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Release: March 13, 2000

UI study: Physical complaints of patients with psychiatric histories taken less seriously

IOWA CITY, Iowa — When patients have histories of psychiatric problems, doctors may be less likely to take the patients' physical complaints seriously, according to the results of a University of Iowa Health Care survey.

The UI investigators, using hypothetical scenarios, found that when family doctors knew that patients had histories of depression or psychosomatic complaints, the physicians were less likely to order diagnostic tests or believe that the patients had any serious physical problems. The UI findings appear in the March issue of the Journal of General Internal Medicine.

"It is unfortunate that we let other factors like psychiatric conditions cloud our judgment," said Mark Graber, M.D., UI associate professor of family medicine and surgery.

Graber, the lead investigator for the study, noted that falling prey to one's own biases is a human reaction and not just something that affects doctors.

Graber and his colleagues received 232 responses from the 300 surveys the investigators mailed to practicing family physicians in Iowa. Participants read two scenarios about patients with new, potentially serious complaints (severe headache and severe abdominal pain). These complaints are symptoms for serious, potentially fatal illnesses such as subarachnoid hemorrhage or aortic aneurysm.

One group of survey participants was given no additional past medical history; another group was told about a past history of depression; and a third group was made aware of the patient's history of somatic complaints for which physical causes could not be established.

The results were as follows:

Of the Group One participants, who did not receive a medical history, 94 percent were likely to order more tests for the hypothetical patient who complained of a headache, and 39 percent believed that the headache might be a symptom of a subarachnoid hemorrhage. Ninety percent were likely to order additional tests for the patient who had severe abdominal pain, with 46 percent believing the patient might have a serious problem.

Of the Group Two participants, who received a medical history with depression, 87 percent were likely to order more tests for the patient with a headache, and 30 percent thought that the patient might be at risk for a subarachnoid hemorrhage. Eighty-one percent were likely to perform more tests on the patient with abdominal pain, with 36 percent suspecting a serious problem.

Of the Group Three participants, who receive a medical history of somatic complaints, 80 percent would order more tests for the patient with a headache, with 21 percent believing a subarachnoid hemorrhage was possible. Seventy-two percent would perform more tests on the patients with abdominal pain, with 30 percent thinking that the patient might have a serious problem.

It should be noted that the headache scenario specified that the patient had not had similar complaints in the past.

"I hope this survey makes physicians aware of our own biases so that we can overcome them," Graber said.

University of Iowa Health Care describes the partnership between the UI College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.