Primary care, grounded in the provision of continuous comprehensive person-centred care, is of paramount importance in the delivery of accessible and effective health care around the world. The central notion of person-centred care, however, relies on often-unexamined concepts of self, or understandings of what it means to be a person and an agent. This cutting-edge book explores contemporary pressures on the sense of self for both patient and health professional within a consultation and argues that building new concepts of the self is essential if we are to reinvigorate the central tenets of person-centred primary care. Contemporary trends such as shared decision-making between health professionals and patients and promoting self-management assume those involved are able to make their own decisions and take action. In practice, however, medicine often opts for reductionist perspectives of patients as passive mechanical systems and diseases as puzzles. At the same time, huge political and organisational changes mean time and resources are scarce, putting further pressure on consultations. This book discusses how we can start to resolve these tensions. The first part considers problems posed by the increasing bureaucratisation of primary care, the impact of information technology in the consultation, the effects of chronic disease on our sense of self and how an emphasis on biology over biography leads to over-diagnosis. The second part proposes solutions based on a strong ontology of consciousness, concepts of creative capacity, coherence and engagement, and will show how these can enhance the self-esteem of patients and doctors and benefit their therapeutic dialogue. Combining theoretical perspectives from philosophy, sociology and healthcare research with insights drawn from clinical practice, this edited volume is suitable for those researching and studying primary healthcare, communication and relationships in healthcare and the medical humanities.

The reorganization of general practice and the NHS mean that GPs now face many new and distinctive ethical dilemmas in their practice. With pressure on resources and an increasing concern to evaluate the outcomes of health care, GPs have additional responsibilities that could conflict with the primary objective of caring for the individual patient.
General Practice and Ethics explores the ethical issues that are encountered by GPs in their everyday practice, addressing two central themes; the uncertainty of outcomes and effectiveness in general practice and the changing pattern of general practitioners' responsibilities. Among the topics examined are:
* the ethical implications of the use of evidence-based medicine in general practice
* consent, autonomy and confidentiality in general practice
* the history of patient-centredness
* research ethics in general practice
General Practice and Ethics presents a topical and comprehensive analysis of the kinds of ethical dilemmas faced by GPs on a daily basis which will be useful to practitioners and students alike.

This book provides up-to-date, practical information for family doctors on how to assess and manage important mental health problems presenting in primary care settings. Patients frequently present with mental health problems in primary care settings around the world, yet family doctors consistently identify gaps in their knowledge, skills and confidence in how best to care for them. Contributors to the book are experts in primary mental health care and have consulted with family doctors around the world, to identify their main learning needs. Each of the nine core chapters will begin with a set of key points on 'how to do it' and will end with educational material in the form of clinical scenarios and multiple choice questions. This book describes core competencies for primary mental health care, clarifies how to conduct a first consultation about depression, reviews non-drug interventions for common mental health problems, discusses the management of unexplained physical symptoms, and advises on the physical health care of patients with severe mental illness. It explores the mental health needs of migrants and young people, and explains how to manage problems of frailty, multimorbidity and dementia. This book will be of interest to family doctors and students specialising in family medicine worldwide.

Primary care, grounded in the provision of continuous comprehensive person-centred care, is of paramount importance in the delivery of accessible and effective health care around the world. The central notion of person-centred care, however, relies on often-unexamined concepts of self, or understandings of what it means to be a person and an agent. This cutting-edge book explores contemporary pressures on the sense of self for both patient and health professional within a consultation and argues that building new concepts of the self is essential if we are to reinvigorate the central tenets of person-centred primary care. Contemporary trends such as shared decision-making between health professionals and patients and promoting self-management assume those involved are able to make their own decisions and take action. In practice, however, medicine often opts for reductionist perspectives of patients as passive mechanical systems and diseases as puzzles. At the same time, huge political and organisational changes mean time and resources are scarce, putting further pressure on consultations. This book discusses how we can start to resolve these tensions. The first part considers problems posed by the increasing bureaucratisation of primary care, the impact of information technology in the consultation, the effects of chronic disease on our sense of self and how an emphasis on biology over biography leads to over-diagnosis. The second part proposes solutions based on a strong ontology of consciousness, concepts of creative capacity, coherence and engagement, and will show how these can enhance the self-esteem of patients and doctors and benefit their therapeutic dialogue. Combining theoretical perspectives from philosophy, sociology and healthcare research with insights drawn from clinical practice, this edited volume is suitable for those researching and studying primary healthcare, communication and relationships in heal

This book provides up-to-date, practical information for family doctors on how to assess and manage important mental health problems presenting in primary care settings. Patients frequently present with mental health problems in primary care settings around the world, yet family doctors consistently identify gaps in their knowledge, skills and confidence in how best to care for them. Contributors to the book are experts in primary mental health care and have consulted with family doctors around the world, to identify their main learning needs. Each of the nine core chapters will begin with a set of key points on 'how to do it' and will end with educational material in the form of clinical scenarios and multiple choice questions. This book describes core competencies for primary mental health care, clarifies how to conduct a first consultation about depression, reviews non-drug interventions for common mental health problems, discusses the management of unexplained physical symptoms, and advises on the physical health care of patients with severe mental illness. It explores the mental health needs of migrants and young people, and explains how to manage problems of frailty, multimorbidity and dementia. This book will be of interest to family doctors and students specialising in family medicine worldwide.

Part of the Reading Well scheme. 35 books selected by young people and health professionals to provide 13 to 18 year olds with high-quality support, information and advice about common mental health issues and related conditions. Meet Julie - a women who suffers from periods of depression. Julie and her family help readers to understand what depression is, what it is like to feel depressed and how it can affect their family life. She explains how coping with depression can sometimes be very difficult but there is support and help available that can relieve the feelings of depression. This illustrated book is an ideal introduction to depression - a condition that can be particularly difficult for children to understand. It is suitable for readers aged 7 upwards and shows family, friends and anyone who knows someone affected by depression how they can offer support.

Is there an epidemic of depression sweeping the world, or are we radically altering our interpretation of normal human experiences? Do we need a dose of medication or a renewed sense of meaning? In this second edition of Beyond Depression, Christopher Dowrick - an academic general practitioner - takes a critical insider's look at commonly held views about the diagnosis and management of depression. He argues that our belief in depression as a medical condition is based on commercial, professional, organisational and cultural factors which combine to sustain the popularity of depression as a concept, which is based more on our values than on science. Based on the best contemporary evidence available, this second edition includes new research findings on the management of mild and recurrent depression, the possibility of a genetic basis to depression, and extended arguments on the limitations of screening, and the placebo effects of antidepressant medication. The author considers alternative ways of understanding the thoughts and feelings that we currently describe as depression, drawing on cross-cultural, religious, political and literary sources. He proposes a conceptual framework that provides a means of moving beyond depression as a medical concept and as a personal problem. When applied to encounters between doctors and patients in primary care it leads us towards enabling narratives, with an emphasis on listening and understanding rather than diagnosis and prescription. Beyond Depression combines a comprehensive analysis of current scientific evidence with an impressive review of linguistic, literary and philosophical perspectives. Moving seamlessly between controlled trials and Camus, from prescribing to Proust, the book is informed throughout by a series of sensitive case studies drawn from the author's personal experience.