Knowledge and Attitudes of GPs in Saxony-Anhalt concerning the Psychological Aspects of Bronchial Asthma: A Questionnaire Study

Mark G Reed,Katrin Werwick,Daniela Adolf,Marcus Herrmann

doi:10.1186/1751-0759-4-23

Mark G Reed, Katrin Werwick + Show 2 more

Open Access

https://doi.org/10.1186/1751-0759-4-23

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Abstract

Bronchial Asthma is a worldwide condition with particularly high prevalence in first world countries. The reasons are multifactorial but a neglected area is the psychological domain. It is well known that heavy emotions can trigger attacks and that depression negatively affects treatment outcomes. It is also known that personality type has a greater effect on disease prevalence than in many other conditions. However, many potential psychological treatments are hardly considered, neither in treatment guidelines nor in reviews by asthma specialists. Moreover, there is very little research concerning the beliefs and practices of doctors regarding psychological treatments. Using a questionnaire survey we ascertained that local GPs in Saxony-Anhalt have reasonably good knowledge about the psychological elements of asthma; a third consider it to be some of the influence (20-40% aetiology) and a further third consider it to be even more important than that (at least 40% total aetiology). Our GPs use psychosomatic counseling sometimes or usually in the areas of sport and smoking (circa 85% GPs), although less so regarding breathing techniques and relaxation (c40% usually or sometimes do this) However despite this knowledge they refer to the relevant clinicians very rarely (98% sometimes, usually or always refer to a respiratory physician compared with only 11% referring for psychological help).

Highlights

Bronchial Asthma is a chronic condition whose worldwide incidence continues to rise unabated, both in richer countries and those with emerging economies [1]
About half of the GPs consider eczema and ulcerative colitis (UC) to have a mainly psychological causality. One third consider this to be so for gastric or peptic ulcers (GU/PU), whereas very few think this for hypertension, hyperthyroidism and rheumatoid arthritis
We further investigated whether the five demographical GP variables mentioned above had an influence on the awareness of psychological links; we found that female and younger doctors were more open to such a link, a difference which was statistically significant for the time working in general practice with P = 0.024

Summary

Introduction

Bronchial Asthma is a chronic condition whose worldwide incidence continues to rise unabated, both in richer countries and those with emerging economies [1]. There are many reasons for this, but perhaps a dominant one is the culture of political correctness; doctors fear offending their patients by implying their illness is “all in the mind"; we may mistakenly think that our patients themselves are convinced their illnesses are entirely physical, whereas many studies have shown that patients do incorporate psychological explanations into their health belief models [9]. We worry they will think we are saying it is their fault, that they should just pull themselves together. How would this be perceived in Britain? In America, psychosomatic medicine does have a more respectable profile as illustrated in a review article by Weiner [10]; it is still somewhat neglected there as emphasised in a JAMA editorial 1999 by Spiegel [3] who writes about how social factors are strongly linked to physical disease outcomes, their influence is often ignored

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