THE IMPACT OF RECENT EMOTIONAL DISTRESS AND DIAGNOSIS OF DEPRESSION OR ANXIETY ON THE PHYSICIAN-PATIENT ENCOUNTER IN FAMILY-PRACTICE

BACKGROUND. Primary care physicians are expected to identify mental he alth problems. Currently, it is unclear how a recent experience-of emo tional distress affects the physician-patient encounter and the diagno stic process. METHODS. Using the Davis Observation Code, we studied 12 69 encounters between family physicians and adult patients who complet ed brief questionnaires after the visit. Patients were separated into three groups using self-report and billing data: those denying recent emotional distress, those reporting recent emotional distress but not receiving a mental health diagnosis, and those reporting recent emotio nal distress and receiving a diagnosis of anxiety or depression. RESUL TS. Nineteen percent of patients reported significant emotional distre ss during the previous 4 weeks; 18% of these patients received a billi ng diagnosis of depression or anxiety Patients not reporting emotional distress had the shortest visits (10.0 minutes); recent emotional dis tress was associated with significantly longer visits: 11.5 minutes fo r those without a diagnosis of depression or anxiety and 12.8 minutes for those with a diagnosis; sis of depression or anxiety. The visits o f patients with a diagnosis of depression or anxiety included more cou nseling, history-taking, and discussions of family information and sub stance use, and less time providing physical examination and evaluatio n feedback. Fewer preventive services and less chatting occurred when patients reported recent distress, regardless of diagnosis. CONCLUSION S. Recent patient emotional distress has a powerful impact on the stru cture of the family practice visit, with important implications for ef forts to enhance diagnosis and treatment of mental health issues. The challenge for the family physician is to recognize and treat a patient 's emotional distress while continuing to fulfill competing medical de mands.