Sarcoidosis: An Update for the Primary Care Physician

Oluranti A. Aladesanmi, MD, MPH

In This Article

The Role of the Primary Care Physician

Sarcoidosis patients have a disease burden that is physical, emotional, and usually complicated by psychosocial problems because it affects people during the most productive years of their lives. African American individuals are disproportionately affected, and sociodemographic factors such as financial, employment, health insurance, and literacy issues affect the processes and outcomes of healthcare in these patients and must be explored in all patients.

Communication skills are vital in the recognition and management of psychosocial contributors to health and illness.[18] In particular, sarcoidosis patients may present with vague or classic clinical problems, and the prevalence of depression in these patients may be as high as 60%.[19] A supportive primary care physician relationship is important and would likely improve health outcomes and facilitate collaboration with other subspecialists involved in the care of the patient.

It has been reported that psychosocial difficulties may prompt up to 50% or more of outpatient generalist visits and cause as much or even more functional impairment than do strictly physical complaints.[20]

The delay in the diagnosis of sarcoidosis is a problem because of the potential for unnecessary healthcare costs that may be out of pocket, extra office visits, unnecessary diagnostic testing, inappropriate treatments before the diagnosis is made, and the frustration, anxiety, and depression experienced by patients when physicians do not diagnose or treat their illness in a timely way.[13]

Another important function of the primary care physician is the education of patients about the unknown etiology of the disease, its prognosis, and treatment options, including the risks and benefits. Exploring patients' explanatory model of illness, sociocultural background, and particular fears and concerns would be helpful in negotiating a therapeutic plan, especially when decisions about invasive tests like bronchoscopic biopsies or initiation of corticosteroid therapy have to be made. This model of communication, abbreviated ESFT, has been applied to the care of hypertensive patients in minority communities to facilitate communication with patients who may have limited understanding of their illness and are nonadherent to testing and treatment plans recommended by their physicians.[21]


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