Underrecognition of patients' psychosocial distress in a university hospital medical clinic

Seventeen areas of psychosocial distress were evaluated in 87 university hospital internal medicine clinic patients by a self- administered questionnaire and a psychiatric interview. These patients' internists then predicted the patients' distress level in each area. Their predictions correlated significantly with their patients' self- reports of distress-level problems in only 3 of the 17 areas. Even when the internists felt that they had sufficient information to make an accurate prediction, their perceptions were often erroneous, including evaluations of such areas as suicidal ideation and drug use. These data suggest the need for active psychiatric education components in internal medicine training programs.