Letters, calls and emails: Clinical acumen, not forms, must diagnose depression

Dear Editor

Dr Liam Farrell’s column inspired me to put my own thoughts on depression down on paper (GP, 22 September).  

This morning I saw three people with depression. One had been suspended from work because of a problem with a manager; one had neighbours from hell and was going to court over it; and one had just been evicted from his home by the mother of his children.  

All three came to see me for something to stop them feeling tearful, anxious, scared and tired. They wanted help. In truth I was the least able person to provide it. All I could offer was palliative care, anxiolytics and antidepressants. The cure for their condition lay in the situation in which they lived.  

Were they ill or were they adjusting to a changing set of social circumstances?  

I admit to not asking any of them to complete a depression score questionnaire. I did not offer them unavailable services such as counselling or CBT. Instead I gave them what little time I had. In the new NHS I would be seen as a ‘bad’ doctor.  

My Collins dictionary describes depression as feelings of gloom and inadequacy. As such, it could be described as a normal state of mind, in that the majority of the population will have such feelings at some time in their lives. If it is so prevalent, can it be genuinely called a medical illness? Are we not medicalising yet another common condition, as we have done with obesity, shyness, erectile dysfunction or ADHD? Such categorisation depends on severity.  

The problem with mental illness is that it cannot be easily quantified. Attempts to do so with questionnaires are debatably validated and tend to be all encompassing. Any individual’s score might oscillate from one end of the spectrum to the other within a day.  

Ultimately, diagnosis is one of the few clinical skills left to the experience and understanding of the clinician.  

GPs, as individuals, pour scorn on such questionnaires yet as a group we meekly accept them as part of the latest quality framework provisions. One cannot measure emotions and yet we have ‘clinical’ targets whose attainment is worth 48 points. We deride the DoH for setting goals irrelevant to patient care but forget that it only acts on the advice of healthcare professionals. It does not pluck subjects like chronic kidney disease or depression out of thin air.  

Who is it that advises the bureaucrats and why are they not accountable to the rest of us who have to implement their ridiculous suggestions?  

Dr Jim Sherifi  

Colchester, Essex 

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