To investigate academic physicians' interest in learning methods to reduce health care costs, we asked the faculty and housestaff of a university-based department of internal medicine to rate their interest in 30 potential topics for medical grand rounds, a traditional forum for continuing medical education. The 30 topics were equally divided among clinical, research and cost-containment categories. The 29 housestaff and the 41 subspecialty faculty members clearly favored clinical and research topics over cost-containment topics (p less than 0.001). On the other hand, the nine general internists considered the cost-containment topics as attractive as the clinical and research topics and ranked them higher than did both the subspecialists (p less than 0.001) and the house-staff (p less than 0.05). Efforts to alter costs in academic medical centers may be hampered by the relative disinterest in cost-containment education among house officers and subspecialists, who are responsible for most of the health care delivery in this setting.

Attitude of Health Personnel↗

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Depression among patients with a chief complaint of chronic fatigue.

The prevalence of mood disorders among patients with chronic fatigue was examined in a group of 100 adults who had experienced fatigue symptoms for an average of 13 years. Patients received a comprehensive history, physical and laboratory evaluation and completed the National Institute of Mental Health Diagnostic Interview Schedule and the Beck Depression Inventory (BDI). Among 44 patients with depressive illness, the onset of their first depressive episode was strongly associated with and preceded the onset of chronic fatigue. The BDI, fatigue history, demographic factors, and findings from the physical examination and laboratory had only modest success in discriminating those patients with depressive illness from other patients. We conclude that depressive illness is an important precursor of chronic fatigue.

Adult↗

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Hypochondriasis influences quality-of-life outcomes in patients with chronic fatigue.

BACKGROUND: To determine how hypochondriacal symptoms influence the quality-of-life outcomes of patients with a chief complaint of chronic fatigue. METHODS: Cross-sectional cohort study of a consecutive sample of 71 patients (mean duration of fatigue of 4.1 years). Forty-eight (68%) patients met criteria for current major depression and 32 (45%) met criteria for chronic fatigue syndrome (CFS). All patients received a comprehensive medical and psychiatric evaluation. Quality-of-life and physical, depressive and hypochondriacal symptom scores were assessed through reliable self-report questionnaires and a structured interview. A path model expressing the relation between predictor variables (hypochondriasis and depression), intervening variables (physical symptoms) and quality of life was postulated and evaluated using structural equation methods. RESULTS: The paths linking hypochondriasis with physical symptoms and mental health and the path connecting physical symptoms and quality of life were each statistically significant. The model applied especially well to patients who fulfilled CFS criteria. CONCLUSIONS: The quality of life of chronic fatigue patients correlates with the severity of their physical symptoms and their hypochondriacal disposition toward illness.

Adolescent↗

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