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History-taking and Preventive Medicine Skills among Primary Care Physicians: An Assessment Using Standardized Patients

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Abstract

Background: The ability of primary care physicians to obtain important clinical information in initial encounters with new patients is a core competency that has received little attention in previous studies. This paper describes the history-taking and preventive screening skills of practicing primary care physicians in initial interactions with ambulatory patients, as determined by a large panel of standardized patients.

Methods: Standardized patient cases with diverse presentations were developed and used to assess the clinical skills of 134 primary care physicians from five Northwest states. Scoring categories for each case identified the percentage and content of essential history items and preventive screening items performed. Physicians’ scores were compared by training and practice characteristics.

Results: Physicians asked 59% of essential history items. They frequently obtained appropriate information about presenting symptoms and medications, but they often missed important information about related symptoms and medical history. Physicians frequently screened for smoking and alcohol use, but rarely asked about recreational drug use. Although board-certified general internists performed more comprehensive histories than board-certified family practitioners in the same amount of time, both groups of providers missed a large number of items that should have been influential in developing diagnostic and treatment plans.

Conclusions: Primary care physicians may miss important patient information in their initial interactions with patients. Medical intake questionnaires or other approaches should be considered to ensure that more complete and accurate information is available to guide diagnostic and treatment plans.

Section snippets

Subject Selection and Description

To identify eligible physicians, a screening questionnaire about practice activities was mailed to physicians in Washington, Alaska, Montana, Idaho, and Oregon who listed their primary or secondary specialty as either internal medicine, family practice, or general practice in the American Medical Association Directory. Eligibility criteria based on information from screening questionnaires included (1) at least 50% of professional time spent in primary care activities, and (2) medical school

Results

Among 134 participants, 36 were women. Nearly half practiced in large metropolitan areas, and the remainder were evenly divided between small metropolitan and nonmetropolitan locations. Nearly half (66) were board-certified in internal medicine, and 45% (n = 60) in family practice. Fourteen internists were also certified in at least one subspecialty of internal medicine. Most participants (96%) were American medical graduates. Physicians were equally divided between those practicing in solo or

Discussion

The standardized patient examination provides a method to assess physicians’ ability to elicit essential information during initial patient encounters. Patient presentations can be controlled prospectively so that all physicians see the same patients and are evaluated in a standardized manner. In this study, we used standardized patients to assess the clinical data-gathering skills of 134 primary care physicians. The results provide insights into the strengths and weaknesses of primary care

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  • Cited by (0)

    Supported by Grant #06454, the Agency for Health Care Policy and Research.

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