Dear GPs

When someone with a history of depression comes to see you, please take the time to actually ask them how they are.  It is not easy to say you are feeling very low, it's not easy to relax your public mask and admit you are struggling.  How much more difficult do you think you make it by a brisk "What can I do for you?"  Clearly you are busy, clearly it is much more convenient for you to just write another prescription and move on to the next patient.  What does it matter that the person you've just hurried out of the door now feels even more worthless than she did when she walked in?  Do you care that she had to hide in the ladies until she had stopped crying enough to go home?  Do you care that she now thinks she is not important enough to be taken seriously?

It is difficult in these days of large surgeries for GPs to get to know their patients as they did when medical practices tended to be smaller.  Surely then it is even more important to ask questions and try and draw out from the patient the true extent of their illness than it was when the patient's demeanour could let you know they were not themselves?  Appearing "fine" is an art perfected by most people suffering mental illness; appearances alone will not tell even the most experienced of GPs how someone is coping underneath the surface.

Of course it would be easy to lay blame with the patient; why did she not just say how bad things are?  After all, the GP is not psychic and cannot be expected to know what is going on in someone's head.  What is the point of going to see a doctor and not telling them how you are?  This point of view totally discounts the difficulty many, if not most, of us feel when admitting we are not coping.  Simply making an appointment to see a doctor about a mental illness is a massive hurdle.  As the appointment gets closer it looms larger and larger in the mind and apprehension means that, by the time the appointment arrives, the patient can be paralysed by their internal turmoil; and yet appear outwardly "normal".

All it would have taken was the right question: "How are you coping?".  Giving an opening is all that is needed.  Let the patient know that they are in a safe place and you want to know how they are really feeling.  Less convenient perhaps, but surely convenience should not be the main focus of a GP's appointment?  Appointment time is limited and GPs often run late so the pressure is always on to keep consultation time to a minimum.  Having someone cry and talk about themselves is messy and time-consuming but if it makes the difference between the patient feeling cared for and valued instead of unimportant, useless and inconvenient is that not worth it?

Looking "fine" does not equate to feeling fine and taking the time to know the difference could not just make a difference to a patient's state of mind; it could, potentially save a life.  Depression may be the most common mental illness but that should not be taken to mean that it is an everyday malady and is not that serious.  Depression can be a severely debilitating and even life-threatening condition and, as such, should always be taken seriously.

So please, GPs, when you have someone sitting in front of you, take the time to ask them how they are.  If you don't ask they may not feel able to tell you and may just leave you feeling worse rather than better.