CONTACT: JENNIFER CRONIN
2130 Medical Laboratories
Iowa City IA 52242
(319) 335-9917; fax(319) 335-8034
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.