With an increasing number of individuals seeking mental health care and insufficient specialized personnel available many patients find themselves in their family doctor’s office. Studies show that 74% of people seeking help for depression(1), for example, will book an appointment with their family doctor first. With little time allocated to each consult and the lack of study in the domain, general doctors are not always the optimal option. Often (but not always) , the doctor talks with the person a few minutes, writes a prescription and does one or two follow ups. As primary care doctor at Massachusetts General Hospital, Suzanne Koven, puts it “You deserve better.”(2) Of the cases diagnosed by clinicians it is estimated that up to 50% are misdiagnosed.(1)
A few months ago, my best friend was on the phone for one and half hours talking to a nurse who was evidently following a questionnaire to figure out what she had. The following month she received a letter saying she had been diagnosed with “Generalized anxiety, depression, bipolar disorder, borderline personality disorder, bulimia and anorexia” and was given a few websites for self help. In my opinion, there were two major issues with the procedure. First, go back to that phone call and realize that a question such as “do you sometimes not eat for a whole day?” and a positive answer to that is obviously categorized into “anorexia.” The answers were categorized, whereas most mental health problems require someone to find out the reason for the answer. Had she seen a professional they would surely have asked for more details, did she do this because her body image was distorted or because it was a way of “hurting” herself? The first response would probably suggest an eating disorder whereas the second could be a way to self mutilate which would rather explain a personality disorder. A psychiatrist who specializes and has expertise in diagnosing and treating mental illness probably has more chances to correctly diagnose a patient rather than give them a whole set of “labels” based on a questionnaire which uses a categorical approach. Usually based off the DSM-5, these tests are overly broad leading to over diagnosing patients and there is a high degree of overlap between mental disorders which could lead to misdiagnosis. Second, the results generated by the test only made the situation worse by diagnosing her whitish many problems and then letting her to herself to sort things out by reading articles online.
Although there is no perfectly constructed diagnostic system yet, this simplistic questionnaire is not the most accurate method we have today. Even though, hiring more psychiatrist is no quick and easy task, people’s lives are at risk, including my friend’s who was two months later hospitalized for mental health issues which could possibly have been avoided.
(1) “Understanding Depression Treatment”. WebMD Medical Reference. (2005).
(2) “Should Mental Health Be a Primary-Care Doctor’s Job?”. The New Yorker. (2013)
(3) “Problems With The Diagnostic System For Personality Disorders. MentalHelp.net.
(4) Reed, V., Gander, F., Pfister, H., Steiger, A., Sonntag, H., Trenkwalder, C., Sonntag, A., Hundt, W. and Wittchen, H.-U. (1998), To what degree does the Composite International Diagnostic Interview (CIDI) correctly identify DSM-IV disorders? Testing validity issues in a clinical sample. Int. J. Methods Psychiatr. Res., 7: 142–155. doi: 10.1002/mpr.44
