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How Academic Psychiatry Can Better Prepare Students for Their Future Patients: Part II: A Course in Ultra-Brief Initial Diagnostic Screening Suitable for Future Primary Care Physicians

Depression is inadequately treated in primary care (PC), primarily because of a failure to recognize symptoms of depression. The results can be catastrophic and include death by suicide. The prevention of suicide is a critical function of physicians. The recognition of depression is the first step to preventing suicide because suicide predominately occurs during depression. The traditional, comprehensive psychiatric interview typically taught by academic psychiatry may inhibit recognition in PC settings because it takes too much time. Attempts to integrate a brief psychiatric interview into the PC-patient interaction to meet these needs of increasing recognition have had mixed results. Instruction to medical students on psychiatry in the use of an ultra-brief screening instrument for these disorders, suitable for the time-pressured PC environment, could help attain the goal of improved recognition. A Four-Question, 90-Second Depression Screen is described and recommended. The author offers a detailed format for establishing an interview course to impart such skills that is appropriate for students and residents in their psychiatry or PC rotations.