The first consultation with a depressed patient: A qualitative study of GPs' approaches to diagnosis.

Arroll, Bruce, Roskvist, Rachel ORCID: 0000-0001-8367-0947, Moir, Fiona ORCID: 0000-0001-6585-4136, Walsh, Esther, Louis, Deana, Buttrick, Lily, Khalil, Nada, Mount, Vicky and Dowrick, Christopher ORCID: 0000-0002-4245-2203 (2022) The first consultation with a depressed patient: A qualitative study of GPs' approaches to diagnosis. Journal of family medicine and primary care, 11 (7). pp. 3934-3942.

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Abstract

<h4>Background</h4>The first consultation with a depressed patient is important because many patients do not return for subsequent visits. Therefore, the first consultation provides a unique opportunity for diagnosis (if required) and treatment, but there are risks of both under and over-diagnosis.<h4>Aim</h4>To understand how general practitioners utilize diagnosis when patients present with a new episode of depression.<h4>Method</h4>We approached a random selection of twenty-one general practitioners (GPs) in Auckland, New Zealand and asked them to participate in a semi-structured telephone interview. The interviews explored "the first consultation for a depressed/distressed patient" were undertaken to theme saturation. Interviews were hand-written and later transcribed.<h4>Results</h4>We identified three major themes in GPs' approach to diagnosis. The issue of diagnosis was underpinned by a complex understanding of depression and the GP role. GPs did not always make a formal diagnosis, but the experience of a patient's distress/depression was understood by drawing on a range of factors and resources. These included time, screening tools, clinician experience, and patient affect. GPs were careful about how they communicated a diagnosis, both in their documentation and in their conversations with patients.<h4>Conclusion</h4>At an initial appointment, the distressed/depressed patient can present to their GP with various symptoms and differing degrees of distress. GPs draw upon a variety of skills and resources to negotiate these complexities. The value of a diagnosis was questioned and issues such as impairment may be more useful concepts for GPs. This is the first study to report the findings of the first visit.

Item Type:	Article
Uncontrolled Keywords:	Diagnosis, depression, general practice, mental health, primary care, psychiatry
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health
Depositing User:	Symplectic Admin
Date Deposited:	19 Mar 2024 10:00
Last Modified:	19 Mar 2024 10:00
DOI:	10.4103/jfmpc.jfmpc_1303_21
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3179444