How do primary care physicians respond when patients cry during routine ambulatory visits?

Abstract

Although crying is universally recognized as a sign of distress in adults, its role in assessing and diagnosing depression in medical settings has received little attention. We sought to describe the interactional circumstances surrounding patients who cry during routine periodic health examinations and the subsequent actions of their physicians. Qualitative content analysis of audio-recorded visits and administrative claims data for adult primary care patients for one year before and after an index visit were used to explore the context of patients’ crying and how physicians responded. Most patients began to cry while discussing emotional pain over the loss or illness of a loved one. While physicians generally responded with immediate expressions of empathy, the intensity of their responses varied. Some patients received minimal assessment regarding their mental health, whereas others were assessed more extensively. Although most physicians did express empathy in response to patients’ tears, some did not systematically assess patients’ mental health status and overall functioning. Physicians may want to view crying as a sign of distress and more fully evaluate whether it fits into a more complex clinical presentation of depression.

Keywords:

• Crying
• Mental health
• Primary care

Acknowledgments

This work was supported with grants from the National Institutes of Mental Health 7RO1MH08109803 and the National Cancer Institute R01CA112379. An earlier version of the manuscript was presented as a poster at the Society for General Internal Medicine in Phoenix, in 2011, Academy Health in Seattle, in 2011, and the HMO Research Network in Seattle, in 2012.

Author information

Cheryl D. Stults, PhD is a Research Sociologist at the Palo Alto Medical Foundation Research Institute. In this role, she studies patient-physician interaction and patient-centered care.

Jennifer Elston Lafata, PhD is Professor in the Department of Social and Behavioral Health in the School of Medicine and co-Program leader of Cancer Prevention and Control at the Massey Cancer Center at the Virginia Commonwealth University. Her research interests include patient-physician decision making and care quality.

Lisa Diamond, MD, MPH, is a member of the research faculty of the Immigrant Health and Cancer Disparities Service at Memorial-Sloan Kettering Cancer Center and an Assistant Professor of Public Health at Weill Cornell Medical College. Her research focuses on language barriers and their impact on quality of care and outcomes.

Lisa MacLean, is the Asst. Dean of Student Affairs and Career Development at Wayne State University School of Medicine. She is a trained Psychiatrist and full time medical educator.

Ashley L. Stone is a Research Associate at Palo Alto Medical Foundation Research Institute. Her research interests include patient-doctor communication and mental health in primary care.

Tracy Wunderlich is the Director of Research Training at Oakland University William Beaumont School of Medicine. Her background is in medical anthropology and her research interests include doctor-patient communication and health disparities.

Richard M. Frankel, PhD, is Professor of Medicine and Geriatrics at Indiana University School of Medicine and the Director of The Walther Center for Palliative Care Research and Education at the IU/Simon Cancer Center. He is also the Associate Director of the Indianapolis VA Center for Healthcare Information and Communication at the Roudebush VA. His research interests are in physician patient communication as it relates to processes and outcomes of care and organizational culture change.

Ming Tai-Seale, PhD, MPH, is a Senior Investigator at the Palo Alto Medical Foundation Research Institute, where she studies the economics of patient-physician communication and patient-centered care for patients with multiple chronic conditions.