Physicians may treat patients with a history of psychiatric illness differently than patients who do not have such a history, suggest the results of a survey of family physicians in Iowa.
Study authors Mark A. Graber, MD, and colleagues at the University of Iowa, in Iowa City, distributed a questionnaire to 232 physicians to determine their probable responses to varying patient scenarios.
All of the patients in the scenarios complained either of a severe headache or abdominal pain. Both symptoms can indicate potentially fatal illnesses. For example, severe headache can be caused by a subarachnoid hemorrhage, which is bleeding in the space between the brain and the membrane covering it. Acute abdominal pain can stem from an aortic aneurysm, an abnormal widening of the abdominal portion of the major artery from the heart.
Graber and colleagues found that survey respondents were less likely to consider the possibility of a serious illness, and were therefore less likely to order testing, for those patients with a prior history of depression or of somatic complaints. Somatic complaints are physical ailments like eating or sleeping disturbances that sometimes accompany depression. The study findings are published in the March 2000 issue of the Journal of General Internal Medicine.
These results are not a sign of physician bias toward individuals with psychiatric histories, according to the researchers. Rather, the findings suggest that survey participants were probably using "cognitive shortcuts" to determine disease probability, in this case by taking previous medical history into account.
Use of such shortcuts can be helpful and relevant in some cases. For example, if both a 19-year-old and a 65-year-old have symptoms of colon cancer, it makes sense for physicians to decide -- based on the known relationship between age and colon cancer -- that the probability of colon cancer is much lower in the 19-year-old, noted Graber and colleagues.
But reliance on such shortcuts can mislead physicians into making false generalizations. "In this study it was specified in the case of the headache that the patient had not had similar complaints in the past. Yet physicians generalized their belief about depressed and somatic patients to our hypothetical patients," said Graber.
Physicians need to be aware of how knowledge of a patient's psychiatric history may adversely impact decision-making. "In our study, the [symptoms] were suggestive of potentially fatal acute illnesses that should be considered regardless of the presence or absence of psychiatric disease," he concluded.
This research was supported by a predoctoral grant from the Department of Health and Human Services.
The Journal of General Internal Medicine, a monthly peer-reviewed journal of the Society of General Internal Medicine, publishes original articles on research and education in primary care. For information about the journal, contact Renee F. Wilson at (410) 955-9868.
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Journal of General Internal Medicine