Monday, September 06, 2004

Another holiday on call....

Just finished my rounds. Some observations from the front lines:
1. We are still far too dependent on medications, and we are using more and more of them, in combinations that can't be supported by much research. When I'm on call, I can peek at the meds ordered by my esteemed colleagues, and I've never seen such complicated combinations of meds.
2. Medical (as opposed to psychiatric) problems are still the most common and the most overlooked causes of confusion and hallucinations in the elderly. We are still not diligent about diagnosing delirium, even when the signs and symptoms are obvious.
3. Staffing on weekends and holidays continues to be a huge issue.
4. The shortage of psych resources in Oregon is becoming more obvious. Right now, our unit is full, and it's only 5:25 pm. What will we do tonite, when patients start crowding into our emergency room?
5. Our staff still has a sense of humor. At about 3 pm, the staff spontaneously started singing together, "You Could Be Swinging On A Star," and the patients were....bemused. And perhaps entertained. But we (staff) had fun!


Blogger Bruce said...

I say "amen" to your opening comment about over medicating. As a lay person, I would always recommend that someone see a psychologist instead of a psychiatrist. (The exception would be those who are in a crisis situation, such as overwhelming depression, suicidal thoughts, etc.) Psychiatrists over medicate, sometimes with little regard for what other meds the patient may be taking at the behest of their regulard MD.

8:24 PM  
Blogger owlish said...

Eek. Given how many people have untreated major depression in the US, I would have a hard time agreeing with "psychiatrists overmedicate." Although PCPs treat MDD more than psychiatrists, anyway.

Yeah, we don't know the exact interactions between multiple drugs. Once you get to the point of having 3 or 4 drugs on board proving what to do next is complicated. But until the science involved in diagnosis improves, we're stuck with our best medical judgement.

8:20 AM  
Anonymous Anonymous said...

I noticed the multiple medication problem when my late mother went through Parkinson's disease. Several times her meds had to be "re-adjusted" - her middle years with the disease actually had less problems with hallucinations and other side effects than her earlier ones - once she got her meds straightened out. It almost seems that a drug interaction specialist (or review board) should examine these cases. (Just what we need - another set of specialists!) Although with computerized case histories, perhaps this could be done in the future in a practical manner - a program that could scan drug use and send memos for potential problems?

5:09 PM  
Anonymous Anonymous said...

First, I wish "Blogger" would let a "non-blogger" member post their contact information and not have to post anonymously. Can anyone tell me how to do this.

Anyway, on to what I came to comment on.

I would agree with you shrinkett that we are too dependent on medications. You tell me, but i think in America today, Doctors seem to bend too easily to the request of their patients about what medications their patients want. I mean, just look at every pharma ad on TV. They mostly all end with "Ask your Doctor if "xxx" is right for you". When I see an ad like that, it tells me that drug companies are targeting the ad toward the consumer thereby creating a demand for said drug.

Although my problem was not psychological (at least not the one I am talking about), I had a VERY high cholesterol count on 280. My good to bad ratio was twice as bad as what they considered normal. I went to my Doctor and he said he wanted me to first try a low fat, low cholesterol diet and exercise. Interestingly enough, those six words was all the advice I got. No, how-to or references I could check. He said he wanted to see me in 3 months. I was by far a fat person, I am 5' 8" tall and at the time i weighed 160lbs. I immediately started a low-calorie (1500 going down to 1200 calories a day) balanced diet consisting of 60% complex carbs, 20% protien, and 20% fat (mostly mono-unsaturated). I also started to exercise by ensuring I raised my heart rate to between 125 - 140 bpm for at least 30 minutes, 5 days a week. Within 3 months, I had lost 30 lbs, and my cholesterol had gone down to 139. That was over 18 months ago and today i still weigh 130 lbs and my cholesterol finally leveled out to 160, but now my good to bad ratio puts me at 1/2 standard risk. I know psyche problems are differnt that physiological problems, but my point is that "some" medical problems can be cured/prevented without the use of any drugs. BTW, I recently found about about taking Inositol Hexanicotinate (Niacin) to help lower my cholesterol. I asked my Dr. about it and he confirmed that it was medically proven to lower cholesterol, in some cases as much as medications such as Lipotor etc. I asked him why more people don't take it. He said two things. 1. People come in asking for Lipotor and other statins and don't believe a simple vitamin like Niacin can help, and 2. Drug companies can't patent, and therefore can not make any money on selling vitamins so there is very little reason for a drug company to promote vitamins. Anyway, sorry for the long ramble. I don't often do that.


8:00 AM  
Blogger owlish said...

Reason 3: taking niacin for high cholesterol requires a much higher dose than for vitamins, which leads to side effects.

11:14 AM  
Anonymous Anonymous said...

Not completely true. Although it may be true that taking large amounts of Niacin may cause flushing, taking Inositol Hexanicotinate typically does not cause flushing. In order to be effective to reduce cholesterol, studies have shown than 500 mg three times a day (1500 mg total) will significantly reduce cholesterol. This is what I am taking and I have experienced no side effects whatsoever.

12:06 PM  

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