Posted by yxibow on November 22, 2008, at 4:37:01
In reply to Re: Patients Should Have Choice In Picking An Ad, posted by desolationrower on November 21, 2008, at 23:58:28
> I disagree with this. Their assumption seems to be that doctors decide how best to treat the illness, then give patient decision on what side effect profile they want from the various treatments. It isn't the doctors place to decide how to treat.
And what did they go to medical school for and sit through years of residency and maybe private practice and possibly care for their patients ??? Who has the medical license and pays 50 grand for malpractice?
The doctor is there to guide the patient through the process and give the patient control of their medical situation.
I saw that in the article....
If a patient wants a drug that is less effective but has certain other benefits, that should be offered as well (or more likely the case, a drug more effective but with higher side effects like a TCA should be offered along side the newer drugs).
I agree there should be a doctor-patient discussion about medication but ultimately the patient may be playing armchair psychiatrist to themselves.
It becomes that there are two doctors in the room. Knowledge by the patient is to be commended but a good psychiatrist has seen 10 years of patients or more.
If they're "green" to the practice, you're probably in a university setting, I hope, and they are shadowed by other psychiatrists.
Also psychiatrists have "journal clubs" sometimes, where they share patient X confidentially and get input.
That doesn't mean ultimately that the patient may get their choice, but it has to be weighed in the mind of the psychiatrist/psychopharmacologist, things like family history, race (yes, ethnicity has places in how drugs are metabolized), and suicidality
(certain agents may be better for that, but then again, certain agents in the hands of someone who has repeatedly mentioned the thought may not be the best because they have a low margin of safety before the patient can just 'check out' with the bottle, I hate to say...).
Psychiatrists, medical practitioners, are not script pad factories. There's a lot at stake, besides malpractice and DEA watching their backs -- they might actually care about their patients.
More rotteness at the core of the medical approach to mental illness.No comment.
>
> -d/r
poster:yxibow
thread:864542
URL: http://www.dr-bob.org/babble/20081114/msgs/864597.html