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British Journal of General Practice

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Questionnaire severity measures for depression

John Gillies, Stewart Mercer, Graham CM Watt, Mairi Scott and Andrew Lyon
British Journal of General Practice 2011; 61 (586): 324-325. DOI: https://doi.org/10.3399/bjgp11X572337
John Gillies
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Stewart Mercer
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Graham CM Watt
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Mairi Scott
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Andrew Lyon
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The paper by Leydon et al illustrates the continuing tension between two important elements of generalism: the biotechnical (use of the measures PHQ9 or HAD-D introduced as part of QOF) that the authors refer to as ‘hard technology’, and the biographical (a narrative-based approach to diagnosis, based on the patient's context) referred to as ‘soft technology’.

Concern about the current extent of the contractual focus on QOF, and its potential to undermine the strength and complexity of the doctor–patient relationship, that supports quality at a deeper level, was one of the drivers behind the ‘Essence of General Practice’ project led by RCGP Scotland. This concern is confirmed by Leydon and colleagues in their paper when they suggest that, in some cases, the use of these tools causes dissonance within the consultation and may in some way ‘trivialise’ the consultation. However, the article also provides some reassurance that the evidence-based debate on the merits and problems associated with some of the elements of QOF continues.

However, the central issue is this: in an evidence-based world, we should look for evidence of improvement of quality as a result of the introduction of a new instrument designed to measure performance. Is there evidence that the diagnosis and management of the complex set of conditions that are labelled as ‘depression’ has been improved by mandating the use of these tools in everyday general practice?

The authors end by quoting the excellent work done by Trish Greenhalgh where she suggests that we need to open up the ‘black box’ of clinical experience and judgement and how they interact with evidence. We concur with their suggestions that in the future, more piloting, more engagement with practitioners, and a more measured response to the difficulties caused by and pertaining to measurement would be helpful for patients and GPs alike.

  • © British Journal of General Practice, May 2011

REFERENCES

    1. Leydon GM,
    2. Dowrick CF,
    3. McBride AS,
    4. et al.
    (2011) Questionnaire severity measures for depression: a threat to the doctor–patient relationship? Br J Gen Pract 61(583):117–123.
    OpenUrlAbstract/FREE Full Text
    1. Reeve J
    (2010) Protecting generalism: moving on from evidence-based medicine? Br J Gen Pract 60(576):521–523.
    OpenUrlAbstract/FREE Full Text
    1. Gunn JM,
    2. Palmer VJ,
    3. Naccarella L,
    4. et al.
    (2008) The promise and pitfalls of generalism in achieving the Alma-Ata vision of health for all. Med J Aust 189(2):110–112.
    OpenUrlPubMed
    1. Gillies JC,
    2. Mercer SW,
    3. Lyon A,
    4. et al.
    (2009) Distilling the essence of general practice: a learning journey in progress. Br J Gen Pract, DOI: 10.3399/bjgp09X420626.
    1. Greenhalgh T
    (2002) Intuition and evidence — uneasy bedfellows? Br J Gen Pract 52(478):395–400.
    OpenUrlAbstract/FREE Full Text
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British Journal of General Practice: 61 (586)
British Journal of General Practice
Vol. 61, Issue 586
May 2011
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Questionnaire severity measures for depression
John Gillies, Stewart Mercer, Graham CM Watt, Mairi Scott, Andrew Lyon
British Journal of General Practice 2011; 61 (586): 324-325. DOI: 10.3399/bjgp11X572337

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Questionnaire severity measures for depression
John Gillies, Stewart Mercer, Graham CM Watt, Mairi Scott, Andrew Lyon
British Journal of General Practice 2011; 61 (586): 324-325. DOI: 10.3399/bjgp11X572337
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