Programme no. 201-WS
Sadness in general practice – strengthening or undermining patient agency
Stefan Hjørleifsson*1, Joanne Reeve*2, Annette Sofie Davidsen*3, Kristina Iden*4, Gisle Roksund*5, Elisabeth Swensen*6
1University of Bergen,Bergen,Norway, 2University of Liverpool,Liverpool,United Kingdom, 3University of Copenhagen,Copenhagen,Denmark, 4University of Bergen,Bergen,Norway, 5Klosterhagen legesenter,Skien,Norway, 6Seljord Helsesenter,Seljord,Norway
* = Presenting author
Objectives: To increase general practitioners’ ability to empower patients dealing with mental problems through refining their awareness of the disempowering consequences of over- and underdiagnosis. To sharpen practitioners’ diagnostic acumen in distinguishing meaningful sadness from counterproductive depression. To enable practitioners to provide support without medicalizing social causes of suffering and turning people into lifelong clients. To encourage practitioners to promote agency in spite of declining health and loss of function as well as social status.
Background: General practitioners meet sad patients risking a diagnosis of depression in situations where distress can be readily understood in the context of disruptive life events. Sensitivity to the context of the patient and the long-term relationship between the doctor and the patient are key features of general practice. Various psychiatry-derived rating scales have been promoted to improve diagnostic efficacy in general practice in the face of an alleged increase in mental disease. However, such approaches decontextualize sadness and a diagnosis of depression can further undermine the ability to engage with an oppressive or disheartening situation.
The participants will learn from a facilitated critical consideration of their own practice, informed from the writing of scholars including Christopher Dowrick and the expertise of the workshop organizers. The organizers will bring experience from the management of sadness in nursing homes (Hjørleifsson, Iden), psychiatric labelling as a facilitator of disability (Roksund, Swendsen), the difference between spcecialist and generalist views on depression (Davidsen), a community project to demedicalise mental health care (Reeve), as well as patient centered clinical method and discussion learning methods for professional peer groups.
Method: The participants will engage with case studies in groups and role-playing sessions. The point of departure will be paradigmatic cases including the impatient mother of Lisa (14) who “just needs a quick referral to psychotherapy - the school nurse already has determined it's perfect for my daughter”, Peter (25) who is applying for a disability scheme, and Anne (86) who is a few months from dying when her son exclaims “Please doctor, I can’t bear to see mummy being so depressed. Can’t you give her an antidepressant?” Group discussions will identify general practitioners’ resources relevant to the management of these cases. These resources will be developed with theoretical input and by engaging with more complex cases supplied by the participants themselves.
Other considerations: Participants should bring relevant stories from their own clinical experience.