>How do GPs see what I call depression? What factors are most relevant e.g.
suicide risk or coping skills? What makes GPs fail to recognise what I have
been taught is so important and continue to do so?
What really pisses me off (amongst other things) is consultant psychiatrist
who come along with suicide roadshows telling us that we need to reduce
suicide rates. They then tell us that most suicides give out signals in the
previous 24 hours that they are going to kill themselves. Yet in our
practice the young, single men, who seem to be the majority of those who top
themselves, have not had any contact with their GP before death. Secondly
the very patients who do come to our attention as making suicidal ideas and
are referred on immediately, seem always to be dismissed as not depressed
sufficiently to need admission.
(AND I spent six months doing psychiatry!!!!)
Dr GM Trowell
Highbridge Medical Centre
Highbridge
Somerset TA9 3YA
01278 783220
[log in to unmask] this bit
Highbridge - a cemetery with lights
-----Original Message-----
From: Mark Winston <[log in to unmask]>
To: David Gill <[log in to unmask]>
Cc: [log in to unmask]
<[log in to unmask]>; [log in to unmask]
<[log in to unmask]>
Date: 05 February 1998 16:25
Subject: Re: "Reverse Diagnosis"
On Thu, 5 Feb 1998 09:22:30 +0000, you wrote:
>Clinicians don't always (/often?) proceed from symptoms to
>examination to diagnosis to treatment in a linear fashion.
>
I think that you have touched on an important issue here. Could I
expand your question a bit: is recognition of any disorder related to
the ability (subjective or objective) to treat it? From my reading of
the primary care literature there seems to be no close relation
between prompted recognition (telling GPs that this or that patient is
actually a 'case') and outcome - please correct me if I am wrong. So
what influences recognition? What about such issues as salience
('condition X doesn't matter') or perceived inability to influence
outcome ('I see hundreds of X - i haven't a clue what to do' or 'this
needs a cognitive therapist - but the nearest is 50 miles away') or
concepts of outcome ('you will get over it' or 'what's the point - he
will always be that way')?
Given the apparent deluge of common mental disorder (CMD) in our
communities this must be an important issue.
I am also intrigued by another phenomenon. Primary care depression
was, i suspect, first identified by social psychiatrists. The concept
of clinical need was then passed on to GPs as their problem.
Subsequent papers and campaigns have reinforced the message that GPs
should spot and treat CMD, do not do it adequately, and should get
rather better at it. As a practicing psychiatrist who has undergone
GP training I am faintly embarrassed by such presumption. How do GPs
see what I call depression? What factors are most relevant eg suicide
risk or coping skills? What makes GPs fail to recognise what I have
been taught is so important and continue to do so?
Could we ask what makes psychiatrists act as they do - and get so
upset when the rest of the world does not think as they do? Is there
any literature on case recognition processes used by psychiatrists?
regards
Mark
|