Patient counselling by primary care physicians: results of a nationwide survey.

The rate of patient counseling in primary care medicine is a pivotal element of inter-specialty differences in styles of care. Using national data on patient care provided in both ambulatory care settings and in the hospital, this study examines the use of counseling by general and family practitioners, pediatricians, internists, and obstetrician/gynecologists. The findings show substantial differences based on physician specialty, with highest rates of counseling for family practitioners and internists, and rates of patient education for these two specialties almost three times that for general practitioners. The data also show generally higher counseling rates for hospital care and for first encounters with patients, and a tendency for office-based pediatricians and solo general practitioners to use less patient counseling compared to their institution-based counterparts. Projections of annual visit rates for the United States show that general practice and internal medicine account for a disproportionate amount of patient counseling compared to other primary care specialties, based on patient volume.