Dear Patient

[HuckleB]

http://scientopia.org/blogs/whitecoatunderground/

"I do believe that you are in pain; I can see it in your eyes, your furrowed brow. I can see it in your hesitant gait, the cautious way you get up and down from my exam table.
But this is the first time I've met you. I don't have your medical records. I don't know anything about your kidney or liver function, whether or not you have heart disease or diabetes. You don't know either, which is not unusual. Many people come to me for the first time without a list of medical conditions or current medications. We can work it out.

You can expect me to take a thorough history, do a complete physical exam, and request your old records. But I am not going to give you a prescription for narcotics today.

It's not that I don't believe what you're telling me: I believe you when you tell me that ibuprofen doesn't work or that you are allergic to it. I believe you when you tell me that all your other doctors have given you narcotic prescriptions. But I don't know you yet, don't know your whole medical picture. Narcotics are potentially beneficial and potentially risky. Dependence is a disease that is very common, and very difficult to treat. You should not expect me to take such a risk with your health at this point.

It is possible that your disease, be it chronic pain or opiate dependence or both, does not let you understand that. You may feel angry, depressed. You may lose your temper, behave inappropriately. If I suspect a narcotic use disorder I may offer you a referral to a local expert.

..."


--------------------------


Shockingly, most MDs actually care a great deal about their patients.

This is beautiful reminder of that. Please read the whole thing.

[Duer 157099]

1. Sure, but go in saying you're depressed

and just watch how quickly that Rx pad comes out with a script for antidepressants.

It's bullshit and hypocritical.

[HuckleB]

2. That's not what the MD's I know do.

I'm not buying your sweeping generalizations for one minute.

[laconicsax]

3. It doesn't work that way.

A doctor won't prescribe you antidepressants just because you say you're depressed. They have to evaluate your symptoms and take a history.

[Maine_Nurse]

5. I wish you were right, but there are plenty of PCP's out there...

that do just that. Some don't even rule out other psychiatric disorders first, which could have disastrous results.

[HuckleB]

6. They are a small percentage of MDs.

Why an article by an MD explaining why he won't prescribe dangerous meds at a first meeting gets derailed by these old cliches is beyond me.

Sheesh.

:eyes:

[Maine_Nurse]

7. A small percentage that does a lot of damage...

I work on the receiving end at an inpatient psych facility. I see some pretty messed up med lists coming from PCP's. The situation is better than it has been in years past, but there are still too many PCP's prescribing psych meds without a good grasp of how to correctly do so. We also have the problem of PCP's not communicating with a patient's psych providers, resulting in bad medication combinations on either side. Sometimes it is the patient's fault for not letting one provider know what the other provider is doing/prescribing, but sometimes it is one of the provider's fault for not forwarding appropriate info to the other for proper coordination of care.

[HuckleB]

8. Maybe.

But find me one profession that doesn't have a small percentage of "professionals" that do damage?

In other words, cut the generalization crap.

[Trillo]

4. "Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy"

http://www.nytimes.com/2011/03/06/health/policy/06doctors.html?_r=2&pagewanted=1&partner=rss&emc=rss

Not a new story, but one I saved. It's all about the docs standard of living.