Friday, August 10, 2007

Prescribing Multiple Antipsychotics, Eh?

The Last Psychiatrist has a highly impressive (and hilarious) post on why prescribing multiple antipsychotics to the same person is not such a hot idea. I strongly encourage everyone to read it as soon as humanly possible.


herb said...

Funny you should reference “The Last Psychiatrist” recent posting. I commented and for whatever reason my post hasn’t made it to the board. What in particular caught my attention was his final statement to which I replied:

Dear Doc,

I had sent you a previous comment relating to this recent posting. Maybe it simply got lost in the ether of the Internet in front of or behind the credit person spammer.

Anyway, thanks for the information and even as a lay-person I understand your message.

But once again I’ll have to take exception to what I think is a convoluted resolution to correcting a problem.

“This impulse towards polypharmacy- shotgun symptom management-- will never change unless there is a financial incentive, or, more accurately, negative reinforcement. And I have one: give doctors a medication budget per day per person.” --- The Last Psychiatrist.

Why not simply better educate your colleagues and newer psych medicos?


TheLastPsychiatrist said...

Herb-- sorry about your comment, it's not me, it's my insane overaggressive spam filter that I can't seem to get reined in.

"Educate my colleagues." Seriously? Have you seen my "colleagues?"

Also, in reference to Wyeth's abilify clone-- while it is, indeed, likely useless, Wyeth's future actually rests on its Alzheimer's drug. I don't own Wyeth (yet) but 46 for that potential blockbuster is an appealing price. It actually doesn't matter if it will work or not: if it gets approved, they will try it. And in a market with few alternatives-- Namenda and Aricept, and that's pretty much it-- it will be gigantic. Please note: for the purposes of Wyeth's stock price, it doesn't matter if it works or not. It will still get used.

Herb-- that's why educating my colleagues is impossible. At best, we can educate patients to keep their psychiatrists in line.

herb said...

The Last Psychiatrist,

"Educate my colleagues." Seriously? Have you seen my "colleagues?" --- The Last Psychiatrist

After 44 years as a support person to my spouse with numerous doctor appointments and a cadre of attending physicians as well as being a former facilitator for DBSA I am very familiar both hands on and indirectly with some of your medical colleagues and associates.

As a side-note to this commentary is a quick story of one of your fellow colleagues highly recommended to us when we were searching early on for a psychiatrist to tend to Joyce’s VNS Therapy. Joyce sat in this one physician’s office filling out his psych questionnaires for about ¾ of an hour. When we finally sat down with the good doctor I interviewed and questioned him whether he knew the company and/or anything about the VNS Therapy and I explained I was looking to have someone attend to Joyce and I would make arrangement to have the attending physician trained.

He replied he didn’t know the company. He vaguely heard about the therapy. He “was not interested in learning something new.” At which time, I said to Joyce, “Come on, let’s go.” That was the shortest meeting we’ve ever had with any medical professional. It was under 3 minutes. When I got to the car I told Joyce I appreciated the fact that he was forthright and upfront and didn’t waste our time but I also said that in a million years I would never recommend that individual to attend to anyone I knew. As a Psychiatrist one would have thought he might have enough intelligence and decorum to have at the very least explained he was swamped etc, etc and might look into the therapy later on.

Yup, I have had experience with some of those “colleagues” but as I often state, “There are doctors, good doctors and better doctors” and certainly it is incumbent upon the patient and/or their support people to ferret out the “better doctors” or at the least the “good doctors.” Joyce and I have been fortunate that in recent years we have, in my opinion, been associated with some of the better and caring doctors which may very well be a reason for her wellness currently.

This is not to preclude what I’ve stated previously and for my having to disagree with your thoughts and part of your additional statement.

“Herb-- that's why educating my colleagues is impossible. At best, we can educate patients to keep their psychiatrists in line.” --- The Last Psychiatrist

I have always advocated for educating the patient and/or his/her support persons while encouraging hope and persistence so we are much in agreement on that point. I am un-accepting of the word “impossible” as my spouse would never have achieved the reasonable success she has and at very least as it relates to this subject matter.

Then it is incumbent upon folks like you, CL PSYCH and others to change and better the system through education of your peers and own kind.

You also took the easy way out when you stated you’re against “Parity.” What you are missing is that patients like my spouse and others have no easy way out and we’re forced to struggle against difficult odds and if folks like you who work and earn a living from the system simply throw up their hands and surrender then while your sharing is interesting and informative you’re really no different than those you write about.

I’m sorry I may be harsh in my commentary but as I’ve stated early on, my wife and I have been battling a long time for her mental wellness and that of others and we’re not ready yet to give in or give up on our causes (i.e. VNS Therapy). I’ll presume there are others like you who still remain somewhat idealistic who can make a better effort to educate and challenge the system (colleagues).

I thank you for this opportunity to share my thoughts while not in agreement with all that you share.


x said...

Good grief. One can't use the word "psychiatrist" on its own without qualifying time, space, position and degrees :) :). Isn't that what the GMC states :).

Rita Pal