The general practitioner and mental health problems
challenges and strategies for medical education
Keywords:
Medical education, Continuing education, Primary health care, Mental disorders, Qualitative researchAbstract
CONTEXT AND OBJECTIVE: Within the context of primary health care and mental disorders, our aim was to study the opinions of general practitioners regarding attendance of people with mental health problems. DESIGN AND SETTING: Qualitative focal group study among primary care services in the cit- ies of Porto Alegre and Parobé, State of Rio Grande do Sul. METHODS: A deliberately selected sample of 41 general practitioners who were working in basic health services met in focal groups. Two videos were presented, which simulated consultations for patients with depression and psychoses. The discussions about the identification and handling of mental health problems were recorded and assessed via content analysis. RESULTS: The opinions related to the difficulties of diagnosing and treating mental problems, the involvement of relatives in caring for patients, the difficulty of compliance with the treatment, the uncertainty experienced by physicians and the difficulty of referring patients to specialized services. CONCLUSIONS: The general practitioners indicated that they perceived the mental health problems among their clientele, but the diagnosis and treatment of these problems are still seen as a task for specialists. The challenge of continuing education on mental health requires methods of interactive and critical teaching, such as the problem based approach.
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References
Almeida-Filho N, Mari J de J, Coutinho E, et al. Brazilian mul- ticentric study of psychiatric morbidity. Methodological features and prevalence estimates. B J Psychiatry. 1997;171:524-9.
Ballester DA, Tietzmann A, Busnello EA. City of Porto Alegre: the Brazilian Concept of Quality of Life. In: Goldberg D, Thornicroft G, editors. Mental Health in our Future Cities. London: Psychology Press; 1998. p. 173-93.
Olfson M, Broadhead WE, Weissman MM, et al. Subthreshold psychiatric symptoms in a primary care group practice. Arch Gen Psychiatry. 1996;53(10):880-6.
Andreoli SB, Blay SL, Mari JJ. Escalas de rastreamento de psicopatologia. [Screening scales of psychopathology]. Rev Psiquiatr Clin (São Paulo). 1998;25(5):229-32.
Katon W, Gonzales J. A review of randomized trials of psychiatric consultation-liaison studies in primary care. Psychosomatics. 1994;35(3):268-78.
Mash B, Meulenberg-Buskens I. ‘Holding it lightly’: the co- operative inquiry group: a method for developing educational materials.. Med Educ. 2001;35(12):1108-14.
Essex B. Diagnostic pathways in clinical medicine: an epide- miological approach to clinical problems. London: Churchill Livingstone; 1978.
DSM-IV-TR. Manual diagnóstico e estatístico de transtornos mentais. 4th ed. rev. Porto Alegre: Artmed; 2002.
Organização Mundial da Saúde. Classificação de transtornos mentais e de comportamento da CID-10 – descrições clínicas e diretrizes diagnósticas. Porto Alegre: Artmed; 1993.
Dowrick C. The educational challenge of mental health. Med Educ. 2000;34(7):545-50.
Pilgrim D, Rogers A, Clark S, Clark W. Entering psychological treatment: decision-making factors for GPs and service users. Journal of Interprofessional Care. 1997;11(3):313-323.
Goldberg D. Training general practitioners in mental health skills. Int Rev Psychiatry. 1998;10(2):102-5.
Schnapp WB, Stone S, Norman JV, Ruiz P. Teaching ethics in psychiatry. A problem-based learning approach. Acad Psychiatry. 1996;20:144-9.
Hodges B, Inch C, Silver I. Improving the psychiatric knowledge, skills, and attitudes of primary care physicians, 1950-2000: a review. Am J Psychiatry. 2001;158(10):1579-86.
Patton MQ. Qualitative evaluation and research methods. 2nd ed. Newbury Park: Sage Publications; 1990.
Mateus MDL. Estudo etnográfico de pacientes com esquizofre- nia e seus familiares em São Vicente, Cabo Verde [thesis]. São Paulo: Universidade Federal de São Paulo — Escola Paulista de Medicina; 1998.
Denzin NK, Lincoln YS. Handbook of qualitative research. 2nd ed. Thousand Oaks: Sage Publications; 2000.
Organização Mundial da Saúde. Classificação de transtornos mentais e de comportamento da CID-10: diretrizes diagnósticas e de tratamento para transtornos mentais em cuidados primários. Porto Alegre: Artes Médicas; 1998.
Bardin L. Análise de conteúdo. São Paulo: Martins Fontes; 1979.
Popay J, Williams G. Qualitative research and evidence-based healthcare. J R Soc Med. 1998;91(Suppl 35):32-7.
Eiser JR. Attitudes, chaos and the connectionist mind. Oxford: Blackwell; 1994.
Oxman AD, Thomson MA, Davis DA, Haynes RB. No magic bullets: a systematic review of 102 trials of interventions to im- prove professional practice. CMAJ. 1995;153(10):1423-31.
Freire P. Educação como prática de liberdade. Rio de Janeiro: Paz e Terra; 1976
Venturelli J. Educación médica: nuevos enfoques, metas y métodos. Washington: Organización Panamericana de la Salud; 1997.
Mamede S, Penaforte J, Schmidt H, Caprara A. Tomaz JB, Sá H. Aprendizagem baseada em problemas: Anatomia de uma nova abordagem educacional. Fortaleza: HUCITEC; 2001.
Busnello EA, Lima B, Bertolote JM. Aspectos interculturais de classificação e diagnóstico tópicos psiquiátricos e psicossociais na Vila São José do Murialdo. [Intercultural aspects of classification and diagnosis psychiatric and psychosocial topics in Vila Sao Jose do Murialdo]. J Bras Psiquiatr. 1983;32(4):207-10.
Goldberg D, Gournay K. The general practitioner, the psychia- trist and the burden of mental health care. Available from URL: http://www.iop.kcl.ac.uk/iopweb/departments/home/default.aspx?locator=519. Accessed in 2004 (Oct 14).
Feuerwerker L, Kalil ME, Baduy RJ. A construção de modelos inovadores de ensino-aprendizagem – as lições aprendidas pela Rede UNIDA. Divulgação em Saúde para Debate. Available from URL: http://www.redeunida.org.br/producao/div_licoes.asp. Accessed in 2004 (Oct 14).
