The Article in Brief

Unwritten Rules of Talking to Doctors About Depression: Integrating Qualitative and Quantitative Methods

Marsha N. Wittink MD, MBE, and colleagues

Background Communication between patients and doctors can influence patients’ health and their willingness to follow treatment recommendations. In this study, the authors set out to understand how older adult patients with depression view their relationship with their primary care doctor and whether that relationship influences the ways they communicate about depression.

What This Study Found Participants’ views of interactions with their doctors included the following themes: (1) “My doctor just picked it up.” Some patients feel that their doctor can “pick up on” aspects of their mood without needing to elicit them directly from the patient. (2) “I’m a good patient.” These patients feel that the doctor doesn’t view them as depressed, perhaps because they think of depression as a moral failing or because they want to avoid complaining or burdening the doctor. (3) “They just check out your heart and things.” In this case, patients do not bring up emotional issues because they may believe their doctor will not be interested. (4) “They’ll just send you to a psychiatrist.” Patients who expressed this opinion feel that the doctor would send them to a mental health specialist, rather than directly addressing any emotional issues.

Implications

• Patients’ expectations and experiences with depression may have an impact on what they are willing to tell the doctor.
• The give-and-take between patients and doctors is dynamic, a “dance” of sorts that influences doctors’ ability to recognize depression and negotiate a treatment plan.
• Doctors may, knowingly or unknowingly, signal to patients how they will address emotional problems. This influences how patients perceive their interactions with doctors about emotional problems.