Assessing the competence of general practitioners in diagnosing generalized anxiety disorder using standardized patients

Abstract

The competence of general practitioners (GPs) in diagnosing anxiety neurosis was assessed using standardized patients (SPs) unknown to the doctors. Out of a computer-generated random sample of 100 general practitioners in Kuala Lumpur, 42 volunteered to participate in the study. The results showed that the GPs can be divided into three groups: group A made the correct diagnosis and informed the SPs about their condition (11.9%); group B prescribed tranquillizers and did not inform the SPs of the actual diagnosis but instead said that they were either normal or were suffering from some stress (28.6%); and group C made various diagnoses of physical disorder or did not detect any abnormality at all (59.5%). Thus about 40% of the doctors considered an emotion-related disorder and only 12% of the doctors were confident enough to make and inform the patient of the actual diagnosis. Group A significantly (P < 0.001) asked higher numbers of relevant questions in the signs and symptoms section of the history than the other two groups. No differences between the three groups were observed in the other two sections of history-taking (personality, family, social and precipitating factors), in the general and specific physical examination and interpersonal skills. Generally, with the exception of the interpersonal skills section, the doctors performed less than 40% of the expected tasks in every section. The study highlighted the lack of competence in making a definite diagnosis of anxiety disorder. Among those who apparently made the diagnosis (group B) or made the diagnosis with certainty (group A), there was no demonstration of appropriate treatment behaviour with respect to pharmacological intervention.(ABSTRACT TRUNCATED AT 250 WORDS)

Initial Insomnia And Paradoxical Intention: An Experimental Investigation Of Putative Mechanisms Using Subjective And Actigraphic Measurement Of Sleep

“…For example, in a recent survey (7) detection rates for mental health problems were found to be considerably higher when screening was based on the General Health Questionnaire-28 (33.2 %) and the Schedules for Clinical Assessment in Psychiatry (SCAN) system (31.5%), than when screening involved direct GP observation (14.1%). Similar results were reported in a study (8) where trained medical students presented to GPs suffering from generalised anxiety disorder. Analysis indicated that 25 of 42 GPs studied made no diagnosis at all, or diagnosed only physical problems.…”

Simulation and mental health outcomes: a scoping review

“…A mixed methods study by Lewy [ 28 ] reported that paediatric residents ( n = 34) working with SPs attained an increased confidence in patient treatment, with 69% stating the intervention was “extremely helpful”. Shahabudin [ 30 ] trained medical students to act as patients presenting with various mental illnesses in order to assess the knowledge and diagnostic abilities of 42 general practitioners (GPs). The findings were grouped into three categories based on the performance of the doctors: group A—where 11.9% of the GPs informed the SPs of their anxiety diagnosis, group B—28.6% of the GPs prescribed medication for anxiety but did not inform the SP of their diagnosis and group C—where 59.5% of GPs did not diagnose nor treat the SP [ 30 ].…”

“…Shahabudin [ 30 ] trained medical students to act as patients presenting with various mental illnesses in order to assess the knowledge and diagnostic abilities of 42 general practitioners (GPs). The findings were grouped into three categories based on the performance of the doctors: group A—where 11.9% of the GPs informed the SPs of their anxiety diagnosis, group B—28.6% of the GPs prescribed medication for anxiety but did not inform the SP of their diagnosis and group C—where 59.5% of GPs did not diagnose nor treat the SP [ 30 ]. This study highlighted the lack of consistent training, assessment and treatment in the GP management of mental health and highlights an opportunity for future research and investigation.…”

Primary Care Physicians' Evaluation and Treatment of Depression

“…Simulated patient methodology, including virtual and standardized patients, has been used effectively in clinical research to assess the impact of patient and provider variables on health care professionals’ decisions (Badger et al, 1994; Durante, McKinlay, Kasten, & Potter, 1997; M. D. Feldman, Franks, Epstein, Franz, & Kravitz, 2006; Kales, Neighbors, Blow, et al, 2005; Kales, Neighbors, Valenstein, et al, 2005; Kravitz et al, 2006; McKinlay, Lin, Freund, & Moskowitz, 2002; Schulman et al, 1999; Shahabudin, Almashoor, Edariah, & Khairuddin, 1994; H. N. Young, Bell, Epstein, Feldman, & Kravitz, 2006).…”