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Psycho-social problem disclosure during primary care consultation

Published online by Cambridge University Press:  11 October 2011

Lidia Del Piccolo
Lidia Del Piccolo*
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Servizio di Psicologia Medica, Università di Verona, Verona
*
Indirizzo per la corrispondenza: Dott.ssa Lidia Del Piccolo, Dipartimento di Medicina e Sanità Pubblica, Servizio di Psicologia Medica, Ospedale Policlinico, 37134 Verona. Fax: +39-045-585871 E-mail: lidia@borgoroma.univr.it
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Summary

Objective – To examine how primary care patients with psychosocial problems actually introduce and present these topics. To examine the influence of some personality traits (emotional dependency and health locus of control) on psychosocial problem disclosure. Design – «Case control». Cases had a GHQ–12 score equal or higher than three. Controls were matched with cases according to GP, GPs' attribution of absence or presence of emotional distress sex, age and presence of chronic illness. Setting – Six single handed primary care practices. Measures – Clinical and Socio-demographic data, Social Problems List, List of 12 Threatening Life Events, GHQ-12, Multidimensional Health Locus of Control, Interpersonal Dependency Inventory and a Social Support Index. Results – The introduction of psychosocial topics by patients is related to the attribution of emotional distress by GP. Patients identified correctly as not distressed present less often psychosocial topics compared to patients recognised as distressed. Distressed patients not recognised as such more often than the others did not offer any psychosocial cue. The personality measures did not influence the presentation of psychosocial problems. Conclusions – The lack of psycho-social cues from patients and of patient-centred skills contributed to the non recognition of emotional distressed patients. GPs' active facilitation of the presentation of psychosocial topics in such patients would improve the recognition of emotional distress.

Riassunto

Scopo – Valutare come i pazienti trattano tematiche psicosociali durante la consultazione in medicina generale e se vi è un'influenza degli aspettà di personalità (dipendenza emotiva e tendenza a controllare o delegare la salute) su tale comportamento. Disegno — “Caso-controllo”. Tra i casi rientravano coloro che avevano punteggio maggiore o uguale a tre nel General Health Questionnaire (GHQ—12). L'appaiamento caso—controllo è stato fatto sulla base del medico curante, del giudizio di presenza/assenza di disagio emotivo espresso dal medico, dal sesso, dall'età e dalla presenza di malattia cronica. Setting — Sei ambulatori di Medicina Generale. Principali misure utilizzate — Scheda del medico con i dati clinici del paziente, Scheda del paziente con dati socio—demografici, Questionario sui problemi sociali, GHQ—12, Questionario sugli eventi di vita. Successivamente i pazienti sono stati ricontattati ed hanno compilato la Multidimensional Health Locus of Control Scale (MHLC), l'Interpersonal Dependency Inventory e il Social Support Questionnaire. Risultati – La probabilità di trattare tematiche psicosociali aumenta quando il medico attribuisce disagio psichico. I pazienti correttamente identificati senza disagio emotivo hanno trattato meno frequentemente temi psico-sociali, pur accennandoli, il contrario si è verificato per i pazienti riconosciuti con disagio. I pazienti con alto punteggio al GHQ-12 e non identificati dal medico (falsi negativi), più degli altri non hanno neppure fatto cenno ad aspetti psicosociali. La presentazione di problemi psicosociali non è risultata influenzata dalle misure di personalità. Conclusioni – L'assenza di accenni a temi psicosociali e la mancanza di un approccio centrato sul paziente hanno contribuito al non riconoscimento del disagio emotivo nei pazienti «falsi negativi». Un atteggiamento attivo da parte del medico nell'introdurre tematiche psicosociali può avere un notevole effetto sul riconoscimento del disagio psichico in tali pazienti.

Keywords

doctor-patient communicationpatient-centred communicationemotional distress identificationcomunicazione medico-pazienteintervista centrata sul pazientericonoscimento del disagio emotivo.
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 9 , Issue 4 , December 2000 , pp. 257 - 271
Copyright
Copyright © Cambridge University Press 2000

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