4-1 GENERAL PRACTITIONERS’ KNOWLEDGE OF THEIR PATIENTS’ PSYCHOSOCIAL PROBLEMS
One aspect of a lasting relationship between general practitioners and their patients is an accumulated knowledge of patients’ psychosocial problems. There is a positive correlation between the duration of the doctor-patient relationship and the level of doctors’ awareness.
This study evaluated general practitioners’ knowledge of a range of patients’ psychosocial problems.
Conclusion: A minority of physicians were aware of patients’ psychosocial problems.

STUDY

1. Questionnaires surveyed consecutive adult patients (n =1400) attending 89 general practices during one working day. A pilot study had indicated that patients experience an average of two problems. Many had one problem which affected their health on a given day.
2. Doctors and patients answered similar written questions mapping exposure to nine indicator psychosocial problems: sorrow; demanding care-giving; violence; family substance abuse; family conflict; loneliness; family disruption; unemployment; job strain.

RESULTS

1. Four of 5 patients answered affirmatives to at least one of the nine questions. One third reported at least one problem affected their present health.
2. Stressful working conditions and sorrow were the most common problems.
3. Doctors’ knowledge of the problems ranged from about 50% awareness of stressful working conditions to about 20% for history of violence or threats.
4. Female and older doctors were more often aware of patients’ problems.

DISCUSSION

1. The study tried to ensure clinical relevance by restricting analysis to the problems that patients assessed as affecting their present health.
2. Patients might avoid discussing such problems because they do not expect the doctor to be able to help them, because they fear being invaded by emotionally disturbing questions, or because they are already reconciled to their situation.
3. Awareness of psychosocial problems can sometimes explain symptoms and prevent unnecessary diagnostic procedures.
4. An interesting finding—although conjugal violence mainly affects women, the proportion of men affected is not negligible.
5. The study found that doctors’ recognition of problems was strongly and significantly affected by patients’ sociodemographic characteristics: age; sex; educational level; or living alone. Doctors were more aware of sorrow among those patients with little education and more aware of difficult conflicts among those at higher educational levels.

CONCLUSION
Patients’ psychosocial problems are abundant and have an adverse effect on their health. A minority of physicians were aware of patients’ psychosocial problems.
BMJ April 5, 1997; 314: 1014-18 Original investigation from Institute of General Practice and Community Medicine, Oslo, Norway

Comment:
Getting to know the patient as a person with psychosocial problems is one of the great privileges and challenges of primary care. RTJ

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