Treatment resistant depression in primary care
Co-constructing difficult encounters
Bibliographic Data
| ID | 4218025 |
|---|---|
| Authors | Susan Mcpherson (0000-0002-9478-9932, University of Essex), Richard Byng (0000-0001-7411-9467, University of Plymouth), Donna Oxley (East London NHS Foundation Trust) |
| Year | 2014 |
| Volume | 18 |
| Issue | 3 |
| Pages | 261-278 |
| Publication date | 2014-05-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Health An Interdisciplinary Journal for the Social Study of Health Illness and Medicine (JOURNAL) |
| Journal identifiers | ISSN: 1363-4593 • E-ISSN: 1461-7196 |
| Publisher | SAGE Publications Inc (PUBLISHER) |
| DOI | 10.1177/1363459313497607 |
| PMID | 23994794 |
| OpenAlex | W2110979355 |
| Language | EN |
| Citations received | 2 |
| References cited | 19 |
Many patients with depression do not recover despite medication or therapy. Individuals with treatment resistant depression often have co-morbid anxiety, personality difficulties and drug or alcohol misuse and have been characterised as difficult, heartsink or problem personalities by general practitioners. Yet critical studies of interaction in medical settings suggest that the context may have a role in constructing the patient. A total of 12 audio-recorded routine consultations were analysed following guidelines for qualitative analysis of medical discourse. The interpretation focused on ways in which the context and structure of primary care consultations in a UK setting construct difficult encounters, which may lead to patients with treatment resistant depression being seen as difficult to manage in various ways. Three overarching observations were that presentation of multiple problems in multiple domains clash with the consultation format; that patients' atypically high level of activity in a time-limited setting prevents patient-centred work; that the question and answer format restricts multifaceted discussions of social and emotional problems, preventing shared understandings emerging. However, although interactions appear uneasy, they are repaired and may be moderately palliative. Suggestions are made for re-orienting general practitioner work with treatment resistant depression towards long-term goal setting outside of the traditional consultation structure in order to develop shared understandings
Anxiety · Personality · Personality psychology · Psychiatry · Psychotherapist · Medicine · Mental Health and Patient Involvement · Mental Health Treatment and Access · Nursing · Psychiatric care and mental health services · Psychology · Social Psychology
Talk and social structure
An Interactional Structure of Medical Activities During Acute Visits and Its Implications for Patients' Participation
Taking the history
The Hospital Anxiety and Depression Scale
On the remarkable persistence of asymmetry in doctor/patient interaction
On Studying the Discourse of Medical Encounters
Narrative Repair
General Practitioner Management of Depression
Negotiating 'depression' in primary care
A step too far
A Critical Theory of Medical Discourse
Framing the doctor-patient relationship in chronic illness
Achieving multiple topic shifts in primary care medical consultations
| Unique citing works | 2 |
|---|---|
| Citations per year | 0.29 |
| Citation span | 2019 - 2021 (3) |
| Citation velocity | historical |
| Highly cited | No |
| Citation types | Neutral: 2 |