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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
When the Dance Breeds Complicity
Unwritten Rules of Talking to Patients
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Jeff L Susman, Cincinnati, OH Professor and Chair, Department of Family Medicine, University of Cincinnati
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Dr Wittink and her colleagues provide keen insights into the nature of the interactions between physicians and patients when considering depression. Understanding the "give-and-take" and negotiation of a treatment plan is a neglected aspect of depression research. Much progress has been made in efforts to advance office systems, instill continuous performance improvement, and capitalize on the strengths and proclivities of practices. Yet, the the heart of the physician-patient encounter remains shrouded. Do continuity and shared experience breed shared complicity in a carefully orchestrated dance that avoids challenging issues? Do physicians and patients self select each other to achieve emotional equilibrium and avoid problems that might upset a forthright and stereotypical encounter? Is "being a good patient" or "they'll just send you to a psychiatrist" a learned response, a behavior modeled by physician cues? How accurately do doctor and patient assess each other's underlying motivations and preferred responses? Clearly, many provocative questions are suggested by this research. To these issues, and devise interventions that address the unwritten rules of doctor patient interactions around depression, a new generation of mixed-methods reseach should simulatenously explore the jazz between doctor and patients. Competing interests: None declared |
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Stephen P. Bogdewic, Indianapolis, IN USA Professor of Family Medicine, Indiana University School of Medicine
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The prevalence of behavioral/psychosocial issues in primary care necessitates an understanding of the perspectives patients bring to their encounters with primary care physicians regarding emotional and/or psychological concerns. Towards that end, this article offers insights for understanding the "dance" between physician and patient with regard to depression care. Having a more refined understanding of the core themes evident in how patients perceive the clinical encounter is valuable but what is the best way to act upon this knowledge? While the authors indicate that their findings have clinical implications, they offer no specific suggestions for how these findings might actually be incorporated into the clinical encounter. This article provokes additional thought about the physician's perspective in talking to patients about depression. The "dance" between patient and physician over depression care involves the patient's views of their interactions with their physician, the actual dynamics of the encounter, and the physician's views of caring for depressed patients. How are the physician's views colored by his or her (a) own emotional/psychological well being, (b)skills for treating depression beyond prescribing medication, (c) ability to be reimbursed for exploring psychological issues when no diagnosis of depression is determined, (d) attitudes toward certain patients "presentations" and (e) success rate in treating depression in a given population? Emotional problems comprise a significant portion of visits to primary care physicians. The findings in this article contribute to a richer understanding of the dynamics that impact these critical encounters. Better understanding the "tune" to which each partner may be dancing can enhance our ability to recognize and properly care for depression. Competing interests: None declared |
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