Good M J, Good B J, Cleary P D
J Fam Pract. 1987 Jul;25(1):53-9.
Research has yielded consistent evidence of high levels of psychiatric morbidity and psychosocial problems among primary care patients, and recent studies have focused on improving physician recognition. These studies are based on the unexamined assumption that patients want their physicians to treat psychosocial disorders; thus, underrecognition is examined by analyzing characteristics of physicians and medical settings. Patient characteristics, particularly attitudes about the appropriateness of seeking help for psychosocial problems in primary care, have not been examined in relationship to underrecognition. This study directly focuses on patient attitudes about appropriateness of requesting care for psychosocial difficulties, the extent to which patients discuss difficulties with their physicians, and the degree to which physician recognition is explained by these patient characteristics. The study sample of 883 adult patients was drawn from 23 primary care practices. Over 70 percent of patients find it appropriate to turn to their primary care physicians for help with emotional distress, family problems, life stress, behavioral problems, and sexual dysfunction; however, only one fifth to one third of patients who have experienced difficulties have discussed these problems with their primary care providers. Attitudes about appropriateness are significantly related to physician recognition of psychiatric symptoms and family difficulties but account for limited variance in levels of recognition.
研究已得出一致证据，表明初级保健患者中存在高度的精神疾病发病率和心理社会问题，并且近期研究集中在提高医生的识别能力上。这些研究基于一个未经检验的假设，即患者希望医生治疗心理社会障碍；因此，通过分析医生和医疗环境的特征来研究识别不足的问题。患者特征，尤其是对在初级保健中为心理社会问题寻求帮助的适当性的态度，尚未与识别不足相关联进行研究。本研究直接关注患者对为心理社会困难寻求护理的适当性的态度、患者与医生讨论困难的程度，以及这些患者特征对医生识别的解释程度。883名成年患者的研究样本来自23个初级保健机构。超过70%的患者认为向初级保健医生寻求情感困扰、家庭问题、生活压力、行为问题和性功能障碍方面的帮助是合适的；然而，只有五分之一到三分之一有困难的患者与他们的初级保健提供者讨论过这些问题。对适当性的态度与医生对精神症状和家庭困难的识别显著相关，但在识别水平上的变异解释有限。
