Maxwell, Margaret.

2018-05-22T12:44:47Z

2018-05-22T12:44:47Z

2003

Despite UK general practitioners being responsible for helping people to manage most emotional distress and the majority of psychiatric problems very little is known about how they do this in their everyday clinical practice. There has been very little systematic research on general practitioners' views of their work and little critical reflection on the issues of 'problem definition'. In addition, whilst the perspectives of patients have been placed at the core ofthe development of health services, there has been relatively little research on the patient's perspective of depression and its management in primary care. This study explored the management of depression from both general practitioner and patient perspectives

Using qualitative interviews, 37 women and 20 general practitioners were recruited from practices in four NHS Board areas of Scotland. Each participant was interviewed at the start ofthe study, and 30 women and 19 general practitioners were re-visited approximately 9-12 months later to review the process of care. The interviews explored how women made sense oftheir experiences, and their evaluations of their care; and how general practitioners made sense of the women's experiences and how they subsequently managed these women in the context of everyday practice.

In making sense of their depressive experience and its management the women drew upon a range of experiential, biographical and common-sense knowledge surrounding health, illness, emotions, depression, antidepressant medications and medication use in general. However, the generally negative views surrounding depression and antidepressants created a moral dilemma for the women in accepting the diagnosis and its treatment. The women did not passively accept their general practitioner's explanation and advice but evaluated this in relation to their own knowledge. They continually evaluated 'formal medical knowledge' and care in relation to their own understandings and as new knowledge (experiential and common-sense knowledge) emerged. General practitioners recognised that patients brought their own understandings to the consultation and their management involved eliciting patient beliefs and addressing the moral dilemmas that some of these beliefs created for the women. General practitioners had to negotiate care by addressing patients' concerns and sometimes acted strategically in order to persuade, or coerce, patients to accept their advice and treatment.

These findings are discussed in relation to the 'medicalisation' thesis through reflecting on patient and professional discourses concerning depression and its management, the doctor-patient relationship, and the doctor-patient interaction. I draw upon the later work of Foucault which affords patient agency through the 'technologies of the self and also on the work of Habermas and the relationship between 'system' and Tifeworld' as a theoretical basis for discussion of these findings. Finally, I consider the implications of the findings for recent policy developments which call for depression to be managed as a chronic disease and comment on the applicability of current guidelines for the management of depression to general practice. I conclude that the development of any management strategies should be based on a consideration of the 'patient's perspective' and acknowledge that 'formal medical knowledge' plays only a part in the management of depression in primary care.

http://hdl.handle.net/1842/30456

The University of Edinburgh

Annexe Thesis Digitisation Project 2018 Block 19

Already catalogued

Making sense of the experience of depression : general practitioners' and women's accounts of the management of depression in primary care

Thesis or Dissertation

Doctoral

PhD Doctor of Philosophy