tag:blogger.com,1999:blog-7772182113499451603.post4810379620700379081..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: How Will Electronic Pill Monitoring Be Accepted In A Post-Orwellian Society?George Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-7772182113499451603.post-39679133211369246772017-12-05T14:12:55.007-06:002017-12-05T14:12:55.007-06:00Agree - lack of BP/pulse monitoring is a significa...Agree - lack of BP/pulse monitoring is a significant problem. In the people with ADHD that I see it is more prevalent than inaccurate diagnoses. That's saying a lot.<br /><br />I also like you idea about ECG machines for both children and adults. In adults there are a lot of abnormalities that you need to know about and whether they are changing with medical treatment. My other concern is machines versus manual. A few of the machines will flag pulse irregularity, but manually checking the pulse is a great way to pick up arrhythmias. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-68406708013395521442017-12-05T13:26:14.401-06:002017-12-05T13:26:14.401-06:00Amen to that last sentence, a blood test in psychi...Amen to that last sentence, a blood test in psychiatry is not just an objective value at the end of the day. If anything else, patients in mental health care seem to be a bit challenging about almost any test that is invasive, like psychiatry can't do medical care interventions.<br /><br />But, it is also almost shameful that I have been following doctors who seem to sell that notion, that the PCP is to get labs done, for meds the psychiatrist is prescribing?! I'll freely admit I am a bit hesitant to do BP checks in the office, but they need done, and frankly, it may be time for CMHCs to have to have an EKG machine in the office, for kids alone as at least MD Med Assistance is demanding EKGS for any and all antipsychotics used under 18 yrs old.<br /><br />Gotta love all these APA folks who want to sell psychiatry as a somatic discipline, and then not take into account what the responsibilities and possible consequences are in doing so. Oh, my bad, the APA folk don't seem to be in CMHCs or even in private practice settings most often.<br /><br />Ivory towers, I guess I should check them out, never been in a bubble before...<br /><br />Joel Hassman, MDJoel Hassman MDhttp://therapyfirst.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-28707678696720430852017-12-05T12:28:40.811-06:002017-12-05T12:28:40.811-06:00They are helpful but only as a secondary feature.
...They are helpful but only as a secondary feature.<br /><br />As an example, in the situation where I think a level might be useful - I typically have a detailed discussion with the patient about the rationale. At some point I tell them that "this level is only useful if you are taking the medication as prescribed." If they are not taking as prescribed most people will acknowledge it at that point and we can make the necessary modification. There will be some who do not acknowledge it until after the level comes back low when I explain the consequence of the low level. Exception might be a more frequent level that is low - like lithium and the patient acknowledges missed doses in retrospect. I have also had people taking high levels of drug, resistant to my advice about reducing the dose, who just reduced the dose on their own when I told them we needed to check the level of drug.<br /><br />In psychiatry - everything has meaning. A blood test is never just a blood test. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-7112056841741008942017-12-05T07:43:01.681-06:002017-12-05T07:43:01.681-06:00This is an aside, but do you find checking plasma ...This is an aside, but do you find checking plasma levels of a drug all that helpful in determining compliance? I thought they only are helpful in saying if the patient is taking any or none of the meds, but not to any more degree. victormtanghttps://www.blogger.com/profile/07733973610708973273noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-61076101325697830702017-12-04T19:07:08.038-06:002017-12-04T19:07:08.038-06:00I found your perspective on this interesting and a...I found your perspective on this interesting and agree strongly with the sentiments in the final two paragraphs.Dr Joehttps://www.blogger.com/profile/03536579611946585510noreply@blogger.com