How physician communication influences recognition of depression in primary care

BACKGROUND. The relationship between physician communication patterns and t he successful recognition of depression is poorly understood. METHODS. We used unannounced visits by actors playing standardized patients to evaluate verbal communication between primary care physicians and a pat ient presenting with a minor depression scenario. Participants (n = 77) wer e assigned to receive 2 visits from a man or woman portraying a 26-year-old patient with chronic headaches who meets the criteria for minor depression . The standardized patients carried hidden audiotape recorders and high-fid elity microphones to document the encounters. The audiotapes were coded at 2-second intervals. These data were linked to information gathered from sta ndardized patient checklists, medical records, and debriefing telephone cal ls with participants. RESULTS. We obtained complete data on 59 (77%) of the physician-patient enc ounters; of those, 43 (73%) of the physicians recognized depression. Physic ians who recognized depression asked twice as many questions about feelings and affect compared with those who did not (for feelings: 1.9% of total ph ysician activity vs 0.9%, P = .017; for affect: composite score of 2.7% of total physician activity vs 1.3%, P = .003), We found no differences in the proportion or timing of broad to narrow questioning between those who did and did not recognize depression. Physicians who successfully recognized de pression later in the interview showed an increase in questions about feeli ngs in the quartile just before recognition occurred. CONCLUSIONS. Physicians who recognized depression differed significantly in the percentage of questions about feeling and affect, and an increase in q uestions about feelings may precede a diagnosis of depression, though more research is needed to establish this as an important finding.