Thursday, November 17, 2005

Mighty Medpundit weighs in

…on the NYT article that ignited my rant:
It's impossible to discern whether this is a true trend or just a New York Times trend. That is, an editor or reporter has a friend or aquaintance who does something or believes something and then writes a whole front page story on the 'trend' based on interviews of the friend and the friend's friends. I suspect the latter, but it's disturbing nonetheless...

They possess two of the worst possible traits that when combined are often fatal - arrogance and stupidity. (Or, as one of my uncles used to say, 'It's not a crime to be stupid, but it is to abuse the privilege.')
The NYT article presents a mishmash of behaviors - some healthy (researching meds, making informed choices) and some dangerous (conning the doctor, practicing ignorant polypharmacy on oneself).

The diagnoses of the patients are never clear. How many are substance abusers? How many are hypomanic, and grandiosely playing doctor, with reckless impulsivity and poor judgment? How many are hypomanic because of their underlying illness, or because of the antidepressants and stimulants that they are recklessly self-prescribing?

How many are paranoid because of their illness and/or amphetamines, and are therefore not trusting of anyone except themselves? How many are in withdrawal from addictive meds? Are their anxiety and insomnia a result of their withdrawal?

There is no better way to sabotage one's treatment than to self-prescribe and not tell your doctor what you're doing. In a way, these patients are letting their doctors off the hook, even as they express their contempt. "Of course the doc can't help me, he doesn't even know what I'm doing behind his back."

Our clinic sees patients who've tried everything described in the article. Some are so addicted to their online meds, or so addled by impulsive, erratic med-and-substance-use, that they don't know where to turn. I ask them to bring in everything they've been taking for the last few months.

"I can't," they might say. "I don't have the bottles, I don't have the pills, I think it was Trazodone. Or Trileptal. Or Tranxene. It had a 'T' in it." They might bring in a baggie full of pills, which we send to our pharmacy for identification. An agitated pharmacist calls back: Where did they get this? What are they doing? Good question, I reply. That’s why they’re here.

The good news is that, if patients can trust us enough to tell us what they're doing, we can usually sort it out, and the patient can usually feel better. There are multiple things to sort through: the diagnosis; the meds taken and not taken; the self-prescribing; the issues that motivated the self-prescribing; and the doctor-patient relationship.


Blogger Maurice Bernstein, M.D. said...

I have to believe that failure in the doctor-patient relationship has much to do with the self-medication. Part of the problem is intrinsic to the physicians themselves-- rushed and not spending enough time listening and developing the connection to the patient. I think, a large part of the problem is that of "too much medical information" being presented to patients or potential patients thru the Internet and the pharmaceutical company's direct to the consumer advertising. Besides this availability of "information", is that the patient is encouraged to view medical care as a consumer issue like buying food, clothing or cars. In addition, the change in recent years, from physician paternalism to that of patient autonomy is all part of the dynamic of the patient's behavior. Finally, it may well be issues intrinsic to the pharmacology of treating emotional/psychiatric disorders. Unlike treating a pneumococcal pneumonia where the recommendation and therapeutic response is fairly clear cut, treating psych illnesses may be more trial and error, hit or miss which leads to more uncertainty regarding the clear benefit in the mind of the physician and also in the patient. And this will tend to disrupt the patient-physician relationship and motivate the patients to try approaches to therapy on their own. ..Maurice.

9:21 PM  

Post a Comment

<< Home

Click for Eugene, Oregon Forecast