The Intrusive, Insensitive Nature of Primary Care

I had to get a PCR test for Covid today (I was negative) and before I had the pleasure of getting the swab inserted in my nasal passages I was subjected to a whole series of even more intrusive probings.

The questions on the multipage form included sex at birth and presently (just like our new EMR prompts us to document in every visit), sexual orientation, income bracket, ethnicity, food insecurity and living situation.

And this was just for a ten second nasal swab by a medical assistant.

If I had come for a primary care appointment with a medical provider, I would have received questionnaires about depression, anxiety, alcohol use, smoking, domestic abuse and maybe more.

I have several concerns about this barrage of questions before you even meet the provider. As clinicians we know that patients don’t always tell us the whole story. That is why we do pregnancy tests on nuns with abdominal pain, for example. We are supposed to use all our professional interviewing and communication skills to establish trust with our patients. That can be extra hard after they are first bombarded by the support staff with extremely personal questions.

This well intended systematic inquisitiveness is extremely insensitive and I seriously question its reliability. It seems odd to me that medical students and other staff categories have to take classes in cultural sensitivity and at the same time have a requirement to probe for personal secrets early in their interaction regardless of the age or cultural background of our patients.

I believe the statisticians are given too much power over how the clinicians work.

29 Responses to “The Intrusive, Insensitive Nature of Primary Care”

  1. 1 Mimi3664 August 18, 2022 at 8:58 pm

    Hear hear!!! I’ve refused to answer the questionnaires but was unable to complete the intake on the tablet in my large Boston practice & then referred to NP to complete (as a problem patient?) Not a good beginning

  2. 3 Mimi3664 August 18, 2022 at 9:37 pm

    I too have been dismayed (and aggravated) by these invasive questionnaires- for me they have the opposite effect, and I have refused to complete this starting the appointment on a negative note

  3. 4 Spring Texan August 19, 2022 at 10:24 am

    I agree completely. These questionnaires are extremely rude and no way to elicit sensitive information. If forced to complete them, I often lie because then I feel more whole, even though I would be candid about any of these matters and am generally a relaxed and disclosing person in a personal encounter.

    It’s really pretty TERRIBLE as is so much of our medical system even though it has a lot of good individuals working in it.

  4. 5 Marilyn E.Findlay August 19, 2022 at 11:01 am

    You are so right. We can’t turn back the times but I wish we could use more common sense in the future. I really miss being one of your patients in Bucksport. There is so much insecurity since covid. Nothing will ever be the same in my lifetime. Thank You for your posts and for speaking out against the wrongs in the world and the system we have to abide by.

  5. 6 David Masters, MD August 20, 2022 at 7:31 am

    I completely agree!

  6. 7 Robert Stuart August 23, 2022 at 11:07 am

    No, it is not in any way well-intended.

    It is rude, intrusive, and fundamentally authoritarian – all in the interest of collecting data that can be used to make a buck.

    We need to stop making excuses for those who are destroying our profession.

  7. 8 Curtis Hartman, FNP August 28, 2022 at 12:42 am

    Exactly! Data/information gathering has replaced the real reason for the patient encounter. How can we take back control of this situation?

  8. 9 Alicia August 28, 2022 at 12:54 am

    I wholeheartedly agree. I find myself working without support staff quite frequently at this stage in my career, and honestly, it is a relief to ask pertinent questions without feeling like my notes are all geared towards someone else’s agenda, i.e. TJC.
    Most importantly, being able to get to know my patients first and personally ask the questions, especially sensitive or intrusive ones, elicits a more honest and helpful answer.

  9. 10 Chris Blount August 28, 2022 at 9:30 am

    I agree 100%. I love taking care of my patients and practicing medicine. Unfortunately dealing with the EHR and all the mandatory data collection will very likely lead me to early retirement. Most days I feel more like a data entry person than a practitioner. It is mentally exhausting to me. I do not like asking all the questions or being asked all the questions when I am the patient. When the insurance companies and the government control everything this is what we end up with. We are better than this.

  10. 12 Michael H Maher August 30, 2022 at 5:01 pm

    We as a collective have all allowed this to happen. Our medical societies collect dues in order to advance ‘our’ interests; however, can’t recall when any recent inquires regards my interests nor have any of my colleagues who practice medicine. We are divided by issues we have limited control over, are not scientific and factually based and/or related to a small segment of the population. Don’t have a specific answer yet; perhaps we can challenge ourselves to start with our own issues, begin respectful dialogue, refuse to participate in divisive conversations, stop giving money to societies no longer representing us. Risky indeed, change is coming, be ready.

    • 13 CW August 31, 2022 at 8:08 am

      I’ve always said this about these medical societies, they don’t care about us, our interests nor quality of life. All they care about are the dues and their political agendas. Medicine no longer feels like medicine. We’re the ones on the Frontline, yet we really are not truly in control of how we practice. All the charting, clicking boxes, nuisance CPT coding for quality measure i.e. 1170F, 1125F, 1159F etc, etc, etc, chart requests by third parties for insurance companies is exhausting in this “information age”. And not to mention the rating of doctors by these insurances. They’ll decide if you’re good at what you do, not your patients. When the business of medicine supercedes actual patient care, that’s a recipe for disaster.

  11. 14 Jabbar Zafar August 31, 2022 at 2:51 pm

    I agree 100% This is all driven by Metrics ( Meaningless) and ACA mandates regarding screenings and does not take into account the personal nature of these questions .

  12. 15 Robert Gispanski, DO August 31, 2022 at 3:30 pm

    You all do realize that these are question that Medicare and most private insurance companies REQUIRE doctors to ask to meet “quality” standards.

  13. 17 Nancy Greenstreet September 2, 2022 at 5:09 am

    I remember a patient who was a poetry professor asking me about a specific question on one of the routine medical forms. She asked, “Are you aware this asks if I ever had a loss of conscience? Do you mean like Nixon?” We had a good laugh about the mix-up of ‘conscience’ versus ‘consciousness’.

  14. 18 H Squier September 3, 2022 at 10:38 pm

    The main reason questionnaires were developed for use in the office setting is because doctors weren’t asking their patients about potentially life threatening problems like major depression, alcoholism, smoking, and spousal abuse. Often primary care office visits are the only time patients with these issues might have sensitive problems addressed. Too often primary care doctors were happy to jump on the assembly line practice model to maximize their income. Now everyone’s patients are seen on an assembly line and no one except staff members have time to ask about these important problems. The solution is a patient centered model of care where doctors have time to actually talk with their patients. Unless you are willing to get off the money train and start addressing difficult issues yourself, stop whining about the need to use questionnaires.

    • 19 acountrydoctorwrites September 3, 2022 at 11:30 pm

      The blunt questionnaires are bogus. I’m not on the money train. I love difficult issues but questionnaires are crude And offensive. Commonsense would tell anybody that when confronted with intrusive questionnaires like that we have to clam up. I am a doctor but I would never go to one in this country and in this culture and in this climate.

      • 20 H Squier MD September 4, 2022 at 1:38 am

        The question isn’t whether they are obnoxious so much as whether they are better than nothing. If they open conversation with the physician then they are better than nothing. As a physician and educator it is clear to me that many providers would do anything to avoid dealing with psychosocial issues. The questionnaires are meant to force their hand. Obviously changing training and culture would be better than resorting to questionnaires.

    • 21 Lambert,MD. September 5, 2022 at 11:47 am

      My question would be do we have evidence that I they are better than nothing? It seems to me like we do a lot in medicine because someone thinks it sounds like a good idea, with no real evidence of benefit.

  15. 22 Donny Delp September 7, 2022 at 7:26 am

    All driven by the insurance companies.

  16. 24 Jean Antonucci MD September 7, 2022 at 6:50 pm

    The trouble is that physicians complain but do nothing .I agree with almost everything Dr D writes In Maine I am required to wrote referrals on my dime for XRT for a woman with breast cancer, for someone who needs ortho becasue they were in the ER with a tib fib fx ,for any eye problem. We never speak up. I do- I made major changes about these kinds of things when I was at the VA and yes took alot of heat. Doctors are right about what they say above-most of all of you but frankly you never DO anything We could team up and push the Medical Association to go after this referral business Why should I get those consultants paid and waste time reducing access for patients? We never put our foot down.We never demand respect. We need to join up and refuse to do somethings while proposing better.

  17. 25 David Gray September 9, 2022 at 10:44 pm

    Just say no

    • 26 acountrydoctorwrites September 9, 2022 at 10:47 pm

      That means not accepting insurance, you know…

      • 27 David Gray September 9, 2022 at 11:05 pm

        I stopped accepting any & all insurance 20 years ago. I left reimbursement hassles to the patient. My charges were transparent & upfront. My patients got my full, unrushed attention. Apparently they felt that the old Doctor-Patient relationship was worth it, as they kept coming back.

  18. 28 Robert Bayer MD September 10, 2022 at 2:33 pm

    I agree, too much questioning by staff inappropriately. Way too much intrusion by assistants who do not have a need or right to know. We don’t need to know if you were a planned conception or a “whoops” unless it is pertinent to the problem.

  19. 29 J. Jellen November 7, 2022 at 7:19 am

    My question: Is there any way to collectively and hopefully effectively voice opposition to these blunt, insensitive questionnaires? Can someone start a petition at least?

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