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Physical Complaints of Patients with Psychiatric Histories Taken Less Seriously.

When patients have histories of psychiatric problems, physicians may be less likely to take their physical complaints seriously, according to the results of a University of Iowa, Ames, survey. Using hypothetical scenarios, researchers 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.

"It is unfortunate that we let other factors like psychiatric conditions cloud our judgment," says Mark Graber, associate professor of family medicine and surgery, the lead investigator for the study, noting that falling prey to one's own biases is a human reaction and not just something that affects doctors. He and his colleagues mailed surveys to 300 practicing family physicians. 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 hemmorhage or aortic aneurysm. One group of doctors was given no additional past medical history; another was told about a past history of depression; and a third was made aware of the patient's history of somatic complaints for which physical causes could not be established

Of the group-one physicians who did not receive a medical history, 94% were likely to order more tests for the hypothetical patient who complained of a headache, and 39% believed that the headache might be a symptom of a subarachnoid hemorrhage, Ninety percent were likely to order additional tests for individuals who had severe abdominal pain, with 46% believing there might be a serious condition.

Those in group two who received a medical history with depression, 87% were likely to order more tests for the person with a headache, and 30% thought that the patient might be at risk for a subarachnoid hemorrhage. Eighty-one percent were likely to perform more tests on the individual with abdominal pain, with 36% suspecting a serious problem.

Of the group-three participants who received a medical history of somatic complaints, 80% would order more tests for the patient with a headache, with 21% believing a subarachnoid hemmorhage was possible. Seventy-two percent would perform more tests on the individuals with abdominal pain, with 30% 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 states.
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Publication:USA Today (Magazine)
Article Type:Brief Article
Date:Nov 1, 2000

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