Detection of psychologic complaints by general practitioners

Abstract

Many complaints, which present as somatic illness at a medical visit, appear afterwards to be partly psychologic in origin. Not every general practitioner (GP), however, is equally sensitive to the psychologic aspects, and not every physician possesses the communication techniques required to detect them. In this respect, it has been considered important that a GP show attention, interest and concern; have a patient-centered attitude; clarify complaints; structure the interview; and have an active, seeking attitude. In this research project the effects of these factors on a patient's presentation of personal problems were investigated; the relationship between the GP's way of communicating and his or her sensitivity to the psychologic aspects of complaints was examined. It appeared that the features of physician-patient interaction, mentioned above are complementary; it was possible to identify one conversational style, expressed by a factor score, based on measurements of the several distinct features. This conversational style appeared to be a good predictor of a physician's initiatives in asking for a patient's problems, but a negative predictor of a patient's initiatives in presenting them. Hence, when a physician communicated in an open, patient-centered way, the patient did not need to take those initiatives; if the patient did so, it was in most cases a sign of the physician's unresponsive attitude. The open conversational style of the physician was related to his sensitivity to the psychologic aspects of complaints. The consequences of these findings for vocational and postgraduate training are discussed.