Posted by stjames on April 4, 2003, at 17:35:58
In reply to Re: what do docs do if you disobey them?, posted by stjames on April 2, 2003, at 15:23:01
> Family docs (such as internists, pediatricians, and OBGYN's) prescribe about 70% of antidepressants.
And they do a poor job:
Do you rely on a family physician to diagnose and treat your depression? Perhaps you should reconsider. In January 2001, three studies came to light that strongly suggest primary care physicians are better off poking and prodding our bodies than getting inside our heads.The first, an Indiana Community Cancer Care-Aetna US Healthcare-Pfizer study of the records of 100 patients who were prescribed antidepressants in primary care, found that 90 charts contained documentation of just three or fewer symptoms of major depression, sixty revealed one or more criteria, and 40 contained no documentation of any criteria. The required five or more symptoms were to be found in only seven charts. Use of screening tools was documented in only four charts. Only 57 of the charts revealed a depression-focused follow-up visit, while just five charts indicated an educational intervention.
In other words, these doctors were indiscriminately handing out meds.
Not surprisingly, only 37 percent of the patients improved. Sixteen percent were referred to specialists. There were two suicide attempts. The article cited other studies suggesting that primary care physicians misdiagnose depression in as many as two out of three cases, and when the correct diagnoses is made, patients are often treated with subtherapeutic doses prescribed over periods of time too short to produce a benefit. The article also noted that 50 percent of patients quit their antidepressants after less than 30 days, but if a follow-up visit was scheduled, 86 percent of patients complied.
According to the authors of the study: "These survey results may add credibility to concerns ... that antidepressants are being used too frequently and without proper consideration and justification."
This is not a minor problem. In 1998, more than 130 million prescriptions for antidepressants were written in the US, the vast majority by primary care physicians, very few who refer their patients to more specialized treatment or counseling.
In the second study, UCLA-Rand researchers found that only 19 percent of a sample of depressed or anxious people they surveyed received appropriate treatment from their primary care physician.
By contrast, 90 percent of those who saw a psychiatrist got proper care.
The study surveyed 1,635 people, more than 80 percent who had seen a health care provider in the past year. On average, only 30 percent received proper treatment.
Those least likely to have benefited were African Americans, men, people with less than a high school education, and those younger than 30 or older than 59.
poster:stjames
thread:215329
URL: http://www.dr-bob.org/babble/20030402/msgs/216277.html