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Although stress is common among people with health problems, few primary care doctors take time to discuss ways to reduce stress with their patients, a new study suggests.
The results show just 3 percent of visits to primary care doctors include discussions of stress reduction, the researchers said.
That's much lower than the 60 to 80 percent of doctor's visits thought to involve stress-related health problems, the researchers said.
Stress counseling was also less common in the study than nutrition counseling, which occurred in about 17 percent of visits, physical activity counseling, which occurred in 12 percent of visits, and weight counseling, which occurred in about 6 percent of visits.
"The low rate of [stress] counseling points to potential missed opportunities, suggesting that physician counseling about stress has not been incorporated into primary care to the extent of other types of counseling," the researchers write today (Nov. 19) in the journal Archives of Internal Medicine.
Primary care doctors, already crunched for time during office visits, may feel they simply can't fit in a discussion about stress management, the researchers said. Indeed, office visits in the study that did involve such discussions were longer.
Changing primary care so that patients are treated by teams of doctors could address this issue, said study researcher Dr. Aditi Nerurkar, a primary care physician at Beth Israel Deaconess Medical Center in Boston. Physicians could partner with nurses and other health care providers who could counsel patients on stress, Nerurkar said.
Stress and disease
Studies have linked stress to high blood pressure levels, heart disease and heart attacks. In fact, another study published today in the same journal found a link between unemployment — a stressful circumstance — and an increased risk of heart attacks.
While stress does not necessarily cause these conditions, it may exacerbate them, Nerurkar said. Stress may also make diabetes harder to control, and affect how people perceive chronic pain.
Nerurkar and colleagues analyzed information from more than 34,000 visits to 1,263 physicians between 2006 and 2009. They looked to see whether the office visits included information on ways to reduce stress, such as through exercise or yoga, or if doctors referred their patients to a specialist to discuss stress reduction.
A little more than 1,000 of the visits included stress management counseling. Patients were more likely to be counseled for stress if they were experiencing a flare-up of a chronic condition, or if they had depression.
This suggests doctors are not preventing stress-related complications, but rather, counseling patients after the fact, the researchers said.
Does stress management work?
Offering stress counseling earlier could lead to better outcomes for patients, but more research is needed to study this, Nerurkar said.
Dr. Doug Campos-Outcalt, chairman of Family, Community and Preventive Medicine at the University of Arizona College of Medicine, said the results should be interpreted with caution, because the study only looked at whether stress counseling was being offered, not whether patients actually needed this counseling.
In addition, it would be important to know how often patients are helped by stress counseling, said Campos-Outcalt, who was not involved in the study.
Nerurkar said that because stress is a culprit in so many medical conditions, "we could all benefit in managing our stress better."
One recent study found that patients with heart disease who practiced meditation — a possible way to reduce stress — had a reduced risk of death during the study period compared with those who did not practice mediation, Nerurkar said.
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There are simple check box screeners that can be used to evaluate distress. They can be completed while in the waiting room and scored in 10 seconds by the nurse before the visit. Anyone with a score of above say a 3 or 4/10 (10 being highest) would be a good candidate for a discussion about stress management.
Many multidisciplinary practices these days are adding medical or behavioral medicine psychologists. If a patient is experiencing coping difficulties then they can be referred for consultation and potential treatment. The medical psychologist is best trained among all healthcare professionals to help the patient make behavioral changes in stress reduction, diet, exercise, smoking cessation, alcohol abuse/dependence, reduced risk taking, etc. Such referrals and integration would lower the cost of healthcare as prevention is the greatest factor in cost reduction.
"Most docs don't talk to patients about stress, study finds"
But study did also find that "most Docs less talk on patient's stress and overall health but spend more time about their fees...
Average time Doc spends with patient about health concern - less than 10 minutes
Average time Doc spends with patient about his/her bill on the 10 minutes - 1 hour
DocHolliday - you need to find a new doctor if thats your experience.
Russ - I would imagine after a while, the feeling of talking to a brick wall would eventually change your habits in how you communicate with your patients. Once you know they dont care and arent listening, why would you bother to continue to waste your breath?
for this reason alone is why I could never be a doctor, i'd be compelled to often to say "if you dont give a @!$%# about your health, why do you come here? why do you think I should care more than you?"
im pretty sure I wouldnt be a practicing doctor too long after saying that a few times to patients.
may the force be with you, and may you keep fighting the good fight!
And, if you live in Texas, talking to your Doctor is more rare than talking to Jesus. And, if you do get the chance to talk to the guy or gal, you will realize he or she is just a person who is kind of scared and almost as unaware of your problems as you are. But, bless him or her, anyways.
>Russ, I can empathize! My patients are primarily the seriously/chronically/terminally ill and require an hour plus of time. Reimbursement is becoming more and more challenging to obtain. If medicare doesn't fix the SGR mess my reimbursement rates are slated to be cut by 37% based on the proposed rates for next year. Most private ins companies follow medicare's lead so it's not looking good.
It seems like every year I get reimbursed 5% plus less yet they want more and more to be done and more and more paperwork.
You can now get reimbursed by medicare/medicaid for 15 min of intensive behavioral counseling for preventative care for certain behaviors, it's not much but every little bit helps.
I feel for you guys, really, that try to tell people about how to improve their own health and the patients don't want to hear it. And I understand spending an hour w/a patient to get the fee for an office visit also stinks. But realize too that I, as a fairly healthy (knock on wood) young person also feel a bit cheated when I go in for say, a sinus infection that I already know I have, the doc comes in and I say, "Yeah, it started as a really bad cold and now it's a sinus infection," he looks me over, agrees, writes a script, and is out the door in 5 minutes. I feel like I did a good part of his job for him, but I still get charged the whole fee for the diagnostic visit, not to mention getting charged the same amount if I see a P.A. vs a real M.D. This is sort of like taking a car to a mechanic. If I drive in and say, "the brakes are bad, replace the pads, turn the rotors," I get charged for that work. If I drive in and say, "It makes a funny noise, let me know," I get charged much more because of the diagnostic work involved. If I could pay for the service I needed and used instead of for the same visit as those people that take 1hr, I'd have more empathy for the reimbursement issues.
>grit.. I specialize in more chronic and serious issues but even for patients who have something minor they get the time at my practice. Sadly, the system is not designed to reward docs for the quality of care they provide but for the quantity. The proposals to change that are well meaning but from the way it looks they will pay less and then punish docs for working with those who are more seriously ill and require more visits/care.
I do recommend that you shop around for a good primary care doc. When you find one that works well, establish a good relationship you'll find that the doctor will spend more time and be much more attentive.
Best of Luck!
Well, it seems the cat if finally out of the bag. The only problem is convincing the insurance companies about the dangers of stress. If the insurance companies can stave off having to pay for all this suggested "counseling" then it means more money for them. If they would only CHOOSE to see it's benefits, which would result in lower claim payouts, they could realize more CHACHING in their collective greedy pockets. I can attest to the effects of stress because it almost killed me. I am one of the fortunate ones whom survived its effects and damage. Come on Insurance industry, see the light.
Doctors are cute. We need more of them in Texas, and in the Deep South. I will personally hug them.
RussH: "Drop your health insurance, pay out of pocket and you will get better care at less expense"
-- until the first time in your life you have to go to the hospital. Hope you've been saving the money you would have spent on insurance premiums. If you have, well, you're back to square one with no savings left. If not, hello, bankruptcy court. Oh, and the rest of us have to pick up the bills you're not able to pay.
There has to be a better way, ultimately (I hope) cutting health insurance companies, each with their infinite number of variables and incredible overhead costs, out of the equation. Barring that, which I suspect is an impossiblity in the near term in this country, strong regulatory action similar to that under which Medicare supplements are offered.
A dirty free for all. http://www.youtube.com/watch?v=edP0L6LQzZE
http://www.youtube.com/watch?v=iP6XpLQM2Cs
Heck, most docs believe they are working for the insurance companies/corporations and can't wait to get you back on the job. They rarely ask you if you feel able to go back to work, just assuming you are a "goldbricker". We need to go to a single payer system, cut out all the fat, and pay doctors to take care of us, not them. I recently had a heart issue and there was never, ever, talk of stress, just meds and back at it.
Not in our city, they all want to blame all ailments on stress and try to give you some medication for depression rather than finding out what is suddenly wrong with your body causing you health problems. Even though you tell them you are not stressed at all.
And being legitimately ill can make you stressed. Alot of people's health needs get ignored because some doctor wants to dismiss it for stress. The reasons why your general practitioner and psychologist should not be the same doctor are too numerous. Good mental health care, as I understand it, means to eliminate or treat physical causes before pursuing psychological care, and determining if it's both. Alot of illnesses are affective towards both and that balancing act is a stress all it's own.
The worst thing you can do is tell a patient to do something you know they don't have the resources to do, which just adds more stress. That's usually not just doctors, but family too.
Actually Luci, good mental health care often occurs concurrently with good medical care. The mind and the body are linked and if you treat one you are impacting the other. Also just because one has a mental health issue that does not preclude one from having and medical issue or v/v.
>Muncie.. That's why it can be helpful to work with a good psychologist who specializes in medical issues, as he or she can support you when you tell the physician that you are not experiencing issues just because you are depressed.
Commonly, hem/onc centers/programs, transplant programs, peds hospitals, etc. these days have psychologists who work with patients and families who are coping with disease stressors. The outcomes of such collaboration is showing fruitful and can even be cost reducing through less re-admissions, better treatment adherence, etc.
The problem is that stress management requires more than just a 2-minute conversation in the middle of a medical visit. It takes me an entire semester to cover it with my class of college students, and I'm happy if they walk away with one or two tools that they'll use at the end of it. While I think it is necessary for physicians to ask the question, finding the solutions takes time and buy-in from the patients. It makes me think of Dr. Herbert Benson's concept of the 3-legged stool of health care: medications, procedures and self-care. The first two can be provided by medical professionals, but the third (and most important) has to be an individual responsibility. Many people just want to be helped with the tools to let them heal themselves.