title: Primary care approach to dysphonia.
abstract: OBJECTIVE
  To understand how primary care physicians manage patients with dysphonia and the barriers they face when evaluating patients for voice problems.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Primary care community.
  
  
  METHODS
  A total of 933 internal and family medicine physicians were randomly selected from a database of physicians in a referral basin of a tertiary care medical center and mailed a questionnaire. Questions concerned physician comfort level in recognizing an abnormal voice, their view of the quality of life impact of dysphonia, frequency of evaluating patients for voice problems, barriers to the evaluation of voice problems, reasons for referral, and common treatments prior to referral.
  
  
  RESULTS
  A total of 271 physicians responded, for a response rate of 29.0 percent. Of those who responded, 36.5 percent routinely evaluate their patients for voice problems. Reasons for not evaluating patients for voice problems were patients not complaining about hoarseness, more pressing issues, not feeling comfortable assessing patients for voice problems, and time constraints. Chronic voice changes and not being able to understand patients' speech were the most common reasons for referral. Reflux and allergy treatment were common treatment modalities prior to referral. A total of 67.5 percent of respondents were interested in learning more about voice problems.
  
  
  CONCLUSIONS
  Primary care physicians face limitations with respect to evaluating patients for voice problems. Otolaryngologists must continue outreach efforts and collaboration with primary care colleagues in order to enhance the screening for voice problems.
authors.affiliation: Duke Voice Care Center, Division of Otolaryngology Head and Neck Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Turley
authors.forename: Seth
authors.initials: S
authors.lastname: Cohen
mesh_terms: D002983:Clinical Competence; D003430:Cross-Sectional Studies; D055154:Dysphonia / Q000175:diagnosis / Q000628:therapy*; D005194:Family Practice; D019538:Health Care Surveys; D006801:Humans; D007388:Internal Medicine; D009657:North Carolina; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012017:Referral and Consultation