GPs should stop making mental health diagnoses or at least use transdiagnostic labels

Problem

GPs are tempted to make mental health diagnoses but we are often seeing people on the worst day of their life and if we waited, and let passage of time assist in the diagnosis, and dealt with the issues rather than the labels we would serve our patients better. If we are going to use labels they should be transdiagnostic such as distress or stuck.

Approach

I would draw upon cross-sectional data from the Magpie study in Wellington which showed that GPs get better at diagnosing depression the more severe it is. I would also draw up a talk by Dr Allan Frances who ran the DSM-IV and is highly critical of DSM 5 who said at the BMJ Overdiagnosis conference 2018 that GPs should not make mental health diagnoses as they have little time and are often seeing patients on the worst day of their lives. The key point is really that the common conditions we see in general practice are distress (depression/anxiety) and the treatments are the same so what is the value of the label. Dowrick (2000) GPs are likely to make a diagnosis of depression if they believe they can manage it so diagnosis follows rather than precedes treatment. GPs are more likely to think in terms problems so why not dispense with the label and get on with the therapy and get the patient moving with their life. In the words of Dr Kirk Strosahl get them back in the "river of life."

Findings

As above time is better spent on getting on with treatment rather than trying to come up with a label. There is a move internationally to use transdiagnostic labels and transdiagnostic interventions e.g. Barlow DH et al The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Compared With Diagnosis-Specific Protocols for Anxiety Disorders. A Randomized Clinical Trial JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.2164

Consequences

The implications are that GPs should rarely if ever make a mental health diagnosis and we should consider stopping trying to make DSM type diagnoses, consider transdiagnostic diagnoses and get on with treatment (non drug to start with).