Compliance issues in primary care.

Primary care medical practice is a broadly based medical discipline, emphasizing continuity of care in both sickness and health and effective doctor/patient communication and involving the patient as a partner in the provision of health care services. Against this background, there is troubling evidence that psychosocial (mental health) problems are not being adequately diagnosed and treated by physicians in general, and primary care practitioners in particular. This deficiency is the first step down the road to poor compliance. This author assumes that a goodly portion of the blame can be laid on the doorstep of the medical education establishment with its emphasis on the biomedical, reductionism, and high-tech tertiary care. Physicians exit the educational system with a predisposition to deal with problems from a biomedical perspective. They are unaware that, by the very nature of the doctor/patient relationship, they possess considerable ability to effectively intervene in the psychosocial area. Suggestions are given as to how primary care practitioners can improve on this dimension of their medical practice and deal with psychosocial issues. Available evidence would indicate that effectively dealing with these issues will improve patient compliance and outcomes.