The ability of trainee general practitioners to identify psychological distress among their patients

Abstract

SynopsisIt is argued that a general practitioner's ability to make accurate ratings of psychological distress is partly determined by the rate at which patients emit cues that are indicative of such distress. This study addresses the behaviours of doctors which influence the rates at which patients emit such cues. Consultations were videotaped involving six General Practice Vocational Trainees, three of them poor, and three of them able identifiers of emotional illness. Consultations were selected so that each trainee was rated interviewing 4 patients with low GHQ scores, and 4 patients with high scores. Behaviours are described which lead to increased cue emission and which are also practised more frequently by able identifiers, while other behaviours reduce cue emission and are practised less frequently by them. Another set of behaviours is no more frequent among the able identifiers, but when practised by able identifiers is associated with increased cue emission by the patients, and when practised by poor identifiers with unaltered or decreased cue emission. Interviews that are ‘patient-led’ are associated with increased rates of cue emission, while those that are ‘doctor-led’ are associated with lower rates. The implications of these findings for training doctors working in general medical settings are discussed.

Psychiatric morbidity and its recognition by doctors in patients with cancer

“…First any screening instrument by definition, will have imperfect sensitivity and specificity itself, although there have been at least 6 studies showing that both of these are very good for the GHQ. There is no true gold standard against which to assess the clinician's ability to detect psychiatric morbidity, but (Goldberg et al, 1993) provide an example of how the GHQ12 has been used successfully in studies aimed at helping general practitioners to identify distress in their patients. Similarly the GHQ28 was used to evaluate physicians' skills in reducing patients' distress in an RCT of a training intervention in the US (Roter et al, 1995).…”

“…This instrument has high internal reliability and validity and was designed specifically as a brief screening instrument in large population studies (Goldberg and Williams, 1988). A conventional scoring method was employed with a threshold of 4 or more indicating probable caseness for psychological morbidity.…”

“…Furthermore surveys in the UK and US have shown that psychiatric morbidity and emotional burnout are almost as common in oncologists as in the patients whom they treat (Whippen and Canellos, 1991;Ramirez et al, 1995). Approximately 29% of British oncologists had above threshold scores (Ramirez et al, 1996) on a psychiatric screening inventory (GHQ12) (Goldberg and Williams, 1988). The under-trained, over-stretched and underresourced doctor is unlikely to actively elicit information about the psychosocial impact that cancer and its treatment exerts on patients.…”

Tailoring communication in consultations with women from high risk breast cancer families

“…Specific strategies to explore emotionality may be required if consultants are to tailor their behaviour accordingly. (Goldberg et al, 1993;Maguire et al, 1996). Improving this aspect of consultants' behaviour may be important as it has been shown to have an impact on patient outcomes in medical consultations (Bertakis et al, 1991).…”

Nurse–patient communication in cancer care: does responding to patient's cues predict patient satisfaction with communication

“…For instance, Davenport et al [5] showed that doctors who are better able to detect psychiatric illness are more likely to allow patients to express verbal cues. Subsequent studies [18] '. A cue has been defined as: 'a hint, which might be an expression or signal, mostly verbal but also nonverbal, which indirectly indicates an issue of presumed importance for the patient and implies an emotion, worry or uncertainty that the patient would like to bring up, or a move to another topic, that should demand an exploration from the provider'.…”