PRIMARY CARE DOCTORS OFTEN MISS CLUES TO EMOTIONAL DIFFICULTIES

Is yours overlooking significant symptoms?

This isn't an effort to belittle doctors. They practice the medicine they were taught. Unfortunately, few medical schools do a suitable job of alerting doctors to be on the lookout for psychiatric symptoms.

Attention to psychiatric symptoms is important these days because the primary-care doctor frequently determines what kind of specialists a patient can and will see.

Some months ago the Journal of the American Medical Association (JAMA) published a study that indicated one in five patients seen in primary-care settings exhibit the symptoms of a psychiatric disorder. That is 20%! According to JAMA, the correct diagnosis is missed half the time. Those figures indicate that one in every ten patients who sees a primary-care physician could benefit from -- but will not get -- professional mental health care.

For that reason, you, your family, and your loved ones may have to be aware of the possibility that one or more of you is suffering from psychological distress that is readily treatable. Yet that treatment may be inaccessible to you because your doctor is not aware of it.

Psychiatric symptoms are frequently overlooked because patients discuss their physical symptoms rather than their psychiatric symptoms. So there is a built-in basis for oversight, for underplaying the significance of psychiatric information, lack of communication about such matters and general confusion on the subject.

Furthermore, physical symptoms are often rather thoroughly intermingled with emotional disturbances so the oversight is understandable. The result, unfortunagely is that conditions such as depression, anxiety, panic disorder, substance abuse and unresolved bereavement, go unidentified and untreated.

This is not a trivial matter. Mental health difficulties have a higher impact than physical illness on those aspects of quality of life related to health. Emotional distress causes more difficulty than physical ailments such as diabetes, arthritis, heart disease, and even cancer. Depression and substance abuse result in more absenteeism than any other medical problems.

Emotional difficulties seriously diminish the quality of life. When psychiatric distress and physical ailments were compared regarding the total impact on the public by such problems as impairment of functioning, pain, difficulty engaging in common activities, and social interaction, emotional distress outweighed physical ailments. Although arthritis and cancer produce more intense pain, they occur in far fewer patients than mood disorders such as depression and anxiety.

Serious Implications in Today's Medical Environment

This issue is important because primary care doctors decide whether and when a patient should consult a specialist and what kind of specialist the patient should see. If a doctor does not ask questions that could disclose emotional problems such as depression, anxiety, substance abuse, or other psychiatric disorders, the patient is unlikely to receive proper treatment.

Which means that it is up to you to be aware of whether your doctor has made an acceptable evaluation. Asking the questions that lead to diagnosis of an underlying psychiatric problem takes something like ten to fifteen minutes. If your doctor overlooks the possibility that you may need psychiatric help, think seriously about finding another primary care physician.

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