Posted by Anyuser on August 22, 2002, at 10:01:06
In reply to Re: Three points, and then I'll drop this » Anyuser, posted by dr. dave on August 22, 2002, at 4:58:29
> About point three - please expand on your concerns about my apparently poorly evolved practice and relationships with my patients. I just wonder what you are inferring from my comments in terms of how you think I relate to my patients.
I see that the way I wrote my third point is insulting, but I meant no insult and I apologize. No excuse, but I was running out of time when I wrote it.
Let me ask you a question. If I scheduled an appointment with you, and you diagnosed depression, and I told you I wanted a prescription for Lexapro, and I told you why (along the lines of what I've said in my previous posts), and money wasn't an issue for me, would you give me the prescription? Perhaps along with your caveat that you think I'm wasting my (or my insurer's) money?
Another question. In your practice, when making a decision about treatment for an individual patient, are you required by professional ethics or governmental regulation to factor in social policies regarding public resources available for mental health, or are such concerns personal to you? Do such concerns arise from your employment situation? Perhaps you work in a public hospital with uninsured patients, I don't know. I don't know anything about, what do you call it, National Health in the UK.
What I'm getting at is that I hear you saying that there is in your thinking a convergence of science and public policy. That is, the science behind Lexapro is deficient and it would be wrongful, in a social sense, to waste money, anbody's money, on such an enterprise.
If I asked you for Lexapro on grounds that it might be somewhat better but in any event no worse than Celexa, and I said money is no issue, and you said to me, "The financial issue is relevant as there will always be some limit on the funds available for treating mental disorder. I think that as much benefit should be obtained from those resources as possible. I don't think we can afford to waste money." I would say, in the US, hey Dr. Dave, that's between me and United Health Care, and ultimately, I suppose, between United Health Care and Forest Labs. I wouldn't want my private physician factoring public policy issues into the decisions he makes about my treatment. I care about such public policy issues, but I would discuss them and act upon them outside my doctor's office ("President Hillary in '04!").
poster:Anyuser
thread:109458
URL: http://www.dr-bob.org/babble/20020821/msgs/117374.html