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Medicine has been studied in Cambridge since 1318, but it was not until the time of John Butterfield (Regius 1976–1987) and Keith Peters (Regius 1987–2005) that the foundation chairs of community medicine (1977) and general practice (1996) were established. Butterfield led the establishment of the school of clinical medicine (1976), and Peters the transformation of the school into a world leading centre for medical research.
The path to realising the academic aspirations of general practice led uphill. The combined efforts of postgraduate general practice educators, the RHA, Royal Colleges and local practitioners took twenty years to establish a chair of general practice.
In the 1970s the Royal Commission on Medical Education strongly recommended including general practice in the clinical curriculum, recognising it as a specialty and proposing structured general practice postgraduate training and senior academic appointments for general practice undergraduate teachers. In East Anglia, regional and associate general practice advisers were appointed in the postgraduate Dean's office, providing the first formal links between general practice education, the RHA and the university.
Bernard Reiss (the first regional adviser from 1973–1976) and Ian Tait (associate), held these key link positions. Having previously introduced pre-clinical student visits to local general practices they pushed for clinical teaching appointments and in 1976 hoped for a general practice undergraduate teaching and research department. The university responded by creating the post of director of studies in general practice.
Most studies of the recognition of depression in primary care have used a categorical definition of depression. This may overstate the extent of the problem.
Our objective was to investigate the relationship between severity and recognition of depression, and its modification by patient and practitioner characteristics.
An association study in multiple consecutive adult cohorts of 18 414 primary care consultations drawn from a representative sample of 156 general practitioners in Hampshire, UK.
There was a curvilinear relationship between the severity of depression and practitioners' ratings of depression. One case of probable depression was missed in every 28.6 consultations. Anxiety and unemployment altered the chances of recognition, but age, gender and deprivation scores did not.
A dimensional approach to severity of depression shows that general practitioners may be better able to recognise depression than previous categorical studies have suggested. Efforts to improve the care of depression should therefore focus on doctors who have been shown to have difficulty making the diagnosis and on improving the treatment of identified patients.