2002

Introduction

Major depressive disorder (MDD) is a common problem in the primary health care setting. The recognition of depression requires a high index of suspicion, as depression can masquerade as many different problems. Depression also commonly coexists with other medical conditions and can be a side effect of medications.

Family practice is in disarray. A service that until recently was taken for granted and long considered the backbone of the health care system now suffers daily losses from full-service practice to episodic walk-in clinics and an increasingly wide variety of other interesting employment. Medical students now consider family practice much less attractive, and graduating FP residents aim for anything but conventional office practice. The recruitment and retention problems we have heard so much about from nursing are matched by our own current situation.

Introduction

Effective treatment of depression requires early detection. Depression can be difficult to identify among subgroups of patients with co-morbid medical illnesses, substance abuse disorders, mental retardation, brain injury, and dementia, or those who are at either end of the age spectrum. This article addresses risk factors and unique aspects of presentation in the young and the old. 

Moral hazard is a trite topic among insurers and economists, but the concept is not commonly known in the medical profession.[1] The concept of moral hazard suggests that the simple act of obtaining insurance inexorably leads to increased insurance claims. Restaurant kitchen fires are rare until insurance is offered; burglary claims increase after burglary insurance is sold.

I am writing in response to the series of articles you have on the subject of whiplash [2002;44(5):236-263 and 2002;44(6):296-321].

It is quite apparent that the conventional approach to this common and costly condition is both inadequate and unsatisfactory. The physician feels frustrated for not being more helpful in alleviating the pain and sufferings of his or her patients. The patient feels he or she is poorly served, not listened to or understood, or worse yet, being labeled a “crying baby” or even a “malingerer” when compensation is involved.