In This Issue: Trade-Offs, Time Use, Depression Care

In this issue, we feature an essay¹ and 2 editorials^2,3 that debate the appropriate balance between investing in developing new technologies vs devoting resources toward improving systems of care to deliver services already known to be effective.

In an interesting empirical twist on this topic, Alper and colleagues evaluate a new technology for bringing synthesized evidence to answer physicians’ clinical questions.⁴ This randomized controlled trial (RCT) shows the feasibility of providing point-of-care information that alters patient care.

Two novel studies involving medical student research fellows as direct observers examines how family physicians spend time outside the examination room. Finding a similar percentage of time spent on face-to-face patient care (55% and 61%), these studies show substantial devotion to patient care activities that may not be adequately reflected in current billing codes and reimbursement procedures.^5,6 These studies also provide a model for engaging medical students in direct observation research.

Another pair of studies examines suicidal ideation among depressed primary care patients. The study by Schulberg et al finds a low risk of suicide among depressed primary care patients.⁷ This risk remains fairly stable over 6 months of follow-up. A randomized study by Nutting and colleagues shows that brief physician and nurse training in primary care can double the rate of initial detection of suicidal ideation.⁸

A study of physician quality of life finds that physicians in independent practice (vs being employees) work longer hours but report greater satisfaction and less intention to leave practice.⁹ In the face of diminishing student interest in family medicine, these findings have implications for retaining and enhancing the effectiveness of our current primary care work force.

Although an emerging body of research examines medical errors, the effect of patients’ experience of a preventable problem has not been examined. The qualitative study by Elder and colleagues finds that among patients who have lived through a preventable medical problem, anger is common, as is mistrust and resignation.¹⁰ This analysis classifies patient responses into 4 categories: avoidance, accommodation, anticipation, or advocacy, each with different implications for subsequent health care.

A new patient literacy screening instrument is subjected to a rigorous evaluation in a methodology study by Weiss and colleagues.¹¹ Given the frequency of low literacy and its effect on health and health care, this instrument deserves attention for both research and clinical use.

An essay by Buetow argues that “care” is defined by “coprovision” in which clinicians and patients each contribute expertise in their domain.¹² This analysis provides an alternative to both medical paternalism and patient consumerism through mutual responsiveness and responsibility.

We invite all Annals readers to participate in the online discussion of these articles at http://www.annfammed.org.

• © 2005 Annals of Family Medicine, Inc.