To score or not to score: a qualitative study on GPs views on the use of instruments for depression

Background. To improve the detection, diagnosis and follow-up of depression in primary care patients, it has been proposed that GPs should employ assessment instruments as a complement to the consultation. However, most GPs do not use such instruments routinely. Objective. To explore perceptions of Swedish GPs on the use of instruments in the medical consultation. Methods. Twenty-seven GPs discussed in five focus groups that were digitally recorded, transcribed verbatim and analysed by systematic text condensation. Results. Six code groups emerged from the focus group discussions: (i) a perceived pressure from authorities and psychiatry to report depression scores; (ii) the scores were considered to be of limited value for the GP but could help the patient by facilitating sick leave compensation and hospitalization; (iii) instruments hampered the dialogue with the patient and non-verbal information was lost; (iv) the reliability of questionnaires was questioned; (v) instruments were seen as not fitting into primary care and GPs were uncertain how to use them and (vi) the main advantage of instruments was to promote communication with specific categories of patients. Conclusions. Using instruments to obtain a quantitative score of depression was of no benefit to the GPs. Given the weak evidence for the clinical relevance of many instruments, there is little reason to introduce them into practice. However, the instruments can facilitate communication with external actors and specific groups of patients.