Definition of "clinical depression" ?
Q.What if the doctor takes a superficial history, does a superficial examination, runs a Chem 20, CBC, thyroid panel, and sed rate and doesn't ask the questions on the list? Would that be a valid diagnosis?
A.It would be difficult to defend GPs against claims of them being superficial. It's difficult to know without having a videotape of the consultation, but I think that if a GP diagnosed depression, they're probably right. Whether the diagnosis is right or not, the treatment (whether CBT or antidepressant) can be trialled. If the treatment works, then the diagnosis is good enough. It's not at all unscientific, I think, to trial a medication on the hypothesis (but not proof) that a person has a disease. You can then change your mind about their diagnosis if the meds doesn't work, or stick with it if the meds do work. Several studies have shown that asking just two questions, "Do you feel depressed," and, "do you no longer enjoy things you used to like to do," is a highly accurate screen, Furhter questions can be explored depending ont he answers and to help identify "target symptoms" to be treated. The truth is that a superficial interview is all that is need eot accurately diagnose the majority of cases of depression. I know it is counter-intuitive. And surprise, surprise, those two questions are asking about two of the three core symptoms of depression under ICD-10: anhedonia and low mood. Definitely, but DSM-IV and ICD-10 aren't greatly in-depth anyways. If you look at the criteria, there are only about 10 general symptoms to ask anyway. That can be done in about 1 minute. most of the other symptoms in the criteria are to gauge severity (mild/moderate/severe with or without somatic symptoms). the original question with the clear agenda to sue someone for malpractice: I don't think the doctor's practice is wrong. First as we all know there is the hierarchy of disease in psychiatry and ORGANIC is the one on the top, so the doctor was right to look for organic causes first. Secondly, a superficial history will often obtain enough data in the mental state exam to make a diagnosis. Thirdly, as we know most doctors don't require patients to do a full DSM-IV questionairre to diagnose depression, according to Bolan's Principle, this doctor is in the clear.
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