Authorship of editorials

The February 2009 issue of the British Journal of General Practice provides some interesting tensions that reflect the insecurities that Donald Berwick alludes to in the John Hunt lecture 2008.¹ The RCGP News for February 2009² rightly has as its headline that academic general practice is the ‘best in the world’, that primary care researchers have performed outstandingly. In the journal itself are three articles on depression and primary care, and an editorial on the same topic. The editorial,³ written by academic psychiatrists, reviews the three articles, and then provides an opinion about what primary care clinicians should be doing in the consultation: ‘Managing depression in primary care: it's not only what you do, it's the way that you do it’ is the helpful title.

The question that I ask myself is why do we need to have an editorial from academic psychiatrists, when we know that academic general practice is so strong? We are fortunate to have at least six Professors of General Practice in England, who have built their careers based on research into common mental health conditions, who are more than qualified to have penned the editorial. Is it a feeling, a sense, that general practice needs the specialist view to endorse the findings from primary care? That without this endorsement, and acknowledgement, the findings are in some way diminished? The reverse is true. Academic medicine is not the same as day-to-day clinical care, and psychiatry is not the same as general practice. We do not need the endorsement of psychiatrists to either review the findings, or to give us their opinion on how we should consult. We should be acknowledging that we do manage people with common mental health problems in primary care, very frequently without the benefit of specialist services, and that this care is some of the best in the world.

If we are to understand the meaning and implications of the articles on managing depression in primary care, then asking an academic psychiatrist is as relevant as asking an academic ENT surgeon how to manage children with acute otitis media. In both cases, it is the GP who has the most experience and knowledge of the topic, not the specialist. The ENT surgeon rarely sees children with acute otitis media, and psychiatrists rarely see people with depression and anxiety who are managed in primary care.

We should be celebrating the high standard of general practice, and the international standing of our Professors by seeking their views of the three articles, not by asking senior lecturers in psychiatry.

Competing interests

I share a hot desk with Dr Boardman — my comments are not directed in any way personally to the authors concerned. I have disagreed with the Professors of General Practice on several occasions, and will continue to do so!