A long-term relationship with a GP – one who knows you and your history – improves your health and even reduces your chance of dying prematurely.

This type of trusted relationship is particularly important if you have a serious or chronic (long-term) condition or multiple conditions. It is also important for trauma survivors, who should not need to retell their story over and over.

However, there are times when you may feel uncomfortable with your current GP. The first step is understanding why, then knowing what to do about it. Here are some reasons you might consider finding another one.

1. Your needs have changed

It is common to change GPs at pivotal times in your life. You may feel uncomfortable discussing your sexual health needs with the “family GP” who has known you since you were a child, or who still sees your parents.

If your family is having children, you may prefer a GP who does antenatal care, or sees a lot of children, so they can more readily empathise with your needs as a young parent. Perhaps your current GP doesn’t share your ideas about health care and parenting, or the practice isn’t particularly child friendly.

You may have appreciated your GP’s practical, straightforward and efficient consultation style for past sports injuries, but find this approach unhelpful when struggling with your mental health.

So you may look for a GP who better meets your current needs.

2. You want another GP who is expert in your illness

Good GPs can get “up to speed” on a variety of conditions, while still keeping the whole person in view. But sometimes, you will have a very specific need that leads to seeking a GP who is expert in that area. An example may be a GP who specialises in skin checks, or a GP who is expert in ADHD (attention deficit hyperactivity disorder).

However, you still need a generalist GP who looks at your other health-care needs. This generalist GP may well be the one who picks up early Parkinson’s disease or bowel cancer while your other GP is focused on your reproductive system or mental health.

3. You want a GP who is more aligned with your values

People differ in the type of relationship they want with their GP. You might be seeking a true partnership, where you both bring your expertise into decision making and you have the final decision. At the other end of the spectrum, you may feel more comfortable with your GP taking a more assertive role. Your needs and preferences may change over time.

Sometimes, your GP doesn’t seem to accept your views on health care. You might feel uncomfortable discussing the role of complementary medicine, or preventive health care, or your decisions to accept or reject certain treatments.

So you may seek a GP who is more aligned with your attitudes and practices.

However, GPs have their limits when it comes to accommodating your preferences. They cannot always supply your preferred medication, referral or other service, for professional, regulatory, legal or other reasons.

4. There has been a fracture of trust or confidence

Everyone makes mistakes. Sometimes, those mistakes are so serious you cannot go back to that doctor. However, there are errors where the relationship can be repaired.

A good GP will explain why an error happened, show how they (and the practice) will rectify the error, and what systems are now in place to make sure it doesn’t happen again. A sincere apology and equally sincere desire to make things right can strengthen a relationship and restore trust.

Sometimes you can feel unheard during a consultation, or the GP can seem distracted. The GP may sincerely apologise, and explain why. They are human, and can be unwell, exhausted by an untenable workload, or simply recovering from a particularly challenging consultation earlier in the day.

However, if there is a pattern of feeling the GP doesn’t hear you, makes frequent minor errors, or simply doesn’t seem to be providing the sort of professional service you expect, you may lose trust. If you feel uneasy or judged, you may need to step away from that GP.

How to break up with your GP

Good GPs understand a partnership with you is important. If you cannot maintain a relationship with them that is open, honest and safe, it is time to move on.

If your needs have changed, but you still value the GP for their care, you can send a thank you card and explain you have chosen to transfer to another doctor. The practice staff can forward your records to a new practice, for which there may be a small administrative fee.

If there has been a rupture in trust or confidence, and the issue is relatively minor, the practice manager will be able to advise how to make a written complaint to the practice.

If the problem is more serious, and you wish to make a formal complaint about a breach of trust that has implications for patient safety, you can report this to the Australian Health Practitioner Regulation Agency.

If the problem is about the GP practice, you can report it to the relevant health-care ombudsman or commission in your state or territory.

Louise Stone, Professor of General Practice, University of Adelaide

This article is republished from The Conversation under a Creative Commons license. Read the original article.

At least one in ten people have depression at some point in their lives, with some estimates closer to one in four. It’s one of the worst things for someone’s wellbeing – worse than debt, divorce or diabetes.

One in seven Australians take antidepressants. Psychologists are in high demand. Still, only half of people with depression in high-income countries get treatment.

Our new research shows that exercise should be considered alongside therapy and antidepressants. It can be just as impactful in treating depression as therapy, but it matters what type of exercise you do and how you do it.

Walk, run, lift, or dance away depression

We found 218 randomised trials on exercise for depression, with 14,170 participants. We analysed them using a method called a network meta-analysis. This allowed us to see how different types of exercise compared, instead of lumping all types together.

We found walking, running, strength training, yoga and mixed aerobic exercise were about as effective as cognitive behaviour therapy – one of the gold-standard treatments for depression. The effects of dancing were also powerful. However, this came from analysing just five studies, mostly involving young women. Other exercise types had more evidence to back them.

Walking, running, strength training, yoga and mixed aerobic exercise seemed more effective than antidepressant medication alone, and were about as effective as exercise alongside antidepressants.

But of these exercises, people were most likely to stick with strength training and yoga.

Antidepressants certainly help some people. And of course, anyone getting treatment for depression should talk to their doctor before changing what they are doing.

Still, our evidence shows that if you have depression, you should get a psychologist and an exercise plan, whether or not you’re taking antidepressants.

Join a program and go hard (with support)

Before we analysed the data, we thought people with depression might need to “ease into it” with generic advice, such as “some physical activity is better than doing none.”

But we found it was far better to have a clear program that aimed to push you, at least a little. Programs with clear structure worked better, compared with those that gave people lots of freedom. Exercising by yourself might also make it hard to set the bar at the right level, given low self-esteem is a symptom of depression.

We also found it didn’t matter how much people exercised, in terms of sessions or minutes a week. It also didn’t really matter how long the exercise program lasted. What mattered was the intensity of the exercise: the higher the intensity, the better the results.

Yes, it’s hard to keep motivated

We should exercise caution in interpreting the findings. Unlike drug trials, participants in exercise trials know which “treatment” they’ve been randomised to receive, so this may skew the results.

Many people with depression have physical, psychological or social barriers to participating in formal exercise programs. And getting support to exercise isn’t free.

We also still don’t know the best way to stay motivated to exercise, which can be even harder if you have depression.

Our study tried to find out whether things like setting exercise goals helped, but we couldn’t get a clear result.

Other reviews found it’s important to have a clear action plan (for example, putting exercise in your calendar) and to track your progress (for example, using an app or smartwatch). But predicting which of these interventions work is notoriously difficult.

A 2021 mega-study of more than 60,000 gym-goers found experts struggled to predict which strategies might get people into the gym more often. Even making workouts fun didn’t seem to motivate people. However, listening to audiobooks while exercising helped a lot, which no experts predicted.

Still, we can be confident that people benefit from personalised support and accountability. The support helps overcome the hurdles they’re sure to hit. The accountability keeps people going even when their brains are telling them to avoid it.

So, when starting out, it seems wise to avoid going it alone. Instead:

• join a fitness group or yoga studio

• get a trainer or an exercise physiologist

• ask a friend or family member to go for a walk with you.

Taking a few steps towards getting that support makes it more likely you’ll keep exercising.

Let’s make this official

Some countries see exercise as a backup plan for treating depression. For example, the American Psychological Association only conditionally recommends exercise as a “complementary and alternative treatment” when “psychotherapy or pharmacotherapy is either ineffective or unacceptable”.

Based on our research, this recommendation is withholding a potent treatment from many people who need it.

In contrast, The Royal Australian and New Zealand College of Psychiatrists recommends vigorous aerobic activity at least two to three times a week for all people with depression.

Given how common depression is, and the number failing to receive care, other countries should follow suit and recommend exercise alongside front-line treatments for depression.

I would like to acknowledge my colleagues Taren Sanders, Chris Lonsdale and the rest of the coauthors of the paper on which this article is based.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

Michael Noetel, Senior Lecturer in Psychology, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.