General practitioners' knowledge of their patients' psychosocial problems: Multipractice questionnaire survey

Objectives: To evaluate general practitioners' knowledge of a range of psychosocial problems among their patients and to explore whether doctors' recognition of psychosocial problems depends on previous general knowledge about the patient or the type of problem or on certain characteristics of the doctor or the patient. Design: Multipractice survey of consecutive adult patients consulting general practitioners. Doctors and patients answered written questions. Setting: Buskerud county, Norway. Subjects: 1401 adults attending 89 general practitioners during one regular working day in March 1995. Main outcome measures: Doctors' knowledge of nine predefined psychosocial problems in patients; these problems were assessed by the patients as affecting their health on the day of consultation; odds ratios for the doctor's recognition of each problem, adjusted for characteristics of patients, doctors, and practices; and the doctor's assessment of previous general knowledge about the patient. Results: Doctors' knowledge of the problems ranged from 53% (108/203) of ''stressful working conditions' to 19% (12/63) of a history of ''violence or threats.'' Good previous knowledge of the patient increased the odds for the doctor's recognition of ''sorrow,'' ''violence or threats,'' ''substance misuse in close friend or relative,'' and ''difficult conflict with close friend or relative.'' Age and sex of doctor and patient, patient's educational level and living situation, and location of practice influenced the doctor's awareness. Conclusions: Variation in the patients' communication abilities, the need for confidence in the doctor-patient relationship before revealing intimate problems, and a tendency for the doctors to be entrapped by their expectations may explain these findings.