GPs on the press/media rack. The Balint approach.

The Times Hannah Devlin Science Editor October 14th Reports:

“Britain is becoming a nation addicted to antidepressants because doctors are  too quick to prescribe medication for mental illness, experts have said.

GPs are 46 times more likely to prescribe medication for depression and other  mental illnesses instead of suggesting exercise, which has been shown to be  no less effective in some cases.

Research commissioned by the charity Nuffield Health also found that mental  illness appeared to have risen sharply in the past five years. Davina  Deniszczyc, Medical Director at Nuffield Health, said: “To offer workable  support early on, when a patient experiences the first signs of mental  distress, such as increased anxiety and low mood, may mean preventing a more  serious depression taking hold.”

The survey of 2,000 people showed that 44 per cent had anxiety symptoms  regularly, an increase from 33 per cent when the recession hit in 2008. The  number of people suffering from low mood had risen to 39 per cent from 31  per cent five years ago.

Nuffield Health called on doctors to provide advice about exercise for mental  health, in the same way that they would describe its advantages for heart  disease, obesity and diabetes.

Mark Porter, a GP, said that the report overstated the evidence for the  benefits of exercise. “It’s no better than any other treatment we have and  it’s certainly not something I would prescribe for a patient at the more  serious end of depression, which is a life-threatening disease.”

Only 1 per cent of those visiting their GP were recommended exercise, the  research found, compared with 46 per cent who were prescribed medication.  Only 4 per cent of patients said they would rather be prescribed medication,  if given the choice.

The Cochrane Review, which assesses medical evidence, estimates that only one  in seven people benefits from taking antidepressants. It found that exercise  was moderately more effective than no therapy for reducing symptoms of  depression — but that when only the highest quality studies were included,  the effect was less conclusive…..”

Commenting on this Dr Neville Davies (The Times Letters October 15 2013), from Hove advocates the Balint approach

We have already commented in NHSreality that Psychiatry is a good area to reduce expenditure on drugs and replace with counselling – but this should to be overt and the drugs need to be rationed out of the care of most patients. The use of budgets for the replacement of drugs with people seems eminently sensible, apart from certain psychotic and cyclothymic (Manic) conditions.

See “Does Mental Illness really exist?”

16 October 2013 Nick Triggle Health correspondent, BBC News‎ reports:

Complaints about doctors ‘double in five years’

No wonder: GPs are collapsing under the weight of increasing demand and demographics, no disincentive to see them, and limited time..  See post on Clare Gerada and her video message.

Bertram Russell’s approach was revealed when he wrote In his 1932 essay, “In Praise of Idleness”: he reckoned that if society were better managed the average person would only
need to work four hours a day”…..

The Economist article linking productivity and work (Economist Working hours) is food for thought for doctors asked to work longer hours.

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About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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