Misdiagnosis of Major Depression in Primary Care
Jerry T. McKnight, MD
University of Alabama School of Medicine Tuscaloosa
Arch Fam Med. 1995;4(1):17-18.
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The article "The Deliberate Misdiagnosis of Major Depression in Primary Care" by Rost et al1 in the April 1994 issue of the ARCHIVES was an intriguing if not misleading title. A more accurate title would have been "The Deliberate Miscoding of Major Depression in Primary Care." It is a well-known practice in primary care to miscode or inaccurately code depression for a number of reasons, not the least of which are diagnostic uncertainty and the lack of disease acceptance by patients. Most family physicians are quite aware whether a given patient is depressed; however, the physician may be attempting to persuade the patient into accepting appropriate treatment by coding somatic complaints rather than the underlying cause. To do otherwise potentially risks patient alienation and this is a judgment the physician makes. Many patients will more readily accept their diagnosis of depression after being lifted from their depressive fog.
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