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Depression is a very common condition. Most patients who suffer with depression get their initial treatment through primary care and the majority of patients get all of their mental health from their PCPs. For various reasons – including cost, convenience, stigma of actually going to a “real” mental health professional – depression is often addressed in the primary care setting.

As a physician, I regard depression as an illness like another – one that has certain demographics, tendencies, treatments, prognoses, etc. That said, if one does not look for something, it might not get found. While no-one would question the value of doing a blood pressure in a person who is not known to have high blood pressure, or doing routine bloodwork to screen for cholesterol, many clinicians and patients are wary of screening for mental illness – especially depression.

At SHFM, we often do depression screens – either in the form of written questionnaires or by carefully interviewing our patients. This process is so important to us and various regulatory bodies – such as the US Joint Task Force (USJTF) and the Centers for Medicare and Medicaid Services (CMMS), that we routinely use a code that can be attached to the electronic charts of our patients. This allows us to avoid missing those who might benefit. It is EXTREMELY important for our patients to understand that being screened for a disease does not mean that they have it or even that we suspect that they have it. Again, I cite the blood pressure example. Of course, should a patient “screen positive” for depression, a competent primary care provider would know how to delve deeper and guide treatment, if needed.

Depression screening is one of the many services that primary care performs. If depression is not an issue for you personally, it is likely that the screen will only take a few moments and you might not even notice it happened – just like you might not have noticed your PCP checking your posture or walk when you came in. So, if you see a note of DEPRESSION SCREEN in your chart or some paperwork, it does not mean that you have been labeled with a diagnosis – just that your PCP is doing his or her work.

should you want some additional information:

Zung Depression Screening tool

PHQ -9 depression (University of Wisconsin)





Shingles, also known as herpes zoster, is a painful skin rash.  This most commonly occurs in older adults, but can affect anyone who has ever had chicken pox.  The chicken pox virus lies dormant in a nerve root and at certain times becomes active again in the form of shingles.  This can occur during times of illness, stress, or when the body’s immune system is compromised.  Sometimes, there is no real reason why the virus becomes active again.  In many people, the virus will never become active again and they will never have shingles.

The blistery rash usually appears in a strip or line on one side of the body after a few days of pain or tingling in that same area.  Over days the clusters of blisters fill with fluid, then open and crust over.  It may take weeks for the rash to fully resolve.  The rash can occur on any part of the body, but is most dangerous if it occurs on the face, near the eyes.  Treatment for shingles includes antiviral pills and pain medications.  Most people with shingles get better and will never have shingles again.  However, there is a possibility for scarring, vision loss (if the rash is in the eye area) and long term pain, also called post-herpetic neuralgia.  Depending on the severity of the shingles, patients may experience pain for over a year after the rash heals.

Many people are concerned about “spreading” spreading shingles to others.  Generally, people who get shingles do not “catch” it from someone else.  It is their own previous chicken pox virus “waking up” again in their body.  There is however, a slight chance the virus may be spread to someone who has never had chicken pox or had the chicken pox vaccine it in the past- if they come in contact with an active shingles rash.

A shingles vaccine is available for those who are 60 years old and over.  Though this vaccine does not guarantee you will never get shingles, it does significantly reduce your chance of getting shingles, the severity of the shingles case and chance of developing long term pain.  Those who have already had shingles can still get the shingles vaccine, as there is a small chance shingles may be recurrent.