I read a post on another blog recently about doctors and depression. The gist of it was that visiting the doctor with depression ended in a prescription for prozac and no questions about feelings or causes. I found that very disappointing. I hope that's not how my patients feel when they present-- as so many now do-- with depression.
To fully understand what we are treating we need to know a little at least about feelings and causes. The only problen is, at initial presentation, talking about scary stuff like feelings, especially to Anglo-Saxons, tends to provoke tears and embarrasment, so many docs don't like to go there. Me I just make sure I have plenty of hankies on hand.
Two weeks in to treatment all talk of feelings and causes is modified by the invisible "prozac forcefield" that kicks in to push all the scary stuff away long enough for people to get better. So why are we so keen to prescribe pills anyway. After all, current guidelines would have us consider Cognitive Behavioural Therapy (CBT) for mild to moderate depression, even ahead of medication.
Well, here's the deal. Doctors like to fix things. It's what we spend our lives trying to do, though many on the receiving end of our ministrations might not appreciate that fact. We know that, for true depression, modern antidepressants work, and work much faster than the old ones used to, and they are actually pretty safe (unless you are an amrerican teenager at least). We also know that CBT, though invaluable, is often not accessible for many months (around 9 at present locally).
AND any GP who has been in practice any length of time knows of several patients who have declined meds and ended up seriously self harming, or dying as a result.
Its hard to talk about the important stuff in a 10 minute consultation, so I choose to overrun, and get nagged about my time management as a result. Others react to the pressures of the surgery differently, but we all mean well, and we all want to help make it better.
There's lot's more to say, but now's not the time so I'll post this and see what happens.