The first consultation for low mood in General Practice. What do patients find helpful?

Problem

Current NICE guidelines suggest that a patient’s initial consultation with a GP for symptoms of low mood is simply a vehicle for assessment, diagnosis, and the formulation of a collaborative management plan. However, patients often report to GPs that they find even initial discussion about their low mood beneficial, but this is very variable even under ostensibly similar conditions. Moreover, if the patient feels that the consultation has not gone well, they are unlikely to return or to adhere to any management plan. We therefore aimed to i) evaluate the patient perspective on whether the initial GP consultation for low mood has provided any therapeutic benefit, ii) describe the specific factors within the consultation that appear to be important therapeutically for patients with low mood.

Approach

Pilot study: Twenty patients aged 18 – 65 who presented to their GP with symptoms of low mood for the first time in the last 12 months were recruited from General Practices in the North of England. A formal diagnosis of depression was not required. Patients who were already on psychotropic medication were excluded. The patients were sent an anonymous questionnaire of our own design (modified General Practice Assessment Questionnaire (GPAQ)) within 14 days of the consultation. Likert-style responses were scored (1-5) and analysed with simple descriptive statistics for ordered, categorical data. Open-ended responses were subject to qualitative, thematic analysis.

Findings

All patients felt some therapeutic benefit (median score 4/5; 5 being maximum benefit) after their first consultation. The most common explanations volunteered by patients for this benefit were feeling that the GP had listened to, and understood their problems, had provided a diagnosis for their feelings, and had offered to help. Specific factors contributing to benefit (from a list provided) that were rated most highly were “knowing how I feel is normal”; “feeling listened to” and being “treated with care and concern”.

Consequences

This pilot study reinforces the importance of a patient-centred approach for symptoms of low mood. It confirms that patients do gain therapeutic benefit from their first consultation. It highlights the importance of time in the consultation, raising doubts about the suitability of the traditional 10-minute GP consultation for this type of presentation. The offer of treatment in the first consultation was also rated highly which questions the suggestion that first consultations should be used primarily for information gathering and assessment.