DR MAX PEMBERTON: Why that grumpy man you love might need help

• Aberdeen University found GPs failed to diagnose major depression in patients  
• READ MORE:  DR MAX PEMBERTON: Stiff upper lip IS better than raking up past

While not entirely unpredictable, it is sad to admit that doctors have their own unconscious prejudices that might influence their clinical decisions. They are human, far from infallible and not immune to bias.

So I was fascinated to read about ChatGPT and the treatment of depression in a study in the BMJ last week. Researchers have found that the AI tool is better at diagnosing and treating depression than GPs. The reason? The chatbot does not discern between genders or class when prescribing drugs and therapy. Instead, it considered everything that the person described and faithfully adhered to the national guidelines when it came to diagnosis and treatment.

Surely this is what doctors do too, you might think? Well, while of course we try, the reality is, sadly, we don’t always succeed.

What this research really exposes is the considerable variation that exists in who is and who isn’t diagnosed with and treated for depression.

Studies have shown that while mental illness accounts for nearly half of all ill health in the under-65s, only a quarter of people in need of treatment actually get it. That means almost three-quarters of mentally unwell people are never treated.

I was fascinated to read about ChatGPT and the treatment of depression in a study in the BMJ last week. Researchers have found that the AI tool is better at diagnosing and treating depression than GPs (stock image)

And further research conducted by Aberdeen University has shown that GPs failed even to diagnose major depression in half their patients, meaning they went untreated. It is upsetting to think that there are such large swathes of the population who are suffering in silence.

You’re much more likely to be diagnosed with depression if you’re under 65, middle class, white and female, for example. You’re also much more likely to be offered treatment. What you say and how you act also matters. You’re more likely to be diagnosed if you say things such as you ‘feel sad’, or ‘down’ or you cry.

While these can be symptoms, there are also other indicators that doctors tend to ignore.

Men will often present with a lack of interest, irritability or physical problems, such as lack of libido, pain or sleep problems. These tend to get overlooked, yet are well-established symptoms.

READ MORE: DR MAX PEMBERTON: Sometimes a stiff upper lip IS better than raking up the past 

Some of the highest rates of under-diagnosis occurred in older men, who also have the highest rates of suicide.

When it comes to antidepressants, we over-prescribe them to some groups, such as young women, who might be better served by psychotherapy, while we fail others. Middle-aged to older men have the lowest rates of antidepressant prescribing, and yet have some of the highest rates of mental distress.

Also consider that half of older people with depression have no previous history. This ‘late-onset’ depression often has subtly different symptoms to that which affects young people, which can make it tricky to spot.

These patients tend not to complain of ‘feeling sad’, but rather have no enjoyment in life. They often become more preoccupied with physical health symptoms and develop anxiety or OCD. In more than 70 per cent of cases, there is evidence of poor memory or thinking, which often mimics dementia (a condition called pseudo-dementia). As a result, depression is all too easily missed.

Doctors simply don’t think of depression when they see an old person — there is an unhelpful and incorrect stereotype that the elderly are a bit grumpy and this is normal.

Even when depression is diagnosed, the treatment offered will vary depending on who you are and where you come from.

DR MAX PEMBERTON (pictured): Further research conducted by Aberdeen University has shown that GPs failed even to diagnose major depression in half their patients, meaning they went untreated

Four in ten people over the age of 75 have depression, yet as few as 3.5 per cent of cases are referred for therapy. Instead, we just prescribe antidepressants, despite older people being more at risk of serious side-effects and complications from this type of medication.

It’s pure ageism, based on stereotypes that older people ‘won’t change’. Yet there’s good evidence older people respond just as well to therapy — some studies show they respond better.

We should be shocked by this because it shows that, for all the advances in recent years with people feeling emboldened to talk about their mental health problems, for some, simply because of their gender or age they still won’t get the help they need.

Is the solution a robot GP? Are us doctors about to be replaced with AI? I’m not convinced.

While much of medicine is about following protocols and algorithms, patients are complex, and we’re a long way from a computer being able to understand the nuances of human illness. Despite the shortcomings, I’m not sure that robots will ever replace the human interaction that is the bedrock of the doctor-patient relationship, but we do all need to try harder to make sure we’re serving our patients as best we possibly can.

Nepotism is never ok, Gwynnie

Gwyneth Paltrow has criticised the use of the term ‘nepo-baby’ – the phrase used to suggest nepotism when a child follows in their famous parents footsteps, particularly in the arts, fashion or modelling.

Oh please. What this is really about is the unfair advantages that those from wealth and privilege have. You’re literally defending a system that perpetuates inequality, Gwyneth.

Now, I don’t blame the children for being born into a family that means they have an easy ride in life. But let’s not pretend it’s fair that simply because of who your parents are you can access careers that others can’t.

Paltrow (pictured with her model daughter Apple) went on to say that nobody criticises the children of doctors for wanting to be a doctor.

Gwyneth Paltrow, Apple Martin Goop, Gucci and Elizabeth Saltzman Host an Intimate Dinner in the Hamptons, Private Residence, NY, Briarcliff Manor, New York on July 15

Gwyneth Paltrow has criticised the use of the term ‘nepo-baby’ – the phrase used to suggest nepotism when a child follows in their famous parents footsteps, particularly in the arts, fashion or modelling

It’s not exactly comparable – to get into medical school requires academic achievement that is not necessary to become a model or actor – but youngsters from poorer backgrounds still face considerable hurdles compared to those from wealthier families getting into medical school.

I’m a mentor on a programme aimed at getting the brightest in some of the poorest boroughs in London into university. For the students, it’s an uphill battle. Their schools let them down and it’s near impossible to get work experience in a hospital, unless you know someone who can pull some strings.

I was talking to the teacher who set up this project and he showed me some depressing research by the London School of Economics; a low-ability child from a high-income family is 35 per cent more likely to be a high earner than a high-ability child from a low-income family.

And research by KPMG shows that class remains the biggest barrier to career progression. Now that’s something to get angry about, Gwyneth.

Dr Max prescribes… 

Hand sanitiser 

I know we’d all rather forget the pandemic, but carrying around small hand sanitisers is one thing I wish we’d all kept doing, to help prevent the spread of germs. 

This one is alcohol-free and contains aloe vera, chamomile and lavender, so it won’t dry your hands out. 

This one is alcohol-free and contains aloe vera, chamomile and lavender, so it won’t dry your hands out

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