The potential numbers of depressed patients in the primary care setting far exceeds the numbers seen in the specialty mental health sector. Reasonable estimates indicate that depression is recognized only about half the time in medical settings. The recognition rate could be dramatically raised in one day if physicians started using some type of self-screening instrument, such as the Beck Depression Scale Inventory, in their waiting rooms. However, this is unlikely to happen. The reasons why shed some light on the general problem.
Physicians are reluctant to recognize depression for many reasons.
Concerns about being paid for the time or treatment of depression also enter in because of payment problems in primary care for psychiatry treatment codes. First, the curriculum in primary care medicine must allow adequate time for the student to learn the material. A minimum of 20 percent of the curriculum each year should be devoted to psychiatric aspects of medical care, including both treatment and medical interviewing issues. Curriculum content must include a didactic core, direct doctor-patient observation and feedback, and longitudinal case supervision. Some type of case-supervision model must be imported into primary care training.