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NYC's recipe for depression
New York is beginning a broad, citywide program to encourage primary care doctors to screen people for depression. Participating doctors (and the goal is to have ALL primary care doctors in the city hospital system participating) will ask any patient they consider at risk nine questions, developed in tandem with the RAND corporation: In the past two weeks, how often have you been bothered by trouble concentrating on things? Feeling tired or having little energy? Poor appetite or overeating?
Not making the list: How many hours a week are you working? Do you get along with your boss? Have enough money to pay rent? Recent break-ups? Family problems? You get the idea...
The Experts say screening is necessary because so many depressed people go undiagnosed. And that very well may be, but methinks the dangers of a program like this outweigh the benefits.
(The New York Times)
Posted by Carrie McLaren on 04/14/2005 | Permalink
Comments
The reponse "feeling tired or having little energy" is weighted with exactly as much importance as "thoughts that you would be better off dead, or hurting yourself in some way".
I wonder where "watching the Tony Danza show while eating cereal straight from the box, dressed only in a t-shirt and one sock" ranks -- 'cause that's what I'm doing right now and it feels pretty good.
Posted by: Damian | Apr 14, 2005 1:49:31 PM
Damian, your little flip comment perfectly demonstrates how critical it is for doctors to diagnose depression and mental illness, and the challenges that face primary care physicians. I come from the perspective of a person who a) has been treated intensively for major depression for the last year and a half, and b) has a brother who is a primary care physician (MD in internal medicine). You obviously have never dealt personally with depression or had a loved one confront it. I assure you, no one would want to live the life I faced each day for the last 18 months, including a 6-month period where I simply could not work (I'm just back at work over the last few weeks).
Mental illness and depression in particular have a stigma attached to it. Think of all the insensitive things people say casually every day, "you're driving me crazy", "he ought to be in the looney bin," or even worse gestures; many people are scared of society's stigma and don't want to be "mentally ill", as if it's something to be ashamed of, a character flaw. Well-meaning friends who don't understand want you to just "snap out of it", or "quit being lazy" or "cheer up."
My brother (who was the first person I approached when I thought something was wrong) sees a lot of patients who would NEVER go to a psychologist or psychiatrist, due to that stigma. He asked me a series of questions, basically the questionnaire mentioned in the article, and stated that there was a good likelihood I was suffering from depression. From there, I went straight to my own primary care physician, and from there to a psychiatrist (and then a therapist and psychiatric clinic as well). But many other people suffering from depression will NOT be as direct in confronting it as I was.
My brother takes the initiative in investigating possible depression when he suspects it might be present in a patient, but he's only 34, he's not an old-school-physician-for-40-years that may not be as vigilant. He prescribes many antidepressants to these patients, under the mindset that the benefits of prescribing antidepressants greatly outweigh the chance that these people are not in fact depressed. Of course, he doesn't ask someone nine questions and then simply hand them a pile of prozac samples. The questions are simply a vehicle for the patient to open up so that the physician can get them appropriate care (ideally through a referral to a mental health professional).
As you can probably guess, I think NYC's idea is fantastic, and WILL save lives, without question.
Posted by: Doogie | Apr 16, 2005 7:22:50 PM
The problem is that the average doctor isn't your brother; s/he is someone who's got five minutes to see you and who may very well be more concerned about HMO reimbursements and skyrocketing insurance costs than your well-being. In judging programs like this, you can't only consider ideal uses of the RAND test (as a "conversation starter"). You need to consider how the test will inevitably be used by lesser practitioners.
Ages ago, I was subjected to one of these "screener" tests myself, after going through a serious bout of insomnia and seeking help at the university hospital. The first words out of the psychiatrist's mouth (or at least the first I remember) was: "have you considered suicide?" or something to that effect. I hadn't -- until then. (A version of this question is on the depression screener.) In my fragile state, the effect was devastating; it didn't make me want to commit suicide, but it was a clear sign that this woman had no fucking clue, that she wasn't seeing me as an individual, and that I wasn't going to find the help I needed there.
Years later, I asked a friend who's a psychiatrist why on earth a doctor would approach the suicide issue in such a way. His answer: malpractice insurance. If the doctor doesn't ask and the patient commits suicide, the doctor can be held liable. One of the dangers with the NY program is that once administering this test becomes common practice, it'll become in some ways mandatory.
People suffering from depression or another mental illness need to WANT to be helped. You sought out your brother, which is different than going to the hospital for a broken leg and then being subject to a test.
I don't agree with everything they have to say, but anti-psychiatry groups like Mind Freedom and the stories their members tell (think forced drugging and institutionalization) show the serious flaws in programs like these.
Posted by: carrie | Apr 17, 2005 10:24:17 AM
