Taking your score to a doctor in Pakistan — GP or psychiatrist, and what to say

Who to see first, what it is likely to cost, exactly what to say in the first two minutes of the appointment, what to bring, and what the doctor will probably do next.

GP or Psychiatrist First?

Deciding who to see first can depend on your score and location. For scores of 5-9 (mild) or 10-14 (moderate), a General Practitioner (GP) is often a good starting point. They can discuss your symptoms, rule out other medical conditions, and provide initial guidance. If your score is higher, indicating moderately severe (15-19) or severe (20-27) symptoms, or if you had thoughts of self-harm on item 9, seeing a psychiatrist directly might be more appropriate. In smaller towns, a GP may be the only accessible option, while larger cities offer more specialists, though access to government hospital OPDs can provide more affordable care compared to private clinics.

Understanding the Costs Involved

The cost of a consultation can vary significantly. A private GP visit is generally less expensive than a private psychiatrist. Government hospital outpatient departments (OPDs) offer significantly lower or no fees, but waiting times can be long. A private psychiatrist's fee can be substantial, and follow-up appointments will also incur charges. It is important to consider these financial aspects and discuss them with your family, as 'log kya kahenge' (what will people say) can sometimes lead to hesitation in seeking help, but your well-being is paramount. Be prepared to ask about fees upfront to avoid surprises.

What to Say in the Appointment

When you first meet the doctor, whether a GP or a psychiatrist, begin by stating clearly that you took a screening test for depression, the PHQ-9, and you have your score. For example, you can say, "I took a depression screening test online, the PHQ-9, and my score was [your score]." Explain that the test asked about how often you experienced certain feelings over the last two weeks. If you answered positively to item 9 regarding thoughts of being better off dead or self-harm, it is crucial to mention this directly and calmly to the clinician. This helps the doctor understand the urgency and your current state.

What to Bring With You

It is highly recommended to bring a printed copy of your PHQ-9 score. This provides the clinician with a clear, objective starting point for your discussion. You should also bring a list of any current medications you are taking, along with any relevant medical history, including other health conditions or past mental health concerns. If you have a trusted family member or close friend who supports you and understands your situation, bringing them along can be helpful, especially if you anticipate difficulty explaining your feelings or remembering details during the consultation. They can also provide additional perspective.

The Doctor's Next Steps

After reviewing your PHQ-9 score and listening to your concerns, the clinician will conduct their own comprehensive assessment. Remember, the PHQ-9 is a screening tool, not a diagnostic one; only a qualified clinician can make a diagnosis. They will likely ask more detailed questions about your symptoms, medical history, and current life circumstances. They might perform a physical examination or recommend blood tests to rule out other medical causes for your symptoms. Based on their assessment, they will discuss potential next steps, which could include further evaluation, lifestyle recommendations, a referral to a specialist, or various treatment options.