Tuesday, March 17, 2009

Here Ye! Here Ye!!


In medicine we're generally careful not to judge our colleagues harshly on paper. We may report what the patient or another doctor tells us, but we usually hold off on condemning people in a chart-- it makes for messy liability issues, and it's really just poor form to write "Can you believe that idiot prescribed this combo of meds" or "the last doctor never even listened to the patient's complaints."

In real life, I don't believe we're quite so generous. It's not at all unusual for docs to condemn-- in an off-the-cuff manner in casual conversation with friends-- their disdain for the practices of others. Can you believe his former doc prescribed 10 mg/hour of Xanax? Or what about the doc who demands every patient come for weekly therapy sessions even if they don't think they need therapy? Or the doc who only sees patients for 10 minute med checks and never really listens to the patients? How 'bout that doc who gave his suicidal patient a 90 supply of Hemlock? Or how could he start a patient with bipolar disorder on an antidepressant-- of course it de-stabilized him!

I think we're quick with our Can You Believe stories. More in psychiatry than in other branches of medicine? Maybe. Why? Perhaps because less of what we do is clearly defined and even amongst ourselves, we have no full consensus on exactly what it is we do, and in what units. We're certainly getting closer with our use of medications, but still, the guidelines don't take into account what to do if a patient fails many trials of many medications and still has a myriad of symptoms. Sometimes our patients are very sick and we get very desperate. And then too, our label says little about what exactly we do-- one shrink only does med checks, another only does therapy, and we amongst ourselves have not come to a consensus about what is the absolute 'right' thing to do, for whom, in what settings, with what staffing and reimbursement issues, how frequently, and when.

What do you think: are we gentle with each other or not?