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Many Doctors Miss Patients' Emotional Clues

Reuters Health - 8/23/2000

NEW YORK -- A growing body of research shows that patients benefit when their doctors address their emotional concerns as well as their medical woes.

But doctors often miss the chance to respond or empathize with patients, researchers report. And when they do pick up on subtle clues about a patient's emotional state, many physicians fail to explore the feelings behind them, according to a report published in The Journal of the American Medical Association for Aug. 23/30.

"In both primary care and surgery, physicians tend to bypass these clues, missing potential opportunities to strengthen the patient-physician relationship," write Dr. Wendy Levinson and colleagues from the University of Chicago.

The researchers taped 116 patient visits to primary care physicians and surgeons. Transcripts of the sessions revealed that about half of visits contained clues about how the patient felt, and the majority of clues (70 percent) were initiated by the patient.

The investigators found that, based on the tapes, doctors responded positively to patients' clues in only 38 percent of surgical cases and 21 percent of primary care cases. Most clues -- 76 percent in primary care settings and 60 percent in surgical settings -- were emotional in nature. In surgery, 70 percent of emotional clues related to how patients felt about their condition, while in the primary care setting, the majority of emotional clues related to psychological or social concerns.

Clues were usually part of a discussion about health problems. For example, a patient might hint at a stressful situation in the context of a discussion about high blood pressure.

"Since these clues are hidden in the fabric of discussion about medical problems, physicians who are busy attending to the biomedical details of diagnosis and management may easily miss them," the authors explain.

This may be particularly harmful when the patient is depressed and indirectly asking for the physician's help, the report indicates.

"Physician recognition of these 'cries for help' is critical since these clues may provide the sole opportunity to help patients seek appropriate care," Levinson and colleagues conclude.

SOURCE: The Journal of the American Medical Association 2000;284:1021-1027.

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