Diagnose Depression

This article below refers probably to the Zung Depression Scale, or a similar scale, and helps us remember, in the wake of recent events, the importance of intervention and vigilance. This is in the wake of thirty two people killed, along with the gunman, and at least 15 injured in two shooting attacks at Virginia Polytechnic Institute a few days ago.

As a medical transcriptionist who works in Electronic Medical Records (EMRs) I see the value of participating in “risk management,” as well as helping to cue health providers on necessary but possibly overlooked tests. Electronic medical records help participate in risk management. Medical transcriptionists work every day in thousands of jobs across the nation in EMRs.

Ben Brewer quoted below writes a column for the WSJ. The incidence of depression goes from 3% to 6% detection using software. In the 1980s a group found suicide risk detection was improved dramatically. This article, and the thoughts from the forum tagged at the end came to our attention here, and I hope that you will find the article and comments thought provoking.

A Family Doctor Tries Harder To Diagnose Depression April 3, 2007

The teenager in the cryptic-looking black hooded sweatshirt thought his mom's concerns about his mood were overblown. She didn't.

His creative writing projects at school were all about death. Was he the next Stephen King waiting to be discovered or a severely depressed guy who didn't realize how much help he needed?

I fired up the depression-screening questionnaire on my laptop and left the room, giving him time to fill out the survey. He seemed more comfortable left alone, answering multiple-choice questions non-judgmentally offered by the computer than asked by the doctor.

In a few minutes we had the results of his test. They showed he was depressed and indicated that he had considered suicide.

We talked about his issues. I started him on antidepressant medication and referred him for counseling. Without the computer's help, I might have written off his odd thought process as just a teenage phase.

We both are curious to see how treatment of his mood problems will affect his writing.

DOCTOR'S OFFICE FORUM

Ben Brewer is trying to find smarter ways to diagnose depression among his patients. What's your experience with doctors and others in the medical community when it comes to depression? We invite you to weigh in. Readers are strongly urged to participate in the forum rather than write to Dr. Brewer directly, as he can't always answer all reader mail.

rimary-care physicians treat a lot of depressed patients, but they miss a lot of depression too. (See this study)

I'm working to change that in my practice by using my computer to help. Many general practitioners rely on their intuition and their suspicions to guide them but don't evaluate each patient in a systematic way or use a computer to double-check their initial impression.

I pay about $50 a month for medical-history-taking software. I can pull out individual psychiatric surveys that have been researched, validated and referenced in journals. I don't think them up on my own.

Perceived time pressures may keep other doctors from using them. When you're already overworked it can be hard to try a new thing. Besides, why pay $50 to do something you already think you're doing well.

I pay up, because I think it's especially important for a family doctor in a rural area far from an academic medical center to be in tune with depression. Without a psychiatrist or a trained counselor in the community, the family doctor sees most of the mental-health problems. There are limited resources for treatment. I treat most depressed patients I see myself and refer some; many patients don't want to travel 20 miles or so to see a counselor even though I think they should.

One in five patients I see for medical care has depression and on some days it seems like more. Other than creating an atmosphere where the patient has enough time to really talk to the doctor, we don't do anything to specifically to attract these patients. They come from all walks of life -- the bank manager, the stay-at-home mom, and the welfare recipient that's never held a steady job in the seven years I've known her.

The computer had some interesting findings for a stay-at-home mom with three kids recently. She was taking three medications for a combination of anxiety and adult attention deficit disorder from another doctor without much success. The computer indicated she may have bipolar disorder instead. I referred her on for a psychiatrist's evaluation. She'll travel an hour from my office to have that done.

Potentially suicidal patients are a particular challenge, especially if they are uninsured. They must be transported by ambulance to a big city ER. to make sure they get there in one piece. Once at the ER. they must have a medical evaluation to see if they are "medically stable." This is often a repeat of the exam that I did in the office. Mental-health intake workers interview them and too often for my comfort they are sent home without seeing a psychiatrist at all. Now they have an ambulance and ER. bill for thousands of dollars and no practical way to follow up with anyone other than me or the county mental health facility 30 miles away.

Last year we volunteered our office as a research site for a three-year study of post-partum depression funded by the National Institutes of Health. We've identified one suicidal post-partum patient in the last year in the course of the research work and found several others in need of treatment. Finding one severely depressed person that we might not have found otherwise makes the extra effort worth it.