SHIFT WORK DISORDER - myCME.com

PrimarycareThescreening questionnaire.16 Theyare thus aof mental disordersgoodby primary869-86.care physicians. Med Care 1989;27:4 Andersen SM, Harthorn BH. recognition, diagnosis, and treatment (Accepted 18 September 2003)compromisebetween the timerequiredto administer5 Spitzer RL, Williams JB, Kroenke K, Linzer M, deGruy IE FV, Hahn SR,the screen and the likelihood ratio. The additional benet al. Utility of a new procedure for diagnosing mental disorders inefit is thatare moreto primary care. The prime-MDIOOO study.JAMA 1994;14:1749-56.general practitionerslikely pre 6 Whooley MA, Avins AL, Miranda J, Browner WS. Case findingscribeto indrugs patientswhomtheyhave made the instruments for depression: two questionsas goodas many.y Gen InternMed 1997;12:439-45.diagnosis.177 World Health Organization.(CIDI). Geneva: WHO.Composite international diagnostic interviewContributors: All authors wrote the paper. AB had the8 Wittchen HU, Lachner G, Wunderlich U, Pfister H. Test-retestoriginalreliabilityof theidea for thestudy andanalysedthe data; he will act as computerized DSM-IV version of the Munich-compositeguaraninternationaltor fordiagnostic interview. Socthe paper. NKhin assisted Psychiatry Psychiatrwith the study designandEpidemiol1998;33:568-78.funding.NKerseanalysedthe data. S Brighouse interviewed the 9 Andrews G, Peters L, Guzman AM, Bird K. A comparison of twopatients.structured diagnostic interviews: CIDI and SCAN. Aust NZJ Psychiatry1995;29:124-32.Funding: Oakley Mental Health Foundation and Charitable10 Centre for Evidence-Based medicine, Mount SinaiTrust of the AucklandFacultyof the Hospital, www.cebm.RoyalNew ZealandCollegeutoronto.ca (accessed Dec 2002).of General Practitioners. Theguarantor accepts full responsibil 11 Jaeschke R, Guyatt G, Sackett D. Users' guidesto the medical literature IQ.ity for the conduct of the study,had access to the data, and How to use an article about a diagnostic test A. Are the results of thecontrolled the decision to publish.study valid? JAMA 1994;271:389-91.12 Jaeschke R, Guyatt G, Sackett D. Users'Competinginterests: guides to the medical literature III.None declared.How to use an article about a diagnostic test B. What were the results andEthicalapproval:Ethicalapprovalwas obtained from the will they helpme in caring for my patientsP/AMA 1994;271:703-7.Auckland ethics committees.13 Bossuyt PM, ReitsmaJB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM,et al. Towards complete and accurate reporting of studies of diagnosticaccuracy: the STARD initiative. BMJ 2003;326:41-4.14 Nease DE, Malouin JM. Depression screening:a practical strategy./ Fam1 Katon W, Schulberg H. Epidemiology of depression in primarycare. GenHosp Psychiatry 1992;14:237-47.Pract 2003;52:118-26.15 US Preventive Services Task Force, www.ahrq.gov/clmic/uspstfix.htm2 Pignone MP, Gaynes BN, Rushton JL, Burchell CM, Orleans CT, Mulrow (accessed May, 2003).CD, et al. Screening for depression in adults: a summary of the evidence 16 Steer RA, Cavalieri TA, Leonard DM, Beck AT. Use of the Beckfor the US preventive services task force. Ann Intern Med 2002; 136:depression inventory for primary care to screen for major depression765-76.disorders. Gen Hosp Psychiatry 1999;21:106-11.3 Gilbody SM, House A, Shledon TA. Routinely administered question 17 Dowrick C. Does testing for depression influence diagnosisornaires for depression and anxiety:asystematic review. BMJ management by general practitioners. Fam Pract 1995;12:461-5.2001;322:406-9.Curiouser and curiouserLast week we buried my father in law, David. He was 92and had had a full life. We put him to rest in a naturalwoodland site, and it was a joyful day.His three sons eachspokebeside his coffin.Curiositywas a strongtheme. He had a neverending curiosityfor howthings worked?engines, boats, paints, clays,instruments. For about the past 20 years he hadprofessednot to be able to see or hear, yet heskillfullymade and mended clocks.Curiosity, apparendy,overcame his disabilities. (Selective deafness was also ahypothesis.)Heacceptedwhat he could do and not doand went ahead and did what he could withgreattenacityand perseverance.He had a healthy irreverence, a naughtiness,whichhisgrandchildrenloved. Adults also benefited from itA retired hill farmer friend who came to the funeralremembered how David had wanted to build a still onhis land. "But that'sillegal.""So?" He had wanted toknow how it would work.People'scuriosities vary. This year'sReith lecturer,the neuroscientist Vilinor Ramachandran, onspeaking"Theemergingmind" showed a passion,not for thewiringof boatenginesbut for the wiringof thehuman brain. An intensecuriosityabout what goeswrong with the wiringto produce sensoryanomalies, such assynaesthesia,drives him on to knowmore and more and toinspireothers to know moreand more.Curiosityaboutpeopleand howtheywork?physically, mentally, emotionally, spiritually?is at the heart of what doctors do. It drives us. Yes,other "C" words?communication, collaboration,consultation, computerseven?are alsoimportantButin a cultureincreasinglyoriented towards datacollection and management, this people curiosityisprecious.There are ninegeneral practitionersin mypractice,and wespenda lot of timediscussingchronic disease management protocolsand caremanagementscreens. Nine doctors, nine views. Theoptimisticview is that all the energy and time divertedinto this will create efficientsystems that will liberatetime for beingcurious aboutpeople,for beingafamilydoctor. The less optimisticview is that, once theclimate has beenchangedto the extent that it has,cultivatingthe curiositystrain of thespecies maybecome more difficult Yet this is the strain theconsumers want and the health service needs,the one mostlikelyto produce good crops (of GPs)in the future.(Gardeningwas another of David'shobbies.)Feedingthe fire ofcuriosity,aboutenginesandclocks and how machines work, gave my father in law alongandhappylife. Sorry,another horticulturalanalogy:the healthy growthof general practicedependsonkeepingthe balance of the soilright,onfeedingthecuriosity.Andperhapsthe naughtiness?LesleyMorrisongeneral practitioner principal,TeuiotMedical Practice, HawickWe welcome articles upto 600 words ontopicssuch asA memorablepatient,A paperthat changed my practice, Mymostunfortunate mistake, orany otherpiece conveyinginstruction, pathos,or humour. Please submit thearticle onhttp://sdubmitbmj.comPermission isneeded from the patientor a relative if an identifiablepatientis referred to. We also welcome contributionsfor"Endpieces," consistingof quotationsof up to 80words (but most are considerably shorter) fromanysource, ancient or modern, which haveappealedto thereader.1146 BMJ VOLUME 327 15 NOVEMBER 2003 bmj.com