Do physicians assess lifestyle health risks during general medical examinations? A survey of general practitioners and obstetrician-gynecologists in Quebec

Background: In Canada several guidelines have been published for the screen ing of lifestyle health risks during general medical examinations. The auth ors sought to examine the extent to which such screening, practices have be en integrated into medical practice, to measure physicians' perceived level of difficulty in assessing these risks and to document physicians' evaluat ion of their formal medical training in lifestyle risk assessment. Methods: An anonymous mail survey was conducted in 1995 in Quebec with a st ratified random sample of 1086 general practitioners (GPs) and with all 241 obstetrician-gynecologists (Ob-Gyns). The authors evaluated the proportion of physicians who reported routine assessment (with 90% or more of their p atients) of substance use, family violence and sexual history during genera l medical examinations of adult and adolescent patients; the proportion of those who find inquiring about these issues difficult; and the proportion o f those who evaluated their medical training in lifestyle risk assessment a s adequate or excellent. Results: The overall response rate was 72.6%. Among adult patients, 82.2% o f the GPs reported routinely assessing tobacco use, 67.2% alcohol consumpti on, 34.2% illicit drug use and 3.2% family violence; the corresponding prop ortions for assessments among adolescent patients were 77.1%, 61.8%, 52.9% and 5.6%. Comparatively fewer Ob-Gyns reported routinely assessing these is sues (56.1%, 28.6%, 20.4% and 1.3% respectively among adults and 62.7%, 35. 2%, 26.8% and 2.8% respectively among adolescents). In the area of sexual h istory, condom use was routinely assessed by more Ob-Gyns than GPs (47.0% v . 28.2%); however, the proportion of Ob-Gyns and GPs was equally low for as sessing number of partners (24.8% and 23.1%), sexual orientation (18.8% and 16.9%) and STD risk (26.2% and 21.2%). The vast majority of GPs and Ob-Gyn s reported finding it difficult to assess family violence (86.5% and 93.0%) and sexual abuse (92.7% and 92.4% respectively). Over 80% of the physician s felt that they had had adequate or excellent medical training in assessin g risk behaviours for heart disease and STD risk. The proportion who fell t his way about their training in screening for illicit drug use, family viol ence and sexual abuse ranged between 12.7% and 31.5%. Interpretation: Although morbidity and mortality associated with smelting, alcohol consumption, illicit drug use, unsafe sexual practices, family viol ence and sexual abuse have been well documented, routine screening for thes e risk factors during general medical examinations has yet to be integrated into medical practice.