How physician communication influences recognition of XXXX in primary care.

@entity1 @entity308 @entity2794
BACKGROUND: The relationship between physician communication patterns and the successful recognition of @entity308 is poorly understood. METHODS: We used unannounced visits by actors playing standardized @entity1 to evaluate verbal communication between primary care physicians and a @entity1 presenting with a minor @entity308 scenario. @entity1 (n = 77) were assigned to receive 2 visits from a @entity1 or @entity1 portraying a 26-year-old @entity1 with @entity2794 who meets the criteria for minor @entity308 . The standardized @entity1 carried hidden audiotape recorders and high-fidelity microphones to document the encounters. The audiotapes were coded at 2-second intervals. These data were linked to information gathered from standardized @entity1 checklists, medical records, and debriefing telephone calls with @entity1 . RESULTS: We obtained complete data on 59 (77%) of the physician- @entity1 encounters; of those, 43 (73%) of the physicians recognized @entity308 . Physicians who recognized @entity308 asked twice as many questions about feelings and affect compared with those who did not (for feelings: 1.9% of total physician 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 @entity308 . Physicians who successfully recognized @entity308 later in the interview showed an increase in questions about feelings in the quartile just before recognition occurred. CONCLUSIONS: Physicians who recognized @entity308 differed significantly in the percentage of questions about feeling and affect, and an increase in questions about feelings may precede a diagnosis of @entity308 , though more research is needed to establish this as an important finding.
