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Objective To examine whether rheumatologists and rheumatoid arthritis (RA) patients with depressive symptoms communicate about depression. Methods The data used in this study came from a randomized controlled trial to improve provider-patient communication about patients' agendas. The current secondary analysis used data collected at baseline, before any intervention occurred. A total of 200 RA patients from 4 rheumatology clinics participated in the study. Patient medical visits were audiotape recorded and patients were interviewed after their medical visits. Physicians recorded patients' American College of Rheumatology (ACR) functional status after their visits. Results Twenty-one (11%) patients were scored as having moderately severe to severe symptoms of depression. Patients who were rated by their physicians as having worse ACR functional status were more than twice as likely to have moderately severe to severe symptoms of depression (odds ratio 2.23, 95% confidence interval 1.1–4.6). Only 4 (19%) of the 21 patients who were scored as having moderately severe to severe symptoms of depression discussed depression during their medical visits, and patients initiated the discussion each time. Conclusion Rheumatologists should consider assessing depressive symptoms among their patients, especially among those with worse functional status.

Some of the most critical and difficult decisions people face involve their health. Patient educators and counselors play a key role in helping individuals to make these decisions. This decision-making role is central to the definition of patient education and counseling which emphasizes individualized and collaborative problem solving and the active participation of patients in their health care [1]. The articles in this special collection on patient decision-making provide but a few examples of the many types of decisions patient educators are called upon to help patients make; decisions concerning reproduction, medication adherence, seeking medical care, and informed consent.