Gulbrandsen P, Fugelli P, Hjortdahl P
Institute of General Practice and Community Medicine, University of Oslo, Norway.
Fam Pract. 1998 Feb;15(1):1-8. doi: 10.1093/fampra/15.1.1.
Health-affecting psychosocial problems are inherent in general practice, present among one-third of the patients and constituting between 3 and 13% of reasons for encounter. Such problems are not always presented, and often overlooked by the doctors.
We aimed to describe the frequency of psychosocial problems presented to the doctor by patients with somatic reasons for encounter, as a proportion of the patients' existing health-affecting problems, and to explore whether characteristics of the doctor, the patient, their relationship or reason for encounter influence the presentation of problems.
A questionnaire survey of 1401 consecutive patients visiting 89 Norwegian GPs mapped the prevalence of nine commonly occurring psychosocial problems and the frequency by which they were disclosed during the consultation.
From 21% (loneliness) to 59% (occupational stress) of problems were disclosed to the doctors. Reason for encounter was the only factor to influence the disclosure from male patients, while reason for encounter, educational level and income source of the patient, gender of the doctor, and the doctor's previous general knowledge of the patient influenced the disclosure from female patients.
Less than half of health-affecting psychosocial problems are disclosed to GPs by patients with somatic reasons for encounter. Occupational stress is disclosed more often than other psychosocial problems. Female patients disclose non-occupational problems more often than male patients, especially if they know the doctor or if the doctor is a woman. Symptoms from the musculoskeletal system are the reasons for encounter most often preceding the disclosure of psychosocial problems.
影响健康的社会心理问题在全科医疗中是固有的，三分之一的患者存在此类问题，且占就诊原因的3%至13%。这些问题并不总是会被提及，而且常常被医生忽视。
我们旨在描述因躯体原因就诊的患者向医生提及的社会心理问题的频率，作为患者现有影响健康问题的一部分，并探讨医生、患者的特征、他们之间的关系或就诊原因是否会影响问题的提及。
对连续就诊于89名挪威全科医生的1401名患者进行问卷调查，以确定九种常见社会心理问题的患病率以及在会诊期间提及这些问题的频率。
向医生提及的问题比例从21%（孤独感）到59%（职业压力）不等。就诊原因是影响男性患者提及问题的唯一因素，而就诊原因、患者的教育水平和收入来源、医生的性别以及医生之前对患者的一般了解情况则影响女性患者提及问题。
因躯体原因就诊的患者向全科医生提及的影响健康的社会心理问题不到一半。职业压力比其他社会心理问题更常被提及。女性患者比男性患者更常提及非职业问题，尤其是在她们认识医生或医生为女性的情况下。肌肉骨骼系统症状是社会心理问题被提及之前最常见的就诊原因。
