I will be the first to admit that I'm not a doctor. Far from it. I will also admit that I do not know my medications as well as I probably should. Oh, I know the highlights. The basic antidepressants, the standard anti psychotics, the ubiquitous mood stabilizers, the every day pain killers. But it's just enough knowledge to pretty much make me look like an idiot past the first paragraph of a blog entry.
That being said, I'm going forward with this blog entry.
I recently assessed a woman who was profoundly depressed for a number of reasons. She had lost her job (laid off), her home, her pets. She was experiencing some family strife. She was living in abject poverty. She could afford to eat and had a roof over her head (Maslow's Hierarchy and all that) and she was furiously looking for a job, but she hit a wall that day and felt she needed to come into the hospital. For some help.
I spoke with her at length and one of the things she mentioned in passing was that she was out of her antidepressant and had been for about a month. She could afford to get the pills as they were on the Wal Mart $4 list, but she couldn't afford the doctor's visit. She had been on the medication for a decade and knew that it helped tremendously. She opined that the big part of her problem was being off her meds. And she should know.
We discussed some practical, cheap ways to combat depression (namely walking, getting tasks done around the house, eating healthy food. Which, by the way, is a whole other can of worms, seeing as healthy food tends to be much more expensive then ) and I essentially provided some emergent counseling. And then I went to the doctor.
Here's the deal: I don't ask doctors to write prescriptions often. As I noted above, I don't have a vast knowledge of medication and it's certainly not my place to tell them how to medically treat a patient. However there are times when I feel the situation is warranted.
And when I have a woman in front of me who cannot stop crying, has been off her antidepressant that she's been on for over ten years, can't afford a doctor's visit but is sitting in an ER* with a doctor right outside?
Situation warranted.
Some doctors are loose with the pad. Others? Not so much. My guy on this particular evening? Vice grip.
He absolutely refused to write the prescription. Refused. I got the standard lecture: People who begin taking SSRIs have a suicidal ideations (Funny. She was there for suicidal ideations. I digress.) and she would have to start her dose from scratch. She needed to see a psychiatrist. When I explained that it would take her at least a month to get in to a psychiatrist at a state facility, he shrugged his shoulders and again with the suicidal ideations rambling he went....
OK, let me reiterate here: She had been on the pills for over a DECADE. She had been off of them for a month. And she was in the hospital because she could barely hold it together. This was her only medication. Her only one. I don't think it's an unreasonable assumption that perhaps she, you know, needed her meds.
I do know the risks associated with SSRIs and suicidal ideations. I've been told this before by other doctors. While they're writing the prescription for SSRIs. I don't think this guy was acting (or, not acting, as the case may be) out of malice or disdain for the patient. I think he was acting out of self preservation. Read: He didn't want to write a prescription, have her off herself and then get sued.
I could go off on another rant at this point, a rant about doctors making decisions based solely on potential litigious outcomes, but I won't. I will simply say this: You called me to come in and assess, doc, which I did. I assessed and acted to the best of my ability and capability. I did my part. Now pony up and do yours. ->
*I know, I know. Irony.
Read the complete post at http://feedproxy.google.com/~r/blogspot/tXCM/~3/Ad7vums-W1w/were-in-this-together.html
Posted
29 Apr 2009 2:13 PM
by
Trench Warfare
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