History-taking and preventive medicine skills among primary care physicians: an assessment using standardized patients

The American Journal of Medicine
P G RamseyM D Wenrich

Abstract

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. 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. 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 pract...Continue Reading

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