[log in to unmask] wrote:
> In any event what I am saying is simply that we come across cases in
> which clients have too readily been put on an anti-depressant regime
> which has then "coloured" their lives.
Hopefully ! The aim of treatment is usually to put some colour back into
lives
variously described as "black, grey, hopeless, futile, not worth living"
etc.
> This has often been on demand from the patient and without consultant input.
Are youy saying we should not consider the patients wishes ?
>Whether the numbers of such cases are large or not is not the point.
Yes it is ! We accept (and are saddened) that cock-ups happen, but
you're extrapolating from your caseload to make assertions (general)
about the treatment of depression suggesting there are (generally)
better ways to treat it than drugs (what had you in mind by the way ?).
> The point is it happens from time to time .
Er, yes...
>Obviously we only hear the bad news.
Insight...that's a good sign, isn't it ?
> But there are better ways to help those patienst cope with such traumas
> and so avoid suicide. The dangers of GPs putting patients on
> anti-depressants is that they do not have the time to be with the
> patient sufficiently when they go on the drugs and to educate the
> patients sufficiently about what they will experience should the drugs
> precipitate a drug induced akathesia itself leading to suicidal
> ideation.
>Lawyers on this board can help the medics avoid misinfornming
>themselves on the law...just as I prefer to listen to doctors on the
>medical aspects of the area of work in which I practice (which is why I
>am here).
<snip>
Your medicolegal input is very welcome Graham (despite the conversation
sliding into a bun fight on occasion).
Reading between the lines though, you do seem to subscribe to the common
misconception (common that is to patients and lawyers acting for them)
that consultant care (in this case for depression) is superior to that
of the GP.
Let's leave aside the uncertainty and difficulty of deciding where the
blurred cutoff is between 'feeling low', 'GML' (General Misery of Life)
and a making formal diagnosis of depression. The medical treatment of
depressive illness is a good example of a disease where the GP is far
more expert than most consultant psychiatrists. I don't say this out of
arrogance but because we probably only refer about 10% of cases to
psychiatry and so the specialist gets a skewed selection of the 'worst'
cases on which to base their experience. I think it was Fry (he of the
general practice hall of fame) who said that 'The specialist roams the
zoo cages, but the GP stalks the jungle and sees disease in it's natural
habitat.'
(Misquoted, sorry Fry ! If someone knows the exact quote let me know
please)
An important part of our job is to keep patients out of the clutches of
specialists, where the great majority would fare worse than they do
under the primary care.
Areas other than psychiatry show this effect too. Much of the recent
change in the delivery of antenatal and intrapartum care follows
evidence that, for the majority of cases, measurable outcomes (rate of
Caesarian section, episiotomy , wound infections, post-natal depression,
and I think most other measures) are worse for consultant obstetric care
(of matched low risk cases) than midwife care.
Managing the patient in primary care is often (I would hope usually) a
positive descision based on the best interests of the patient. 'Normal'
depression should be treated in primary care, it is not a fudge, a fob
off or a second best option based on costs, but the best available care
giving the best results. This is because we have greater experience and
expertise.
Complicated, severe, atypical, and rare variants of depression do better
under consultant care where their experience exceeds ours, and we are
delighted (and often relieved) to have their help.
Depression is under diagnosed, common and can be life shattering (or
indeed life ending). Drug treatment has been shown to be effective,
often similar in efficacy to prolonged talking therapies, is an
efficient use of rescources, and (when considering the risks of not
treating) relatively safe.
Remember your experience of medical cock-ups, and justified and
un-justified patient grievances is the lens through which you view the
medical profession, and is itself "coloured".
P.S. I would be delighted to provide you with the references to the
studies which you require, including evidence that depression is
generally undertreated, and with professional interperetation of the
evidence into lay terms.
My fees for such work are in line with those charged by our local
solicitor for checking over our 'Practice Agreement' i.e. £150 per hour
plus VAT :-)
Paul Galloway
GP Oxford
Considering position at Messrs. Sue, Grabbit and Run
--
GIF87aš
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