Family Practice Advance Access originally published online on February 17, 2005
Family Practice 2005 22(2):223; doi:10.1093/fampra/cmh722
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Correspondence |
Which GP deals better with depressed patients in primary care in Kastamonu, Turkey: the impacts of ‘interest in psychiatry’ and ‘continuous medical education’
University of Akdeniz, Faculty of Medicine, Department of Family Medicine, Antalya, Turkey
Email: hakanyaman{at}akdeniz.edu.tr
It was with great interest that I read the article by Atilla Soykan and Bedriye Öncü in the October 2003 issue of Family Practice.1 The authors report, from a preliminary study, the impact that the GPs' level of interest in psychiatry and their participation in previous Continuous Medical Education (CME) have on their ability to recognize and treat major depression.
The authors report that GPs were selected and participated in this study. However, they do not clarify that these doctors are graduates from medical schools without a vocational training in general practice. These doctors are called doctors under such terms as ‘Pratisyen’ or ‘Medical Practitioners’ in the Turkish Health Care System. In Turkey, only the specialists of family medicine are allowed to hold the GP equivalent title, which is awarded after a three-year postgraduate clinical training.2,3 According to this, it seems obvious to compare Medical Practitioners' results with the GPs' findings in the literature. On the other hand, the statements on the management of depression and the findings of this study might not be generalizable to all primary care physicians in Turkey, because a course in psychiatry which lasts at least four months during vocational training and which is obligatory to family physicians (GPs), may certainly improve the recognition and treatment of major depression in primary care.3
Low attributable changes in GPs' detection rates might not be dependent only on personal interest to the CME subject, but also on the methods used during the CME activity or on appropriately addressing the needs of the physicians. Further, it has been shown that factors which might positively affect the CME participants are: i) the degree of active learning opportunities; ii) learning delivered in a longitudinal and sequenced manner; and iii) the provision of enabling methods to facilitate implementation in the practice setting.4 Since these methodological points were not considered during the study, suggesting that the GPs' interest in psychiatry ought to be taken into consideration when planning education and other interventions for improving the detection and treatment of depression in primary care might not be solely appropriate.
In my opinion, even though an effort has been made to prove the impact that the Medical Practitioners' interest in psychiatry has in the diagnosis and treatment of depression, and despite certain limitations of the study, there are certain points that need to be stressed: i) reliable and valid diagnostic guidelines and tools (instruments) need to be provided for primary care physicians; ii) postgraduate training of Medical Practitioners in primary care (Family Medicine) needs to be emphasized, because clinical involvement might be the best way of learning clinical subjects; and iii) trust in the primary care health system and in the medical practitioner needs to be developed, in order to increase the acceptability of clinical practice in the population. Provision of CME solely might not help to guarantee enhancement quality of mental health care in Turkey. Basic and infrastructural changes to the primary health care system in Turkey are urgently needed to manage this.
References
1 Soykan A, Öncü B. Which GP deals better with depressed patients in primary care in Kastamonu, Turkey: the impacts of ‘interest in psychiatry’ and ‘continuous medical education’. Fam Pract 2003; 20: 558–562.
2 Yaman H. Training in Family Medicine: The Current State in Turkey. Education for Primary Care 2002; 13: 394–397.
3 Yaman H, Ozen M. Satisfaction with family medicine training in Turkey: survey of residents. Croat Med J 2002; 43: 54–57.[Medline]
4 Davis D, O'Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? J Am Med Assoc 1999; 282: 867–874.
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