Robert E. Rakel, MD

Stress affects daily activities, influences the way symptoms are perceived, and detracts from quality of life; it plays a role in everyone’s life and is a component of every illness. The responsibility of the primary care physician is to help manage the stress and recognize when specific therapeutic measures are needed. The fourth edition of The Fifteen Minute Hour presents biopsychosocial approach concepts from the earlier editions of the book and provides new material to make the principles and techniques more useful to primary care health professionals.

ABSTRACT: Many patients with diabetes are anxious or fearful about the disease. These negative emotions stem in part from the fact that the patient is responsible for many facets of diabetes management, such as exercise, dietary modification, and blood glucose measurement. For example, failure to adhere to a regimen may engender guilt. Up to 30% of patients with diabetes are depressed, and hemoglobin A1c levels are higher in such patients. Even patients with good metabolic control may not be doing well psychologically. It is thus essential to ask about patients' concerns and fears, identify their psychosocial needs, and provide emotional support.