PsychSense: Sensible Psychological Solutions

I realize I am a little late posting on this story, but I have been struggling with what to say. I decided to tell my own experience around this issue. I read the story on Harvard MDs and drug company money with a mixture of guilty pleasure (I was right!!!) and disgust.  The guilty pleasure comes from the I told you so feeling that I couldn’t help.  I had been complaining about the Harvard view for a long time (but nobody had listened.)

As a psychiaric nurse practitioner I have been prescribing medication for years. I can tell you  that MOST NPs  have a different perspective from MOST physicians.  I don’t see every psychological problem as a diagnosis or a disease to be treated or cured. I see many problems as social, enviornmental and learned. I firmly believe they shouldn’t be given a label or diagnosis ( did you know insurance companies require a diagnosis in order to make payment) and can’t be fixed with pills .

 Having said that, I also know that clinical depression, and other legitimate mental illnesses often MUST be treated with medication. The problem is often figuring out which is which. It seems that many people who really need medications don’t get them, and so many who don’t need them are taking them ( and thus the medicine “doesn’t help”.)

 Any way, back to the “I told you so” part. As a concientious prescriber I have always feel it is critical to keep up on the latest in medication information. To do this for a number of years I went to what I thought was the “best”, Harvard .I attended quite a few of Harvard’s well known and respected psychopharmacology conferences. More then once I listened to the physicians who are now identified as not reporting their drug company income. After a few times I got tired of the same old message: more medications, higher doses, polypharmacy and  a drug for each symptom. I stopped going.

I have to say many of the physicians in the audience seemed to be swallowing these ideas whole. This is in part because of the traditional viewpoint taught in medical schools, the “disease and cure model”.  

Now comes the  hard part. We all need to take some responsibility for fostering this as this is ALSO the public expectation of medical care That is, we expect providers to be able to “fix it”, no matter what it is.  We often want, no insist on a pill. This is a big part of the reason for the overuse of antibiotics.

Dr. Biederman’s push for the diagnosis of Bi-Polar disorder in kids was particularly disturbing to me. Of course if we give them this diagnosis, it will naturally follow that we can give them a drug (or two) and FIX them. Few seem willing/able to look at social or environmental facts. Or if they do, they realize how difficult it is to change these things; pills are so much easier!  By the way pills are all most insurance companies will pay for (with higher and higher copays of course) and pills are what many of the public wants instead of dealing with all the other factors.

In order to make things better there are many pieces that need to be looked at. The first is regulation, but also I recommend the following:

• Patients need to stop expecting doctors to know everything and fix everything, and ask more questions. Even when they are afraid of the answers! If they don’t get their questions answered in a way they understand (not necessarily like),  they should  get a second opinion.
• Doctors and all health care providers start excepting there own limitations and the limitations of our medical knowledge
• We also need more self oversite by medical professionals. This is not a closed private club, its a public trust. Persons who break that trust should be given fair treatment but severe consequences.
• The broken health care system in this country needs to be seriously overhauled.

Ok lets get to work.