ABILITY OF PRIMARY-CARE PHYSICIANS TO RECOGNIZE PHYSICAL FINDINGS ASSOCIATED WITH HIV-INFECTION

Objective.-To assess the ability of primary care physicians to identify physical findings associated with human immunodeficiency virus (HIV) infection. Design.-Standardized patient examination. Participants.-A total of 134 general internists and family practitioners were randomly selected after stratifying by year of medical school graduation, specialty, and experience caring for patients with HIV infection. Main Outcome Measures.-Recognition of physical findings of Kaposi's sarcoma, oral hairy leukoplakia, and diffuse lymphadenopathy. Results.-Despite being directed by presenting histories to sites of prominent physical abnormalities, only 23 (25.8%) of 89 physicians evaluating a patient with Kaposi's sarcoma and 22 (22.7%) of 97 physicians evaluating a patient with oral hairy leukoplakia detected and correctly diagnosed the abnormalities. Twenty-th ree (17%) of 133 physicians detected diffuse lymphadenopathy in a patient complaining of fatigue, fever, and arthralgias. Physicians with the most experience treating patients with HIV infection more frequently identified oral hairy leukoplakia, but HIV experience did not influence identification of Kaposi's sarcoma or detection of lymphadenopathy. There were no differences between general internists and family practitioners or among physicians by year of medical school graduation in identifying the three physical findings associated with HIV infection. Conclusions.-Primary care physicians may frequently miss important physical findings related to HIV infection during patient examinations,