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Despite high prevalence, emotional distress among primary care patients often goes unrecognized during routine medical encounters.

To explore the effect of communication-skills training on the process and outcome of care associated with patients' emotional distress.

A randomized, controlled field trial was conducted with 69 primary care physicians and 648 of their patients. Physicians were randomized to a no-training control group or one of two communication-skills training courses designed to help physicians address patients' emotional distress. The two training courses addressed communication through problem-defining skills or emotion-handling skills. All office visits of study physicians were audiotaped until five emotionally distressed and five nondistressed patients were enrolled based on patient response to the General Health Questionnaire. Physicians were also audiotaped …