Stress Reduction Talks Uncommon at Doctor Visits

Although stress is common among people with health problems, few primary care doctors take time to discuss ways to reduce stress with their patients, a new study suggests.

The results show just 3 percent of visits to primary care doctors include discussions of stress reduction, the researchers said.

That's much lower than the 60 to 80 percent of doctor's visits thought to involve stress-related health problems, the researchers said.

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Stress counseling was also less common in the study than nutrition counseling, which occurred in about 17 percent of visits, physical activity counseling, which occurred in 12 percent of visits, and weight counseling, which occurred in about 6 percent of visits.

"The low rate of [stress] counseling points to potential missed opportunities, suggesting that physician counseling about stress has not been incorporated into primary care to the extent of other types of counseling," the researchers write today (Nov. 19) in the journal Archives of Internal Medicine.

Primary care doctors, already crunched for time during office visits, may feel they simply can't fit in a discussion about stress management, the researchers said. Indeed, office visits in the study that did involve such discussions were longer.

Changing primary care so that patients are treated by teams of doctors could address this issue, said study researcher Dr. Aditi Nerurkar, a primary care physician at Beth Israel Deaconess Medical Center in Boston. Physicians could partner with nurses and other health care providers who could counsel patients on stress, Nerurkar said.

Stress and disease

Studies have linked stress to high blood pressure levels, heart disease and heart attacks. In fact, another study published today in the same journal found a link between unemployment — a stressful circumstance — and an increased risk of heart attacks.

While stress does not necessarily cause these conditions, it may exacerbate them, Nerurkar said. Stress may also make diabetes harder to control, and affect how people perceive chronic pain.

Nerurkar and colleagues analyzed information from more than 34,000 visits to 1,263 physicians between 2006 and 2009. They looked to see whether the office visits included information on ways to reduce stress, such as through exercise or yoga, or if doctors referred their patients to a specialist to discuss stress reduction.

A little more than 1,000 of the visits included stress management counseling. Patients were more likely to be counseled for stress if they were experiencing a flare-up of a chronic condition, or if they had depression.

This suggests doctors are not preventing stress-related complications, but rather, counseling patients after the fact, the researchers said.

Does stress management work?

Offering stress counseling earlier could lead to better outcomes for patients, but more research is needed to study this, Nerurkar said.

Dr. Doug Campos-Outcalt, chairman of Family, Community and Preventive Medicine at the University of Arizona College of Medicine, said the results should be interpreted with caution, because the study only looked at whether stress counseling was being offered, not whether patients actually needed this counseling.

In addition, it would be important to know how often patients are helped by stress counseling, said Campos-Outcalt, who was not involved in the study.

Nerurkar said that because stress is a culprit in so many medical conditions, "we could all benefit in managing our stress better."

One recent study found that patients with heart disease who practiced meditation — a possible way to reduce stress — had a reduced risk of death during the study period compared with those who did not practice mediation, Nerurkar said.

Pass it on: Few primary care doctors counsel their patients about stress management.

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