September Focus

[摘要] From the publication of the first studies revealing GPs' apparent inadequacy at identifying and treating patients with depression, mental health has dominated the primary care research agenda. Much effort has been expended to find a way of transmuting yesterday's erratic GPs into tomorrow's infallible diagnosticians. But for the most part this philosopher's stone has eluded discovery. On page 665 a group in New Zealand document the effect of systematic case finding. The authors conclude that it is unlikely to be a useful approach, illustrating the difficulties of using screening instruments that are always imprecise. They also found that the doctors in the study were better at spotting depression in patients they already knew, placing the discussion, in their phrase, ‘within the context of general practice continuity of care.’ The accompanying leader takes up this aspect, with the statement that ‘the diagnosis of a mental health disorder … evolves in a context of trust’ (page 659). The leader, however, also quotes the NICE guidelines, which recommend screening for depression among certain high risk groups. NICE guidelines state openly the level of evidence on which the recommendations are made, but innocent recipients of the guidelines may be forgiven for occasionally forgetting to check, and others may wonder what on earth this august body is doing including in its recommendations anything that rests on such a flimsy evidential base. Or is NICE playing a more subtle game, deliberately including ludicrous recommendations in order to signal that the others are not to be taken seriously?

[学科分类] 卫生学