Abstract
PURPOSE We wanted to understand concordance and discordance between physicians and patients about depression status by assessing older patient’s views of interactions with their physicians.
METHODS We used an integrated mixed methods design that is both hypothesis testing and hypothesis generating. Patients aged 65 years and older, who identified themselves as being depressed, were recruited from the offices of primary care physicians and interviewed in their homes using a semistructured interview format. We compared patients whose physicians rated them as depressed with those whose physicians who did not according to personal characteristics (hypothesis testing). Themes regarding patient perceptions of their encounters with physicians were then used to generate further hypotheses.
RESULTS Patients whose physician rated them as depressed were younger than those whose physician did not. Standard measures, such as depressive symptoms and functional status, did not differentiate between patients. Four themes emerged in interviews with patients regarding how they interacted with their physicians; namely, “My doctor just picked it up,” “I’m a good patient,” “They just check out your heart and things,” and “They’ll just send you to a psychiatrist.” All patients who thought the physician would “just pick up” depression and those who thought bringing up emotional content would result in a referral to a psychiatrist were rated as depressed by the physician. Few of the patients who discussed being a “good patient” were rated as depressed by the physician.
CONCLUSIONS Physicians may signal to patients, wittingly or unwittingly, how emotional problems will be addressed, influencing how patients perceive their interactions with physicians regarding emotional problems.
Footnotes
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Conflicts of interest: none reported
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Funding support: The Spectrum Study was supported by grants MH62210-01, MH62210-01S1, and MH67077 from the National Institute of Mental Health. Dr Wittink was supported by a National Research Service Award from the National Institutes of Health (MH019931-08A1). Dr Wittink was supported by a National Research Service Award from the National Institutes of Health (MH019931 08A1) and a Mentored Patient Oriented Research Career Development (K23)award(MH073658).
Presented in part at the North American Primary Care Research Group (NAPCRG) annual meeting, Banff, Canada, October 28, 2003.
- Received for publication June 8, 2005.
- Revision received December 9, 2005.
- Accepted for publication December 12, 2005.
- © 2006 Annals of Family Medicine, Inc.