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May 14, 1997

Underdiagnosis of Depression in Primary Care: By Accident or Design?

Author Affiliations

Des Moines, Ia

JAMA. 1997;277(18):1433. doi:10.1001/jama.1997.03540420029012

To the Editor.  —Germane to the issue of "underdiagnosis" of depression1 is the essential role of the primary care physician as patient advocate. The physician incentive is not to make a diagnosis of depression, but rather to make a symptom diagnosis and to treat depression. While the authors may question the logic and ethics of this statement, consider that both health and life insurance companies currently request copies of patient office charts, not summaries prepared by the primary care physician. I have had a significant number of patients either rated (ie, charged a higher insurance premium) or refused insurance coverage when the diagnosis of depression was noted on the chart by the insurance company.Most depressed patients treated by this primary care physician are not suicidal, but I certainly agree that they are much happier and more productive with rather than without treatment. But reporting the diagnosis of depression