[Role of the general practitioner in outpatient care for schizophrenic patients from the patients' perspective]. / Die Rolle des Hausarztes in der ambulanten Schizophreniebehandlung aus Sicht von Patienten.

OBJECTIVE: To explore the view of schizophrenic patients regarding the role of general practitioners (GPs) in outpatient psychiatric care. METHODS: Semi-structured interviews with 20 schizophrenic patients were tape-recorded. Using the software Atlas.ti, the data were analysed according to the model of inductive category development (Mayring, 1995). RESULTS: Nearly all patients regarded the GPs as doctors "for the body" and--in contrast--the psychiatrists as doctors "for the soul". At the same time, an appointment with a GP was perceived as less embarrassing and stigmatising. Patients consulted their GP mainly because of somatic complaints or to receive follow-up prescriptions for their antipsychotic medication. They liked to get a "second opinion" regarding medical decisions by GPs. Some patients wished to have more consultation time with their GP to discuss psychological problems. CONCLUSIONS: Schizophrenic patients appreciate the distinction, and the choice, between different medical specialties. Primary care offers services with an exceptionally low threshold for schizophrenic patients because consultations with a GP are to a lesser degree perceived as embarrassing or stigmatising.

Doctors' strategies in prescribing drugs: the case of mood-modifying medicines.

BACKGROUND: Little is known about doctors' decision-making processes in prescribing antidepressants and how this is handled. OBJECTIVE: To describe and understand doctors' strategies in prescribing mood-modifying drugs, especially when confronted with challenging patients or situations. METHODS: Face-to-face interviews were conducted with GPs in Göttingen and Hannover, two areas in the north of Germany. GPs were enrolled until a sufficient variation ('saturation') had been reached (n = 19). Interviews were audiotaped and then transcribed verbatim. To analyse the GPs' concepts and strategies in prescribing antidepressants, the interviews were structured according to themes and recurrent items extracted by theoretical coding. RESULTS: We identified four main strategies used by GPs in the pharmacological management of depressive patients: marketing additional beneficial drug effects, addressing the patients as experts, somatic attribution of the disease and referral to a specialist. CONCLUSIONS: To support their prescription, GPs use a variety of strategies to motivate both patients to take a certain drug and themselves to deal with difficult patients or situations in their management of depression.