Stressed Out? Does Your Doctor Know?

Stress counseling not offered enough by primary care doctors

(RxWiki News) Stress may be a part of life, but it can get too intense and interfere with daily life and sleep. It can also contribute to medical conditions – but your doctor may not talk about it.

A recent study found that only 3 percent of primary care visits involved stress counseling. However, stress is probably a factor in the majority of primary care visits.

Since it takes extra time to offer stress counseling, doctors may not automatically do it. But patients can always ask.

"Ask your doctor about stress relief."

Lead author Aditi Nerurkar, MD, MPH, the assistant medical director at the Beth Israel Deaconess Medical Center's Cheng & Tsui Center for Integrative Care, said stress is the "elephant in the room."

Everyone knows it's there, but physicians rarely talk to patients about it," Dr. Nerurkar said in a release about the research.

Dr. Nerurkar and colleagues used data from the 2006-2009 National Ambulatory Medical Care Survey, which included information about 34,065 visits to 1,263 doctor offices. They found that 3 percent of these office visits included stress management counseling by the doctors – less than every other kind of counseling offered by the doctor. About 17 percent of the visits involved nutritional counseling, 12 percent involved physical activity counseling, 6 percent on weight loss and 4 percent on quitting smoking.

Yet past research has shown that stress is likely a factor in 60 to 80 percent of all primary care doctor visits.

The kind of stress management counseling that the researchers were looking for included "information intended to help patients reduce stress through exercise, biofeedback, yoga, etc." or else referrals to other medical professionals to help patients deal with stress.

The patients who were most likely to receive counseling on stress reduction were those suffering from depression or those who had chronic conditions or multiple issues.

"This care pattern implies that counseling is being offered downstream, rather than as a preventive measure, similar to physician counseling about other therapeutic lifestyle changes," the authors wrote.

Why aren't doctors providing more stress counseling during primary care visits? One reason might be the extra time it takes. Dr. Nerurkar's team found that stress management counseling occurred in longer office visits, and past research has shown that lack of time is a major barrier for doctors in offering counseling on stress reduction.

"We know that primary care physicians are overburdened," said senior author Gloria Yeh, MD, MPH. "With the volume of patients they see, there simply may not be enough time to provide stress management counseling during the office visit."

Patients who are interested in receiving counseling on stress from their doctor should specifically request it.

The research letter was published November 19 in the Archives of Internal Medicine. The research was funded by the National Institutes of Health and partly by the Harvard Catalyst and the Harvard Clinical and Translational Science Center. The authors stated they had no conflicts of interest.

Review Date: 
November 22, 2012