title: The duty to be well-informed: the case of depression.
abstract: It is now an ethical dictum that patients should be informed by physicians about their diagnosis, prognosis and treatment options. In this paper, I ask: 'How informed are the 'informers' in clinical practice?' Physicians have a duty to be 'well-informed': patient well-being depends not just in conveying adequate information to patients, it also depends on physicians keeping up-to-date about: (1) popular misunderstandings of illnesses and treatments; and (2) the importance of patient psychology in affecting prognosis. Taking the case of depression as an entry point, this paper argues that medical researchers and physicians need to pay serious attention to the explanations given to patients regarding their diagnosis. Studies on lay understanding of depression show that there is a common belief that depression is wholly caused by a 'chemical imbalance' (such as 'low serotonin') that can be restored by chemically restorative antidepresssants, a claim that has entered 'folk wisdom'. However, these beliefs oversimplify and misrepresent the current scientific understanding of the causes of depression: first, there is consensus in the scientific community that the causes of depression include social as well as psychological triggers (and not just biochemical ones); second, there is significant dissensus in the scientific community over exactly what lower level, biological or biochemical processes are involved in causing depression; third, there is no established consensus about how antidepressants work at a biochemical level; fourth, there is evidence that patients are negatively affected if they believe their depression is wholly explained by (the vague descriptor) of 'biochemical imbalance'. I argue that the medical community has a duty, to provide patients with adequate information and to be aware of the negative health impact of prevalent oversimplifications-whatever their origins.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Blease
mesh_terms: D000928:Antidepressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001923:Brain Chemistry / Q000187:drug effects*; D003142:Communication; D032882:Comprehension; D003863:Depression / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism / Q000517:prevention & control; D030881:Disclosure; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D010817:Physician-Patient Relations; D010820:Physicians / Q000941:ethics* / Q000592:standards; D040242:Risk Reduction Behavior; D055502:Secondary Prevention; D012701:Serotonin / Q000378:metabolism; D013315:Stress, Psychological / Q000150:complications* / Q000517:prevention & control; D006113:United Kingdom; D014481:United States
chemical_list: D000928:Antidepressive Agents; D012701:Serotonin
keywords: Clinical Ethics; Education for Health Care Professionals; General Medicine / Internal Medicine; Informed Consent; Psychiatry