Experiencing depression, experiencing the depressed: The separate worlds of patients and doctors

Abstract

Using findings from a qualitative study of the management of depression in primary care, this paper explores the ways that doctors and patients conceptualise and respond to depression as a problem in the specific organisational context of primary care. This is done by drawing on the narratives of patients and their general practitioners (GPs). Twenty-seven patients and 10 GPs were recruited from 10 different practices in the Greater Manchester area. Patient accounts from the semi-structured interviews illuminated the background to, and ways in which, people made contact with and experienced, help seeking, consultation and management. While the need for help was pressing and anxiously sought, the overall contact with primary care was found to be of relatively little significance when set against the magnitude of their experienced problems. Our analysis suggests that the perceived nature of primary care provision and whether or not the nature of their problem was perceived to be legitimate influenced expectations. Dealing with depression, from a GP perspective, constitutes work that is shaped and constrained not simply by individual preferred treatment decisions, but by the wider formulation of medical knowledge and practice, and the political organisation of resources and professional interactions in primary care.