Physician Personality Characteristics and Inquiry About Mood Symptoms in Primary Care

  • Paul R. Duberstein
  • Benjamin P. Chapman
  • Ronald M. Epstein
  • Kelly R. McCollumn
  • Richard L. Kravitz
Original Article

ABSTRACT

BACKGROUND

Depression treatment is often initially sought from primary care physicians.

OBJECTIVE

To explore the influence of physician personality on depression assessments.

DESIGN

Secondary analysis of data collected in a randomized controlled trial.

SETTING

Offices of primary care physicians in Rochester, NY.

PARTICIPANTS

Forty-six physicians; six female actors.

Intervention

Eighty-six unannounced standardized patient (SPs) visits; physicians saw one SP with major depression and one with adjustment disorder.

MEASUREMENTS

SPs listened to audiotapes and completed a form on doctoring behaviors and symptom inquiry immediately following the visit. For the assessment of diagnostic documentation, SPs’ medical records were reviewed. Physician personality was assessed via items from the NEO-PI-R.

RESULTS

Physicians who are more dutiful and more vulnerable were more likely to document a diagnosis of depression; those who are more dutiful also asked fewer questions concerning mood symptoms.

LIMITATION

Roles portrayed by the SPs may not reflect the experience of a typical primary care patient. Most of the PCPs were white men. The sample of PCPs was limited to a single geographic location. Effect sizes were modest.

CONCLUSIONS

The clinical, educational, and translational, implications of research showing that physician personality traits could affect practice behaviors warrant consideration. Current models of treatment for depression in primary care could be engineered to accommodate the variability in physician personality. Given that there is no single “correct” way to ask about mood disorders or suicide, clinicians are encouraged to adopt an approach that fits their personal style and preferences.

KEY WORDS

mental health primary care physician personality suicide depression 

Notes

Acknowledgements

The authors wish to thank Blue Shield of California, the UCD Primary Care Network, Western Health Advantage (Sacramento), Kaiser Permanente (Sacramento), Brown & Toland IPA (San Francisco), and Excellus BlueCross BlueShield and Preferred Care (Rochester). This work was supported by United States Public Health Grants R01MH064683, T32 MH073452, K24MH072712, and K24MH072756.

Conflict of Interest

The design, conduct, data collection, analysis, and interpretation of the results of this study were performed independently of the funders. The funding agency also played no role in review or approval of the manuscript. The authors have no conflict of interest to declare.

References

  1. 1.
    Gaynes BN, West SL, Ford CA, Frame P, Klein J, Lohr KN. Screening for suicide risk in adults-a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004;140:822–35.PubMedGoogle Scholar
  2. 2.
    Nutting PA, Dickinson LM, Rubenstein LV, Keeley RD, Smith JL, Elliott CE. Improving detection of suicidal ideation among depressed patients in primary care. Ann Fam Med. 2005;3:529–36.PubMedCrossRefGoogle Scholar
  3. 3.
    Regier DA, Narrow WE, Rae DS, Manderscheid RW, Locke BZ. The de facto US mental and addictive disorders service system-epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Arch Gen Psychiatry. 1993;50:85–94.PubMedGoogle Scholar
  4. 4.
    Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers before suicide-a review of the evidence. Am J Psychiatry. 2002;159:909–16.PubMedCrossRefGoogle Scholar
  5. 5.
    Klinkman MS. Competing demands in psychosocial care-a model for the identification and treatment of depressive disorders in primary care. Gen Hosp Psychiatry. 1997;19:98–111.PubMedCrossRefGoogle Scholar
  6. 6.
    Nutting PA, Rost K, Smith J, Werner JJ, Elliot C. Competing demands from physical problems-effect on initiating and completing depression care over 6 months. Arch Fam Med. 2000;9:1059–64.PubMedCrossRefGoogle Scholar
  7. 7.
    Rost K, Nutting P, Smith J, Coyne JC, Cooper-Patrick L, Rubenstein L. The role of competing demands in the treatment provided primary care patients with major depression. Arch Fam Med. 2000;9:150–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Feldman M, Franks P, Duberstein PR, Vannoy S, Epstein RM, Kravitz R. Let’s not talk about it-doctors rarely ask depressed patients about suicide. Ann Fam Med. In press.Google Scholar
  9. 9.
    Kessler D, Lloyd K, Lewis G, Gray DP. Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care. BMJ. 1999;318:436–40.PubMedGoogle Scholar
  10. 10.
    Wells KB, Miranda J, Bauer MS, et al. Overcoming barriers to reducing the burden of affective disorders. Biol Psychiatry. 2002;52:655–75.PubMedCrossRefGoogle Scholar
  11. 11.
    Van Ryn M, Fu SS. Paved with good intentions-do public health and human service providers contribute to racial/ethnic disparities in health. Am J Public Health. 2003;93:248–55.PubMedCrossRefGoogle Scholar
  12. 12.
    Duberstein PR, Meldrum S, Fiscella K, Shields CG, Epstein RM. How good is your doctor? patients’ ratings are influenced by physician demographics and physician personality. Patient Educ Couns. 2007;65:270–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Manuel RS, Borges NJ, Gerzina HA. Personality and clinical skills-any correlation. Acad Med. 2005;80:S30–3.PubMedCrossRefGoogle Scholar
  14. 14.
    Stratton TD, Elam CL, Murphy-Spencer AE, Quinlivan SL. Emotional intelligence and clinical skills-preliminary results from a comprehensive clinical performance examination. Acad Med. 2005;80:S34–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Epstein RM, Franks P, Fiscella K, Shields CG, Meldrum SC, Duberstein PR. Measuring patient-centered communication-observable behaviors and patient reports. Soc Sci Med. 2005;61:1516–28.PubMedCrossRefGoogle Scholar
  16. 16.
    Kravitz RL, Epstein RM, Feldman MD, et al. Influence of patients’ requests for direct-to-consumer advertised antidepressants-a randomized controlled trial. JAMA. 2005;293:1995–2002.PubMedCrossRefGoogle Scholar
  17. 17.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4Washington, DC: American Psychiatric Association; 2000.Google Scholar
  18. 18.
    Costa PT Jr, McCrae RR. Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) Professional ManualOdessa, FL: Psychological Assessment Resources; 1992.Google Scholar
  19. 19.
    Deary IJ, Agius RM, Sadler A. Personality and stress in consultant psychiatrists. Int J Soc Psychiatry. 1996;42:112–23.PubMedCrossRefGoogle Scholar
  20. 20.
    STATA. Version 9.0, StataCorp, College Station, TX.Google Scholar
  21. 21.
    Epstein RM, Morse DS, Frankel RM, Frarey L, Anderson K, Beckman HB. Awkward moments in patient-physician communication about HIV risk. Ann Intern Med. 1998;128:435–42.PubMedGoogle Scholar
  22. 22.
    Duberstein PR. Are closed-minded people more open to the idea of killing themselves. Suicide Life Threat Behav. 2001;31:9–14.PubMedCrossRefGoogle Scholar
  23. 23.
    Owens C, Lambert H, Donovan J, Lloyd KR. A qualitative study of help-seeking and primary care consultation prior to suicide. Br J Gen Pract. 2005;55:503–9.PubMedGoogle Scholar
  24. 24.
    Chapman BP, Duberstein P, Epstein RM, Fiscella K, Kravitz R. Patient centered communication during primary care visits for depression: What is the role of physician personality? Med Care, in press.Google Scholar
  25. 25.
    Bartels SJ, Coakley EH, Zubritsky C, et al. Improving access to geriatric mental health services-a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use. Am J Psychiatry. 2004;161:1455–62.PubMedCrossRefGoogle Scholar
  26. 26.
    Bruce ML, Ten Have TR, Reynolds CF III, et al. Reducing suicidal ideation and depressive symptoms in depressed older primary care patients-randomized controlled trial. JAMA. 2004;291:1081–91.PubMedCrossRefGoogle Scholar
  27. 27.
    Unützer J, Katon W, Callahan CM, et al. Collaborative care management of late-life depression in the primary care setting-a randomized controlled trial. JAMA. 2002;288:2836–45.PubMedCrossRefGoogle Scholar
  28. 28.
    Lebowitz BD. Clinical trials in late life-new science in old paradigms. Gerontologist. 2004;44:452–8.PubMedGoogle Scholar
  29. 29.
    Kohn ML. Social structure and personality through time and space. In: Moen P, Elder G Jr, Luscher K, eds. Examining Lives in Context: Perspectives on the Ecology of Human Development. Washington, DC: American Psychological Association; 1995:141–68.CrossRefGoogle Scholar
  30. 30.
    Kohn ML, Schooler C. Job conditions and personality-a longitudinal assessment of their reciprocal effects. Am J Sociol. 1982;87:1257–86.CrossRefGoogle Scholar
  31. 31.
    Kravitz RL, Franks P, Feldman M. Influence of patient, physician and system factors on referral decisions for depression in primary care-results from a randomized trial using standardized patients. J Gen Intern Med. 2006;21:584–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Robbins JM, Kirmayer LJ, Cathebras P, Yaffe MJ, Dworkind M. Physician characteristics and the recognition of depression and anxiety in primary care. Med Care. 1994;32:795–81.PubMedCrossRefGoogle Scholar
  33. 33.
    Noar SM, Benac CN, Harris MS. Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychol Bull. 2007;133:673–93.PubMedCrossRefGoogle Scholar
  34. 34.
    Gilbody S, Sheldon T, Wessely S. Should we screen for depression. BMJ. 2006;332:1027–30.PubMedCrossRefGoogle Scholar
  35. 35.
    Addis ME, Mahalik JR. Men, masculinity, and the contexts of help seeking. Am Psychol. 2003;58:5–14.PubMedCrossRefGoogle Scholar
  36. 36.
    Callahan EJ, Bertakis KD, Azari R, Helms LJ, Robbins J, Miller J. Depression in primary care-patient factors that influence recognition. Fam Med. 1997;29:172–6.PubMedGoogle Scholar
  37. 37.
    Stoppe G, Sandholzer H, Huppertz C, Duwe H, Staedt J. Gender differences in the recognition of depression in old age. Maturitas. 1999;32:205–12.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Paul R. Duberstein
    • 1
  • Benjamin P. Chapman
    • 1
  • Ronald M. Epstein
    • 2
  • Kelly R. McCollumn
    • 1
  • Richard L. Kravitz
    • 3
  1. 1.Laboratory of Personality and Development, Department of PsychiatryUniversity of Rochester Medical CenterRochesterUSA
  2. 2.Rochester Center for the Improvement of Communication in Health Care, Department of Family MedicineUniversity of Rochester Medical CenterRochesterUSA
  3. 3.Center for Healthcare Policy and Research, Department of Internal MedicineUniversity of CaliforniaDavisUSA

Personalised recommendations