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The review by Donohoe¹ regarding differences in generalist and specialty care lists mental illness care, with a particular emphasis on depression, as one of the major areas where studies show significant superiority in the knowledge base and quality of care provided by specialists. While the editorial by Johnson² notes that the lack of studies on outcomes of care, rather than intermediate measures of processes of care, weakens some of these conclusions, neither this comment nor Donohoe's review adequately address the reasons by which the care of patients with depression is a remarkably poor example of the apparent superiority of the care provided by specialists over that of generalists.

Earlier generations of community-based studies did, indeed, demonstrate a remarkable level of apparent underdiagnosis and undertreatment,³ but subsequent studies have investigated more carefully the ways that primary care patients with depression differ markedly from those in psychiatric settings,⁴ the fact that accurate . . . [Full Text of this Article]

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