Abstract
Background/Aims Didactic training in medical education on how to address significant emotional distress is inadequate. Even if unfamiliar with mental health assessment tools, any physician presumably can recognize distress when presented with an adult crying. This study describes the reasons disclosed during routine periodic health examinations (PHEs) for patient crying and how primary care physicians respond to this distress.
Methods The 9 cases where patients cried during a PHE were identified from an existing observational study of 322 audio-recorded office visits in 26 clinics of an integrated delivery system in Detroit and surrounding suburbs between 2007–2009. All patients were insured and aged 50–80 years. Physicians were general internal and family medicine physicians practicing with a salaried medical group that includes provision of comprehensive behavioral health services. Administrative claims data for the spanning 12-months before and after the visit were joined with audio-recordings. Content analysis was used to explore patient-stated reason(s) for crying and the physician’s response to the patient’s crying.
Results We found that most patients (6/9) began to cry within approximately the first five minutes of the visit. Suffering from emotional pain was the main disclosed precipitator for patient’s crying, the most common trigger being bereavement over the death of a loved one (5/9). Physicians’ responses to patient crying ranged from immediate (7/9) or delayed (1/9) statements of empathy to one case of no expression of empathy. Most physicians performed some inquiry of mental health or recommendation for behavioral health treatment for the patient (8/9). Among those, only three patients were asked more than four of the recommended PHQ9 diagnostic questions for depression.
Discussion Most patients who cried during routinely scheduled PHEs did so over psychosocial issues. Nearly all of the physicians provided some expression of empathy within moments of the patients’ tears. However, when assessing the patient’s mental health status, physicians did not ask all of the diagnostic questions for depression, nonetheless in some cases provided a depression visit diagnosis code. A patient crying during a visit can be viewed as clear signal of patient distress and possible need for professional help to alleviate suffering.
