Family doctors and psychiatrists and the patient with depression: the need to re-adjust health care approaches and organisational dynamics

To find out the perceptions of family doctors (FD) and psychiatrists (PS) on their inter-relationships in the health care of patients with depression. Qualitative methodology. Exploratory design based on FD and PS discussion groups (DG). Primary health care centres (PHCC) and mental health centres (MHC) of the Basque Country Health Service in Vizcaya. A total of 29 FD from 20 PHCC, and 13 PS from 11 MHC, distributed according to the socioeconomic level of the reference population. The meetings were arranged and held in the PC research unit. An intentional sample to configure 4 DG of FD and 2 of PS, homogenous as regards socioeconomic level, and heterogeneous as regards the centres they came from, work experience and gender. The meetings were recorded and transcribed and a sociological discourse analysis was made. Triangulation between researchers and results comparison with the participants was carried out. The perceptions and attitudes of the FD and PS differed, in their connections with the patient, expectations and health care context. In both cases they perceived the unsuitability of the real patient as regards the prefixed perceptions of the professional. The increase of the problem and its management seemed to be conditioned by a social medium which was uncontrolled, and due to increasing deficiencies in the collaboration between health care levels. Care of the patient with depression requires diagnostic and treatment approaches centred on the patient and shared by FD and PS.