General Practice Physicians Research Articles

Duration of Outpatient Antibiotic Therapy in Common Outpatient Infections, 2017

Background: Community-acquired pneumonia (CAP), urinary tract infection (UTI), pharyngitis, acute otitis media (AOM), and skin and soft-tissue infection (SSTI) are among the most common outpatient conditions for which antibiotics are prescribed. The objective of this study was to describe the observed duration of outpatient antibiotic therapy compared with guideline recommendations for these common conditions in 2017 in the United States to identify antibiotic stewardship targets. Methods: We estimated therapy duration for oral and parenteral antibiotic prescriptions associated with CAP, AOM, pharyngitis, acute cystitis, pyelonephritis, SSTI, and sinusitis diagnoses from the IQVIA National Disease and Therapeutic Index 2017 dataset, a two-stage stratified cluster sample of office-based physician visits. We excluded azithromycin due to its unique pharmacokinetics, and we limited our study to prescriptions from emergency medicine, family practice, general practice, geriatrics, internal medicine, osteopathic medicine, and pediatrics physicians. We excluded observations with antibiotic prescriptions for multiple conditions. We used NDTI projection weights and complex sample methods to estimate antibiotic prescription numbers and durations by condition and age group. Results: Table 1 shows antibiotic prescriptions by condition and population. The median antibiotic therapy duration for all conditions except acute cystitis was 10 days. The median duration for acute cystitis was 7 days. Conclusions:Clinicians prescribed 10-day antibiotic courses for the most common outpatient conditions, regardless of guideline-recommended duration. Antibiotic stewardship efforts targeting excessive durations of antibiotic therapy for common outpatient conditions, particularly sinusitis in adults, CAP, SSTI, and acute cystitis, are needed.Funding: This work was supported by the Centers for Disease Control and Prevention. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.Disclosures: Laura M. King is a contractor employed by Northrop Grumman Corporation to fulfill research needs at the Centers for Disease Control and Prevention as part of a contract covering many positions and tasks. All other authors declare no conflicts.

Assessment of Antibiotic Prescribing for Influenza in the US Outpatient Care Setting

This retrospective research aimed to study the prescribing trends of antibiotics for influenza and adherence to the guidelines issued by the Infectious Diseases Society of America (IDSA) by utilizing the National Ambulatory Medical Survey (NAMCS) 2016 database. This was based on a sample of visits to non-federally employed officebased physicians who are engaged in direct patient care at community health centers. Patient sex, race, as well as the source of payment, and the provider type were among the demographic variables studied for adherence to the guidelines. The total number of ambulatory care visits were 1,753. Of those, 63.6% of patients were prescribed, inappropriate agents. General and Family Practice physicians were the most frequented providers (32.9%), followed by Nurse Practitioners (21.9%), and Pediatricians (17.1%). Family practice physicians and nurse practitioners appeared to prescribe more inappropriately as compared to the other specialties (X2 =0.001). White and black patients were prescribed more inappropriately as compared to other races (X2 =0.032). Antibiotic resistance is a public health problem of increasing magnitude, and finding effective solutions to address this problem is critical. Antibiotic resistance is also an economic healthcare burden. Adherence to guidelines minimizes antibiotic resistance and promotes patients and public health.

General practice nurses and physicians and end of life: a systematic review of models of care

BackgroundGeneral practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide palliative care (PC) or end-of-life care (EoLC) as the population ages. In order to maximise the impact...

General practitioners\u2019 perceptions of their practice of evidence-based chronic disease prevention interventions: a quantitative study in Shanghai, China

BackgroundEpidemic chronic diseases pose significant challenges to the improvement of healthcare in China and worldwide. Despite increasing international calls for the inclusion of evidence-based decision-making (EBDM) processes in chronic disease prevention and control programming as well as policymaking, there is relatively little research that assesses the current capacity of physicians and the factors that influence that capacity in China.MethodThis cross-sectional study was conducted in community health centres (CHCs) in Shanghai, China, using multistage cluster sampling. An evidence-based chronic disease prevention (EBCDP) evaluation tool was employed to assess physician EBCDP awareness, adoption, implementation and maintenance based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and using a 7-point Likert scale. Linear regression analysis was used to assess associations between each EBCDP aspect and overall EBCDP status with participant characteristics or organizational factors.ResultA total of 892 physicians from CHCs in Shanghai, China, were assessed. The physicians perceived their awareness (mean = 4.90, SD = 1.02) and maintenance (mean = 4.71, SD = 1.07) of EBCDP to be relatively low. Physicians with relatively lower job titles and monthly incomes (> 9000 RMB) tended to have relatively higher scores for the awareness, adoption, and implementation of EBCDP (P < 0.05). Those who had participated in one program for chronic disease prevention and control were less likely to adopt (b = − 0.284, P = 0.007), implement (b = − 0.292, P = 0.004), and maintain (b = − 0.225, P = 0.025) EBCDP than those who had participated in more programs. Physicians in general practice (Western medicine) had a lower level of awareness of EBCDP than those in other departments (P < 0.0001). Physician from CHCs located in suburban areas had lower scores for awareness (b = − 0.150, P = 0.047), implementation (b = − 0.171, P = 0.029), and maintenance (b = − 0.237, P = 0.002) that those from urban CHCs. Physicians in CHCs affiliated with universities had higher scores on all four EBCDP aspects that those in CHCs not affiliated with a university.ConclusionsThis study provides quantitative evidence illustrating EBCDP practices among physicians in CHCs with various personal and organizational characteristics, respectively. More methods should be provided to increase the awareness of such physicians regarding EBCDP to stimulate the use of EBCDP for their patients and in connection with other public health priorities.

Factores asociados a la percepción de la validez científica de la homeopatía en un grupo de médicos generales de Perú

Introducción. La homeopatía es una terapia ampliamente utilizada en diversas partes del mundo; sin embargo, su eficacia no se ha comprobado científicamente.Objetivo. Evaluar los factores asociados a la percepción de la validez científica de la homeopatía en médicos generales de Perú.Materiales y métodos. Estudio transversal analítico. Se realizaron encuestas autoaplicadas a médicos generales que asistieron a los cursos de capacitación y orientación vocacional en especialidad y residentado en salud del Colegio Médico del Perú en 2017. La variable principal del estudio se evaluó por medio de la siguiente pregunta: ¿considera que la eficacia de la homeopatía está científicamente probada? Para evaluar los factores asociados se calcularon razones de prevalencia crudas (RP) y ajustadas (RPa), así como sus intervalos de confianza al 95% (IC95%).Resultados. Se incluyeron 285 médicos generales (55.1% mujeres) con una edad mediana de 28 años. Del 67.4% que reportó haber escuchado sobre la homeopatía, 22.5% consideró que su eficacia estaba científicamente comprobada. Lo anterior fue más frecuente en mujeres (RPa: 1.80; IC95%: 1.03-3.16) y menos frecuente en quienes habían publicado algún artículo científico (RPa: 0.23; IC95%:0.06-0.88).Conclusiones. Una parte de los médicos encuestados considera que la eficacia de la homeopatía está científicamente comprobada. Lo anterior puede deberse a vacíos en la educación médica con respecto a las terapias médicas alternativas y complementarias, así como a la influencia de la educación no formal en la toma de decisiones del médico joven.

Anthony Kyriacou Antoniou

The death of Anthony Kyriacou Antoniou (“Tony”) on Monday, 2 December 2019, at the age of 80 from cancer has, with great sadness, extinguished the light of one of our...

Profile and generalist physician knowledge about neurology in emergency department: headache management.

Neurological complaints are frequent in emergency department routine. Among them, headache is a common disorder, which requires a certain degree of knowledge on Neurology because of its extensive differential diagnosis. To assess general practice physicians' level of knowledge about headaches, in addition to outlining the profile of professionals who attend in emergency departments, as well as the profile of their respective workplaces in terms of neurological approach. We included in evaluation physicians who attend emergency care units for adult public as general practitioners. A questionnaire was applied with questions regarding participants' general knowledge on headache, neurological approach, demographic profile, and workplace profile. 159 physicians answered the questionnaire. The professionals' profile corresponded to recently graduated individuals (mean of 6.31 years). Knowledge about headache management was regular. Those who do not have any specialization or are not majoring a specialization were statistically significantly more confident in neurological patients care (p=0.006). Only 18.24% reported access to Magnetic Resonance Imaging and 35.85% had no access to any type of neuroimaging. General practice physicians often do not feel confident when performing neurological exams, demonstrating low knowledge about the topic. The profile of professionals working in these departments is predominantly of newly graduates, which may affect in some way on care quality. There was also a lack of structure for adequate care.

Appraising Commercial Expenditure Efficiency of General Medical Education and Residency Programmes in Nigeria

Purpose: The purpose of the research is to establish the standard period taken in full recovery of cost outlays, rate of returns for general physicians and marginal returns to consultants, and appropriate profitability indices. Mixed ex-post “facto” data and primary data-sets pertaining medical education expenditure across levels and lifecycle career earnings of Nigerian physicians in public service were employed. The longitudinal secondary and primary data-set were obtained from cohorts of physicians that participated in the two stages of medical education, published programmes charges posted in brochures of some public universities’ medical schools and gazette consolidated medical salaries scheme of scale for medical workers in the public service. Method of Analysis: Break-even analysis was applied to determine minimum number of years required to fully invested capital; “elaborate (full cash flows) discounting” with internal rate of return method was used for calculation of the private and marginal rate of returns. Then, profitability ratio approach was applied to determine the level of viability of medical education across levels. Cost construction indicates that about N30 million and N69.5 million are committed as investments on general medical education and residency training of the licensed general physicians and consultant-physicians respectively. The lifecycle career earnings estimates of the general practice physicians and consultant-physicians employed in the public service worth N356 million and 814 million. Results: The break-even period for full recovery of investments in general practice physicians is 5.25 around the thirteenth years of medical education and 6.33 years for residency-trained consultants, occurring in the 21st period of this layer of vocational training respectively. Individual rate of returns on investments in general medical education of average licensed general physicians is 32 percent and 32 percent marginal rate of returns to additional investment expenditures on residency training (earnings premium of consultant-physicians). This combined rate of returns of consultant-doctors (general medicine plus residency training) is 64 percent. Net present value of cash-flows of the average general physician and consultant-doctors in Nigeria is worth N326 million and N744 million respectively. Whilst the profitability index derived from the present value of net cash-flows is 1.32 for general physicians and 1.69 for the specialist. Conclusion: The paper concludes that investments to medical education in Nigeria are worth-while; but more rewarding for residency training. Timing of education (age-range when doctors get certified) influences the earnings and rate returns to investments and value of one’s intellectual capital and net-worth (statistical financial value of life). Contribution to Knowledge: The results of assessment of individual’s expenditure efficiency in medical/higher education confirm that investment in medical education is worthwhile. The findings enhance rational decision for individuals, private sector and government organizations respectively and veritable information for policy formulation. Originality: This research is an exploratory assessment of individual participants’ spending efficiency in medical education in Nigeria and other developing country establishes tentative pay-back period of such investments, unit rates of returns across levels and profitability indices.

Physician Burnout and Timing of Electronic Health Record Use.

Rates of burnout among physicians have been high in recent years. The Electronic Health Record (EHR) is implicated as a major cause of burnout. To determine the association between physician burnout and timing of EHR use in an academic internal medicine primary care practice. We conducted an observational cohort study using cross-sectional and retrospective data. Participants included primary care physicians in an academic outpatient general internal medicine practice. Burnout was measured with a single-item question via self-reported survey. EHR time was measured using retrospective automated data routinely captured within the institution's EHR. EHR time was separated into four categories: weekday workhours in-clinic time, weekday workhours out-of-clinic time, weekday afterhours time, and weekend/holiday afterhours time. Ordinal regression was used to determine the relationship between burnout and EHR time categories. EHR use during in-clinic sessions was related to burnout in both bivariate (OR=1.04, 95% CI 1.01, 1.06; p=0.007) and adjusted (OR=1.07, 95% CI 1.03, 1.1; p=0.001) analyses. No significant relationships were found between burnout and afterhours EHR use. In this small single-institution study, physician burnout was associated with higher levels of in-clinic EHR use but not afterhours EHR use. Improved understanding of the variability of in-clinic EHR use, and the EHR tasks that are particularly burdensome to physicians, could help lead to interventions that better integrate EHR demands with clinical care and potentially reduce burnout. Further studies including more participants from diverse clinical settings are needed to further understand the relationship between burnout and afterhours EHR use.

Risk Factors for Low Bone Mineral Density Determined in Patients in a General Practice Setting.

Osteoporosis increases the risk of bone fractures. It is diagnosed based on an individual's bone mineral density (BMD) or a fracture without trauma. BMD is usually measured by the dual energy X-ray absorptiometry (DXA) method. Here we investigated factors for the earliest possible prediction of decreased BMD by examining the relationships between patients' BMD values and changes in the patients' physical and laboratory values. We retrospectively reviewed the medical records of 149 patients who visited our department in 2014-2015 for a variety of reasons and underwent an area BMD examination by DXA. We analyzed the relationships between decreasing BMD and the patients' gender, age, body mass index (BMI), medical background, hemoglobin, electrolytes, and thyroid function. Thirty-nine of the patients were diagnosed with osteoporosis based on their T-scores. An adjusted analysis showed that female gender, aging, and increased serum calcium level were significantly related to decreasing femoral BMD, whereas high BMI was associated with an increase in femoral BMD. Collectively the results indicate that for the early detection of low BMD, it is important for general-practice physicians to consider conducting a BMD checkup when treating female and elderly patients with a low BMI and/or elevated serum calcium level.

General practice physicians’ and nurses’ self-reported multidisciplinary end-of-life care: a systematic review

BackgroundGeneral practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide end-of-life care (EoLC) as the population ages. To enhance primary palliative care (PC), the care they provide...

First-year medical student attitudes about general practice in China: a comparison between Chinese and international students.

IntroductionChinese policy increasingly emphasizes growth of general practice (GP). The purpose of this research was to understand attitudes toward GP among first-year Chinese and international medical students studying in China.MethodsBased on a cross-sectional survey using a 5-point Likert scale of medical students at Peking University Health Science Center regarding attitudes toward specialty choice, practice setting, care of patient age groups, care types, and GP, we compared responses of Chinese and international medical students.ResultsIn total, 258 national and 77 international students participated. International students ranked equally or more highly as favorable practice settings associated with GP, eg, outpatient (P=0.05) and home care (P<0), types of care associated with GP, eg, preventive services (P<0) and palliative care (P=0.01), and age-groups of interest, eg, care for babies (P<0), children (P<0), and adult women (P=0.03). Chinese students more strongly endorsed beliefs that GP physicians are needed in rural Chinese areas (P<0), supported by the government (P=0.02), and respected by society (P<0).DiscussionChinese students’ attitudes about the social desirability of GP are consistent with Chinese policy, but international students more strongly endorsed desirable work characteristics of actual GP. These differences accentuate the need for more attention in the medical curriculum to educate Chinese students about why GP can be a personally rewarding career.

Barriers to the use of hydroxyurea in the management of sickle cell disease in Nigeria

Hydroxyurea (HU) is a well-known Hb F-inducing agent with proven clinical and laboratory efficacy for patients with sickle cell disease. However, concerns about its long-term safety and toxicity have limited its prescription by physicians and acceptability by patients. Thus, this study aims to evaluate clinician’s barriers to the use of HU in the management of patients with sickle cell disease in Nigeria. An online survey targeted physicians in pediatrics, hematology, medicine, family medicine and general medical practice managing sickle cell disease in Nigeria. The survey was in four sections: demographic, knowledge and experience with HU, and barriers to the use of HU. Ninety-one (73.0%) of 123 contacts completed the survey. Seventy-three percent and 74.0% of the respondents noted that HU reduced transfusion rates and improved overall quality of life (QOL) of patients, respectively. While the majority of the practitioners (55.6%) see between 10-50 patients per month, most (66.7%) write <5 prescriptions for HU per month. Lack of a national guideline for use of HU, especially in children (52.0%), concern for infertility (52.0%), and safety profile of HU in pregnancy and lactation (48.2%), top the factors considered by the respondents as major barriers to the use of HU. Hydroxyurea is grossly under prescribed in Nigeria, despite that the vast majority of physicians who attend patients with sickle cell disease know about its clinical efficacy. Evidence-based clinical practice guidelines could be explored as a way to standardize practices and improve confidence of practitioners to improve physicians’ prescription of HU in the management of sickle cell disease.

Training Pathways to Working as a General Practitioner in China

To achieve the goal of 300,000 general practitioners by 2020-an increase of 215,200 in a decade-China is utilizing multiple training pathways. To comprehensively illustrate general practitioner training strategies in China, this article introduces and describes these pathways. We used descriptive policy analysis. This involved taking an inventory of existing literature and source documents and developing a model to illustrate pathways for training general practice physicians. The rural doctor pathway represents rural clinicians who had only basic training and practiced multiple years prior to training reforms. The 3+2 pathway to assistant general practitioners requires 3 years of junior college and 2 years of clinical training. The transfer pathway for current physicians requires 1-2 years of training. The 5+3 pathway comprises 5 years of bachelor of science degree training in clinical medicine and 3 years of standardized residency training. Despite the development of advanced degree programs, their use remains limited. These pathways illustrate significant heterogeneity in training of general practitioners. Training ranges from a 2-year technical degree to a doctorate with research. Emphasis on the 5+3 track shows promise for China's goals of improved quality and new goal of 500,000 additional general practitioners by 2030.

Atypical Gout Manifestations in General Practice–Family Medicine: Own Clinical Observations and Literature Data

The objective: to study and systematize own clinical observations and management of gout cases and atypical gout manifestations and literature data on this item. Clarification of main characteristics of atypical manifestations of this pathological condition.Scientific and practical base of the investigation was Kiev City Clinical Hospital № 8, which admits patients by the reference of primary care physicians in general practice – family medicine.Clinically gout is preferably a male disease. The condition is more often seen in men, than in women, but in women it is more obvious in postmenopausal period. Women with gout are more proun to have atypical manifestation (for example, disease on fingers and ankle joint), which becomes at atypical age, making efficiency of treatment problematic because of coexisting comorbidities.Gout is a common and exclusively painful form of inflammatory arthritis, which typically involves first metatarsophalangeal joint (and terminologically this is gout). Atypical signs of the gout are described now with increasing rate in definite populational groups, such as elder people, people with genetic predispositions, enzyme deficiencies, prosthetic implants and those receiving immunosuppressive therapy. Gout can mimic other conditions, such as septic arthritis, osrteoarthritis, rheumatoid arthritis, pseudogout (accumulation of calcium pyrophosphates) and even periarticular tumors. Gout can coexist with other arthropaties, making diagnosis more difficult. Article contains the description of authors own observations of patient with multiple gout atypical manifestations during 35 years. Lower extremities were not involved in the process for a long period of time, and only near 2,5-3 last years patient noted, that tophuses start to appear ass well on both legs.Atypical features differ from “classical” gout, which is found in men of middle age with different aspects: there is no prevalence of men, but there is more uniform gender distribution, polyarthicular involvement with upper extremity, less of acute gout episodes, not intensive clinical picture and increase rate of tophuses formation.

Clinical Inertia in Type 2 Diabetes Patients in Primary Health Care Clinics in Central Bosnia.

BackgroundThe goal of this research was to determine the frequency of clinical inertia of general practice physicians in the region of Central Bosnia in healthcare for type 2 diabetes patients, to analyze characteristics of patients and physicians, as well as glucose regulation during clinical inertia, and, on the basis of these indicators, give recommendations for reducing clinical inertia.Material/MethodsThis study included 29 doctors, family physicians, or general practitioners, who collected data in a total sample of 541 type 2 diabetes mellitus patients from July to November 2017. The research was conducted using 2 questionnaires. The glucose concentration in plasma and the percentage of glycosylated hemoglobin (HbA1c) were determined. Concertation of cholesterol, triglycerides, AST, and ALT were also measured. After the collection, new data were processed and the degree of clinical inertia was determined.ResultLevels of HbA1c ranged from 4.3% to 13.0%, and 38.4% of all patients had HbA1c level higher than 7.5%, while 8.3% of them had HbA1c level 9.0% or higher. Clinical inertia in our research was 12.6% out of all patients and 48.2% were referred to a specialist by their doctor.ConclusionsFor better regulation of glycemia and reduction of clinical inertia with type 2 diabetes patients, more specialized training is needed for selected physicians. Strengthening of primary healthcare and encouraging doctors to perform procedures can contribute to better outcomes of treatment, lower clinical inertia, and better education of patients.

Impact of emergency medicine training implementation on mortality outcomes in Kigali, Rwanda: An interrupted time-series study

IntroductionAlthough emergency medicine (EM) training programmes have begun to be introduced in low- and middle-income countries (LMICs), minimal data exist on their effects on patient-centered outcomes in such settings. This study evaluated the impact of EM training and associated systems implementation on mortality among patients treated at the University Teaching Hospital-Kigali (UTH-K).MethodsAt UTH-K an EM post-graduate diploma programme was initiated in October 2013, followed by a residency-training programme in August 2015. Prior to October 2013, care was provided exclusively by general practice physicians (GPs); subsequently, care has been provided through mutually exclusive shifts allocated between GPs and EM trainees. Patients seeking Emergency Centre (EC) care during November 2012–October 2013 (pre-training) and August 2015–July 2016 (post-training) were eligible for inclusion. Data were abstracted from a random sample of records using a structured protocol. The primary outcomes were EC and overall hospital mortality. Mortality prevalence and risk differences (RD) were compared pre- and post-training. Magnitudes of effects were quantified using regression models to yield adjusted odds ratios (aOR) with 95% confidence intervals (CI).ResultsFrom 43,213 encounters, 3609 cases were assessed. The median age was 32 years with a male predominance (60.7%). Pre-training EC mortality was 6.3% (95% CI 5.3–7.5%), while post-training EC mortality was 1.2% (95% CI 0.7–1.8%), constituting a significant decrease in adjusted analysis (aOR = 0.07, 95% CI 0.03–0.17; p < 0.001). Pre-training overall hospital mortality was 12.2% (95% CI 10.9–13.8%). Post-training overall hospital mortality was 8.2% (95% CI 6.9–9.6%), resulting in a 43% reduction in mortality likelihood (aOR = 0.57, 95% CI 0.36–0.94; p = 0.016).DiscussionIn the studied population, EM training and systems implementation was associated with significant mortality reductions demonstrating the potential patient-centered benefits of EM development in resource-limited settings.

Characteristics of Medical Malpractice Litigation in Thailand: Cases from Government‐Run Hospitals

Current malpractice policy debates have been contentious in Thailand for years. There is a lack of a national database for malpractice claims to provide comprehensive information to policymakers; therefore, the development of policy related to malpractice has been prolonged. This study uses the best available data to create a database and describe characteristics of medical malpractice cases in Thailand during 1996–2016. Like many countries, cases related to pregnancy and childbirth are the most common cause of malpractice lawsuits. Unlike other countries, general practice physicians in Thailand are sued the most. The proportions of wrongful death claims were higher in community hospitals, among physician interns, and on weekends. Moreover, a no‐fault provision appears to help settling claims out of court. To develop a success policy, Thailand needs to establish a national database for malpractice claims. Furthermore, expanding the no‐fault provision to all types of health insurance could be a desirable policy.

A abordagem psicossomática na medicina geral e familiar: estudo transversal

Aim: To establish how the Portuguese general and family specialists perceive and integrate the psychosomatic perspective in their practice. Design: Cross-sectional study. Setting: Portuguese general and family practitioners. Method: Providers answered a self-reported survey from August to November of 2013. Self-reported data collected from 100 Portuguese general and family medicine doctors. Participants are between 26 and 70 years old, 77% female and 23% male. Results: A hundred doctors participated in the survey (77% females) with age from 26 to 77 years old. Professionals use the psychosomatic approach in their clinical practice and they agree with the definition of psychosomatic provided. Conclusions: We find indicators towards the relevance and need for greater information and guidance of general practice physicians.

Meaning of depressive syndrome for general practice physicians in a Colombian region

ObjectiveTo determine the perception that some general clinical practitioners have about depressive syndrome in a region of Colombia. MethodologyThe qualitative approach was established as a basis for this study using grounded theory for the description, analysis, and interpretation of data collected in 20 semi-structured interviews aimed at general medical practitioners who had treated patients with depressive syndrome in their clinical practice. ResultsThroughout the interviews, some essential elements are highlighted such as: “seeing beyond a body,” where the interest of the physician is reflected by individualising each patient case because regardless of having the same disease, knowing that not all can be addressed or treated equally. “From insignificant to terrifying” shows that the network of experiences, experiences, emotions, and desires that make up part of the physician, are reflected in the compassion that he has for patient with depression, a situation that makes him confront as a human being before the suffering of others. In contrast appears the “my hands are tied” with a health system that prevents proper care of these patients, and generates problems for the treating physician. ConclusionsThe malleable and unfinished scenario where the physicians interact with the depressive syndrome, allows them to understand their humanity while reflecting on the possibilities, limitations, meanings, attitudes and actions that they have about this disorder that is reflected in the ability of general physicians to diagnose and treat depression that is not necessarily associated with age or experience in practice. However, errors in care can be reduced with sufficient knowledge and an appropriate approach to mental illness.