Tonight's picture was taken in March of 2005. Mattie was almost three years old. That day we took Mattie to Bunnyland, a springtime festival at Butler's Orchard in Maryland. Mattie loved going to the farm, taking hayrides, walking through corn mazes, and going on an Easter egg hunt. As you can see "Farmer Brown" was on a tractor ride-on vehicle and was all business.
Quote of the day: Today's coronavirus update from Johns Hopkins.
- Number of people diagnosed with the virus: 29,336,578
- Number of people who died from the virus: 532,312
Yesterday I went for my annual physical. Before I entered the exam room, I was handed a survey on a clipboard. It was in essence a screening tool for depression. Certainly given that we are all locked down because of the pandemic, it maybe not be such a bad idea to assess for psychosocial concerns! I applaud that, but there is ONE BIG problem!!! What is that?
Well I held onto the clipboard throughout the entire time I was in the office! No one asked to see it, not even the doctor! So let's say I was having trouble sleeping, found little interest or pleasure in activities, feeling down, having a poor appetite, etc, how would that have been addressed during my physical? Are they expecting the patient to address it with the doctor? Highly unlikely given the time constraint placed on doctors, and the process and procedure for a physical is time consuming. It doesn't leave much time to talk about psychosocial concerns.
So what good is it to offer patients a screening for depression if you don't look at it before meeting one on one with the patient? You might as well not even doing the screening! If I was a betting woman, I would guess that the screening is connected with reimbursement from insurers. Therefore the office can check the box that they are doing this and complying. Yet at the end of the day, a patient who is struggling isn't going to feel heard from such a visit.
Now in all honesty, I am not sure what happened with the screening tool after I left the office. I can imagine someone looked at it, scored it, and then filed it. It is the hope that there would be follow up if patients do score in a range that indicates greater symptomatology. But frankly who knows! I think if doctors are giving patients such a screener, some mention should be made as to why it is being administered and how it will be used to guide care! Otherwise, in some way I feel like I should not even take this screening seriously and worse that I am not part of my own healthcare team.
The problem with this is internists/family practitioners are the first line of defense for patients. These are the doctors we initially share our concerns with, and if we sense that doctors want us to just stick to all things medical, then our psychosocial issues remain unaddressed. So insurers really need to think about incentivizing medical practices who think holistically and provide outlets for patients to discuss psychosocial issues with their doctors and be linked to resources within the community to support these concerns.
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