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medpundit |
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Thursday, May 23, 2002“Two questions ought to become part of the basic repertoire of every patient visit, the task force recommended in an announcement that coincided with the American Psychiatric Association's annual meeting here: "Over the past two weeks, have you felt down, depressed or hopeless?" and "Over the past two weeks, have you felt little interest or pleasure in doing things?" If a patient answers yes to either question, the task force recommended that doctors offer patients written or oral questionnaires. These ask more specific questions and establish whether the problems are transient or persistent. If the problems have lasted throughout the previous two weeks, and have interfered with the patient's ability to perform day-to-day tasks, doctors may make a diagnosis of depression.” It would be the rare person who could answer “no” to either of those questions. If I follow their guidelines, I’m going to be giving lengthy questionnaires to the majority of my patients and running hopelessly behind as a result. I’m also probably going to be overtreating a lot of people for depression. The U.S. Preventive Services Task Force knows this. The guidelines state: “The potential harms of screening include false-positive screening results, the inconvenience of further diagnostic work-up, the adverse effects and costs of treatment for patients who are incorrectly identified as being depressed, and potential adverse effects of labeling. None of the research reviewed provided useful empirical data regarding these potential adverse effects.” (italics mine) So why did they come out with this recommendation if they don't know what its adverse effects will be? It’s so unlike them. They are usually very good about basing screening recommendations on sound evidence, but lately they’ve been very sloppy. Their recent politically correct decision on mammograms entirely ignored the evidence-based recommendations of the respected Cochrane group. Now, they come out with a less than thoroughly evaluated recommendation on screening for depression, a cause that was dear to the heart of former Surgeon General David Satcher. I’m beginning to lose respect for the Task Force. They’re becoming too politically vested. I guess I’ll have to look to the Canadians for sensible guidance on evidence-based preventive health. posted by Sydney on 5/23/2002 06:30:00 AM 0 comments 0 Comments: |
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