HISTORY-TAKING AND PREVENTIVE MEDICINE SKILLS AMONG PRIMARY-CARE PHYSICIANS - AN ASSESSMENT USING STANDARDIZED PATIENTS

BACKGROUND: The ability of primary care physicians to obtain important clinical information in initial encounters with new patients is a cor e competency that has received little attention in previous studies. T his paper describes the history-taking and preventive screening skills of practicing primary care physicians in initial interactions with am bulatory patients, as determined by a large panel of standardized pati ents. METHODS: Standardized patient cases with diverse presentations w ere developed and used to assess the clinical skills of 134 primary ca re physicians from five Northwest states. Scoring categories for each case identified the percentage and content of essential history items and preventive screening items performed. Physicians' scores were comp ared by training and practice characteristics.RESULTS: Physicians aske d 59% of essential history items. They frequently obtained appropriate information about presenting symptoms and medications, but they often missed important information about related symptoms and medical histo ry. Physicians frequently screened for smoking and alcohol use, but ra rely asked about recreational drug use. Although board-certified gener al internists performed more comprehensive histories than board-certif ied family practitioners in the same amount of time, both groups of pr oviders missed a large number of items that should have been influenti al in developing diagnostic and treatment plans. CONCLUSIONS: Primary care physicians may miss important patient information in their initia l interactions with patients. Medical intake questionnaires or other a pproaches should be considered to ensure that more complete and accura te information is available to guide diagnostic and treatment plans. ( C) 1998 by Excerpta Medical Inc.