By Kayt Sukel
At my last annual physical exam, my primary care physician took note of my height, weight, blood pressure, temperature and heart rate. Before I even entered the exam room, she had me update a questionnaire about my medical history, asking me about how often I exercise and drink alcohol—as well as whether or not conditions like diabetes, cardiovascular disease and cancer run in my family. She performed a heart and lung exam, using her stethoscope to check the performance of my heart and lungs, and then had me open up and say, “Ahhhh,” so she could look at my teeth, gums and throat. She looked into my ears and tapped on my abdomen. As she scanned my medical history, she asked if I had any current medical concerns.
But what she did not specifically ask me about was my mood—or whether I might be experiencing any mental health issues—despite the fact that I had noted on my questionnaire that depression runs in my family. And that oversight, particularly due to the stigma surrounding mental health conditions, is a serious one.
Of course, many, if not most, healthcare providers do offer a depression screening during a well visit. But my doctor is likely not alone in putting more of a focus on physical health while evaluating a patient. A new study in the journal Health Affairs that surveyed doctors’ strategies for treating patients suggests that even if I had reported depressive symptoms to my primary care provider, she may not have followed up on those concerns. In fact, researchers discovered that doctors are more likely to help patients deal with physical over mental health issues—and less likely to help those with depression or other mental health conditions manage their illnesses over time. So, if you have high blood pressure or diabetes? The doctor is likely to set up a care strategy and facilitate you following it. But, unfortunately, it would seem the needs of individuals with mental health conditions often fall through the cracks.
I can believe it. Since seeing my PCP, I’ve gotten a few email follow-ups about physical illnesses. One of those emails highlighted the best ways to avoid cardiovascular disease. And a second offered me strategies to eat healthier and exercise more while living a busy life—both concerns for women of my age with a certain medical history. But, to date, I’ve seen nothing about caring for my mental health.
So should doctors be paying more attention to mental health? Part of it is due to time— my visit took all of 15 minutes; we didn’t have much time to go over every single aspect of my health. And, historically, PCPs saw their job as handling physical issues. However, we’re now learning that mental and physical health are closely intertwined. The two influence each other more than we knew—and it’s important to regularly take stock of both.
That’s why the results of this Health Affairs study are so significant. Patients are often encouraged by their insurance companies to see their PCPs for all issues—including mental health ones. This study suggests that primary care practices are not thinking about depression as a chronic illness and trying to manage it as they would for diabetes or other chronic conditions. If they are simply responding to depressive symptoms with a prescription or referral, and are not following up over time to make sure that the patient is getting the relief they need, that is a concern.
But it is possible to make changes. Several years ago, patients with diabetes often fell through the cracks. Healthcare networks, insurance companies and government agencies found ways to incentivize chronic care management and helped ensure that primary care practices were doing appropriate follow-up. The authors of the Health Affairs study suggest that such incentives could also work for the care of chronic depression and other mental health conditions. In addition, many healthcare networks are now offering care managers, individuals who work with primary care practices, as well as online management tools, to help both doctors and patients stay on target for managing chronic illnesses.
On my next visit to my doctor, when asked about any concerns, I plan to specifically mention my family history with depression and see where the conversation may lead. It will help my physician make sure she has all the information she needs to help me maintain my health over the following year.