38 percent of cases in surgery and 21 percent in primary care. More frequently, they missed opportunities to adequately acknowledge patients' feelings. This is significant because many studies suggest outcomes are better when doctors address patients' emotional concerns as well as their medical problems.

Details are in "A study of patient clues and physician responses in primary care and surgical settings," by Dr. Levinson, Rita Gorawara-Bhat, Ph.D., and Jennifer Lamb, B.S., in the August 23, 2000, Journal of the American Medical Association 284(8), pp. 1021-1027.

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