tag:blogger.com,1999:blog-7772182113499451603.post668130937372312078..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: Can You Trust Your Physician?George Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-7772182113499451603.post-3787179249101582452014-03-12T13:08:32.845-05:002014-03-12T13:08:32.845-05:00I see it as a way that psychiatrists can be perman...<i>I see it as a way that psychiatrists can be permanently shuffled out the door.</i><br /><br />I do too. You read my response to Dr. Moffit where I stated that "I am 100% behind your vision" regarding embedding them in GP offices. I choose my words carefully as I know the odds are high that this will not work out well for either patients or psychiatrists in actual practice. Too bad really.Not a Doctornoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-68789234079355278582014-03-11T09:00:05.795-05:002014-03-11T09:00:05.795-05:00It's appalling that people who claim to be exp...It's appalling that people who claim to be experts in human behavior can so often be duped over and over again and not learn from their experience. Or maybe they don't care because the end game doesn't affect their tenure or economic future personally.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-80150666997343591672014-03-10T22:21:26.674-05:002014-03-10T22:21:26.674-05:00Could not agree more. One of the political issues...Could not agree more. One of the political issues that physician organizations seem oblivious to is the big tent effect. We don't want to risk alienating minority factions because we don't want to lose any dues paying members. There is perhaps no better example than not wanting to lose the managed care proponents in either the APA or the AMA. The corrosive effect of those decisions are evident to people who have been around for a while, but I think they are lost on newer generations when that is all they know. <br /><br />The corollary for me is also abdicating medical quality for some ideas cooked up by somebody from business school. I notice that the current APA President came out with a statement on collaborative care today. In his statement he talked about how insurance companies decided long ago to pay psychiatric services according to a different scheme. I guess the gurus in charge believe that it will be harder to NOT pay psychiatrists embedded in primary care clinics.<br /><br />I see it as a way that psychiatrists can be permanently shuffled out the door. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-91048422075510867702014-03-10T15:24:45.731-05:002014-03-10T15:24:45.731-05:00The AMA and APA have been promoting big government...The AMA and APA have been promoting big government intervention for years to promote parity and mental health funding. So they got big government and are now surprised that government tells them how to practice. All of which was predictable from the beginning. James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-47811236261970950872014-03-05T07:04:06.605-06:002014-03-05T07:04:06.605-06:00What a great answer. One that I am pleased to see ...What a great answer. One that I am pleased to see stated in this age of evidence-based medicine where I am expected to fit the evidence and not just by doctors, but by insurers, gov't, and most of society. And, yes, politics only adds to this burden.Not a Doctornoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-85116702660549998232014-03-05T00:43:59.441-06:002014-03-05T00:43:59.441-06:00Your post highlights the difference between the go...Your post highlights the difference between the goal of treating individual patients and what has come to be known as "population based medicine". The government and the managed care industry have the grand idea that all treatment and treatment guidelines can be focused at the level of the population or more generally what you might find in a large clinical trial. <br /><br />Physicians on the other hand treat individual patients and have to be alert to the fact that what might be a great medicine for 50% of people in the field trials can be toxic or worse for anywhere from 1 person in 50-100,000 or even higher percentages. On that basis, the only logical conclusion is that the patient must be aware of rare side effects, encouraged to report them as well as any unusual experience they have and that both the patient and the physician need to be alert to any potentially new but unreported side effects.<br /><br />The same thing is true of clinical phenomenon independent of medication and there is no better example than the issue of abortion. Several years ago both APAs came out with statements about how research shows that abortion does not increase the risk of depression or other disorders. On the other hand it is not uncommon to encounter women who attribute some or all of their anxiety or depression to abortion. It would be completely inappropriate to discount that experience based on a population survey of symptoms and their relationship to a previous abortion. <br /><br />Any physician will ideally function to recognize the autonomy of the person and meaningfulness of their life experience and come up with options for them. The business and political trends of one size fits all members in society and all of the physicians treating them is an insult to human biology. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-39956131325156369552014-03-04T23:20:38.164-06:002014-03-04T23:20:38.164-06:00How much trust do you place in the patient's e...How much trust do you place in the patient's experience vs what the current scientific literature states? And, in the case where you lack trust in it, how much autonomy do you acknowledge the patient has a right to? I'd say in general, not in psychosis or when they are a threat or in harm's way. <br />Two simple examples. I commented here that modafinil helped my driving. Not 24 hrs later, I came across a recent scientific paper that confirmed this. Second example, abortion may not cause an increase in depression in the literature, yet it most certainly would have in my life. So, in both examples, the literature was inconsequential to me; I knew my own experience.<br /><br />In regards to the autonomy, I love the truth and seek it out, but the more everyone seems to know what is best for me the less I am given the opportunity to follow what I deduce is correct for me.Not a Doctornoreply@blogger.com