Dr. Kroenke, in his recent editorial [1], clearly and sensitively lays out the crux of the issue of the role of primary care physicians in diagnosing and treating depression. On the one hand, depression is common, costly, and disabling; it is also poorly detected and treated in primary care settings. On the other hand, the diagnosis of depression, particularly in persons with comorbid general medical conditions, is complex, takes time, and often requires more frequent observation and follow-up. Recognizing and treating depression in primary care is also complicated by the fact that primary care physicians have many other conditions knocking on their doors. They must attend to the full array of medical problems that their patients manifest or might manifest, from neurologic symptoms to cardiovascular disorders to dermatologic problems, and at the same time they must implement the latest recommendations for prevention. In other words, there is no free lunch.

Although we are sure that he did not intend this, some may infer that Kroenke is letting primary care physicians off the hook. Clearly, as he suggests, many primary care physicians do not have the interest, experience, or time necessary to effectively care for persons with depressive disorders and will need to refer these persons to a psychiatrist for appropriate diagnosis and treatment. Nonetheless, primary care physicians have a critical role to play.

At a minimum, the assessment of common psychiatric problems in primary care should be a core skill taught in medical school and residency. Curriculum aids such as the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Primary Care Version [2, 3], developed by the American Psychiatric Association, the American College of Physicians, the Society for General Internal Medicine, and other primary care groups, can be easily implemented in training programs. Preferred models of teaching have also been described [4, 5]. Furthermore, knowledge and skills in these areas should be incorporated into accreditation requirements for primary care residencies and board certification examinations. To paraphrase a line from the movie Field of Dreams, "if you test for it, they will come."