Involvement with the psychosocial concerns of patients. Observations of practicing family physicians on a university faculty.

BACKGROUND: Physician involvement in patients' psychosocial problems, including family concerns, is a vital aspect of comprehensive medical care. This study was conducted to better understand the extent to which experienced family physicians on a university faculty address psychosocial issues and involve family members during routine outpatient office visits.
METHODS: Five family physicians on a university faculty were videotaped during 200 office visits (40 per physician). Each visit was then rated on one of two five-point scales based on the extent to which psychosocial issues were addressed with individual patients and family members. Interrater reliability was 73%.
RESULTS: Most interviews were focused solely on medical issues. The physicians regularly elicited the patient's opinions in a collaborative manner. Psychosocial issues (ie, family, job) were discussed in approximately 25% of the interviews, emotional reactions of patients or family members were addressed less frequently, and counseling was rarely conducted. Greater involvement in psychosocial issues was associated with longer office visits.
CONCLUSION: The experienced physicians in this sample actively elicited patient's views of medical problems (ie, a "patient-centered" approach). The infrequent discussion of psychosocial concerns of the patient may be related to time limitations. Based on patients' opinions, specific attention to psychosocial issues may be most beneficial during well-child examinations and care of chronic illnesses.