GPs’ and patients’ views on the value of diagnosing anxiety disorders in primary care: a qualitative interview study

Background: In the UK between 1998 and 2008, GPs’ recording of anxiety symptoms increased, but their recording of anxiety disorders decreased. The reason for this decline is not clear, nor are the treatment implications for primary care patients.

Aim: To understand GPs’ and patients’ views on the value of diagnosing anxiety disorders in primary care.

Design and setting: In-depth interviews were conducted with 15 GPs and 20 patients, purposively sampled from GP practices in Bristol and the surrounding areas.

Method: Interviews were held either in person or by telephone. A topic guide was used to ensure consistency across the interviews. The interviews were audio-recorded, transcribed verbatim, and analysed thematically.

Results: GPs reported preferring to use symptom rather than diagnostic codes in order to avoid assigning potentially stigmatising labels, and because they felt diagnostic codes could encourage some patients to adopt a ‘sick role’. In addition, their decision to use a diagnostic code depended on symptom severity and chronicity, and these were hard to establish in a time-limited clinical consultation. In contrast, patients commented that receiving a diagnosis helped them to understand their symptoms, and encouraged them to engage with treatment.

Conclusion: GPs may be reluctant to diagnose an anxiety disorder, but patients can find a diagnosis helpful in terms of understanding their symptoms and the need for treatment. As limited consultation time can discourage discussions between GPs and patients, followup appointments and continuity of care may be particularly important for the management of anxiety in primary care.