Rafael Ángel Castro Jiménez and Javier de Diego Adeliño.
The patient with major depression It is usually first detected in Primary Care and, according to the current model, it is subsequently referred to Mental Health Services. However, the doctors want “remove” this structure and bet on a shared approach with psychiatry professionals that guarantees the continuity of care for the patient.
“This type of patient is going to enter through Primary Care, not through other sites. The patient does not belong to anyone, he belongs to everyone. Barriers have been created and twe have to tear them down” claims Rafael Ángel Castro Jiménez, a member of the SEMG Mental Health Group during the XXVIII National Congress of the Spanish Society of General and Family Physicians (SEMG).
The doctor is clear that it is necessary to “remove” the clinical practice of referring the patient to mental health and forgetting about it. “This is not correct. What is effective and adequate is the shared approach”, claims Castro Jiménez, who considers that this is even greater when it comes to a patient who lives in a rural environment and is made to go to the city. “If I am the one who provides the treatment, what is the point of making him go?”, the doctor asks.
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Rafael Ángel Castro Jiménez, member of the SEMG Mental Health Group and Javier de Diego Adeliño, psychiatrist and clinical researcher at the Hospital de la Santa Creu i Sant Pau. |
Communication between Psychiatry and Family Medicine
The solution to avoid these displacements goes through a establishment of “links” so that the patient benefits from the collaboration without make “differences and forget about it”. “When he has to go see the psychiatrist, he will go, but we cannot spend all day with him. rally now you have it and now I. When the patient is more serious, they will have to go, but if they are not, a mental health approach can be given from Primary School”, Castro Jiménez claims.
These “links”, as detailed by the member of the SEMG Mental Health group, go through a communication and teleconsultation between psychiatrist and family doctor. “What we need are quick responses to the problem that comes up in consultation, not refer it,” reveals the specialist.
A vision shared by Javier de Diego Adeliño, psychiatrist and clinical researcher at the Hospital de la Santa Creu i Sant Pau: “I am a convinced of the shared approach. Many times a call or a session around the problems that we are finding in the patients is the key so that later they can be treated in the best way”.
Aspect of the room during the table ‘Treatment in patients with depression in the Primary Care consultation’. |
How to solve the lack of time to do clinical interviews?
Castro Jiménez and Diego Adeliño also share the importance of the clinical interview, however, the care conditions of Primary make it difficult for it to be done in depth. “Is he main problem we have in Primary Care”, reveals the Family doctor, who points to a possible solution: “I think this can be corrected by giving the Family doctor stability in your quota so that you really know the patients with whom he is. If I know him I can play detective and it is easier to detect warning signs in the clinical interview. That is, it takes less time.
For Diego Adeliño, knowing the patient well has a “valor incalculable”. “On many occasions, by calling the patient, you already know how things are going,” details the psychiatrist, who also assures that this is key to an early diagnosis. “You have to treat as soon as possible. If we do things early, we will have better response rates and symptomatic remission.”
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