Depression in family practice

David Rapoport

I am indebted to Dr Rachelle Sender, who wrote this haiku¹:

Fifteen minute slot

A lifetime’s stored sorrow spilled

Next: child with sore ear

Depression is life-threatening at any age. Because of a shortage of available psychiatrists, family physicians do most of the treatment, under difficult circumstances.

Like most family physicians, I am comfortable seeing 4 or 5 routine patients each hour. Unexpected longer visits for supportive psychotherapy breed chaos and resentment for other patients piling up in the waiting room. We must ignore the grumbling, because this first visit for a severely depressed patient is crucial. I call this the Kleenex moment, first for the patient during the visit and then for me after the visit when I look into the waiting room.

The follow-up can be done at a quieter time when there are fewer distractions, usually as the last appointment of the morning or afternoon. This is still less than ideal, because by this time we are hypoglycemic and suffering from information overload, having made our usual multiple inquiries and examinations with the other 15 or so patients seen by then. An apple before the visit goes a long way here. Even so, this requires a change in attitude and the patience to listen far beyond the usual 10- or 15-minute time period.

Family physicians who practise psychotherapy full time have the luxury of the 50-minute hour, with just 3 or 4 patients per half-day. The rest of us do our best.