Posted by stjames on January 6, 2004, at 19:12:49
In reply to Re: anecdotal evidence, posted by stjames on January 6, 2004, at 18:58:59
http://www.mcmanweb.com/article-121.htm
Do you rely on a family physician to diagnose and treat your depression? Perhaps you should reconsider. In January 2001, three studies came to light that strongly suggest primary care physicians are better off poking and prodding our bodies than getting inside our heads.
The first, an Indiana Community Cancer Care-Aetna US Healthcare-Pfizer study of the records of 100 patients who were prescribed antidepressants in primary care, found that 90 charts contained documentation of just three or fewer symptoms of major depression, sixty revealed one or more criteria, and 40 contained no documentation of any criteria. The required five or more symptoms were to be found in only seven charts. Use of screening tools was documented in only four charts. Only 57 of the charts revealed a depression-focused follow-up visit, while just five charts indicated an educational intervention.
In other words, these doctors were indiscriminately handing out meds.
Not surprisingly, only 37 percent of the patients improved. Sixteen percent were referred to specialists. There were two suicide attempts. The article cited other studies suggesting that primary care physicians misdiagnose depression in as many as two out of three cases, and when the correct diagnoses is made, patients are often treated with subtherapeutic doses prescribed over periods of time too short to produce a benefit. The article also noted that 50 percent of patients quit their antidepressants after less than 30 days, but if a follow-up visit was scheduled, 86 percent of patients complied.
According to the authors of the study: "These survey results may add credibility to concerns ... that antidepressants are being used too frequently and without proper consideration and justification."
This is not a minor problem. In 1998, more than 130 million prescriptions for antidepressants were written in the US, the vast majority by primary care physicians, very few who refer their patients to more specialized treatment or counseling.
In the second study, UCLA-Rand researchers found that only 19 percent of a sample of depressed or anxious people they surveyed received appropriate treatment from their primary care physician.
By contrast, 90 percent of those who saw a psychiatrist got proper care.
The study surveyed 1,635 people, more than 80 percent who had seen a health care provider in the past year. On average, only 30 percent received proper treatment.
Those least likely to have benefited were African Americans, men, people with less than a high school education, and those younger than 30 or older than 59.
According to James Underberg MD, who operates a general internal practice in New York City, in an article in WebMD: "In a busy general internal medicine office, physicians often don't have the time to fully explore those kinds of problems. Most of the time, we're limited to ten or 15 minutes."
Enough time to spot a tumor or a heart beat irregularity, perhaps, but nowhere near enough to unearth the silent enemy that is depression and intelligently work with the patient in finding the right treatment. The final study bears this out, a survey of 1,001 patients and 900 primary care physicians commissioned by the National Depressive and Manic-Depressive Association which found that more than than three-quarters of those being treated for major depression felt their illness is not under complete control.
Other key findings include:
While 69 percent of physicians said they usually mention sexual problems as a possible side effect of medications and 47 percent usually mentioned weight gain, only 16 percent of patients reported either problem was ever brought up.
Forty percent of patients believe they have to tolerate avoidable medications side effects compared to just nine percent of physicians who believe side effects can't be avoided. While 90 percent of the patients who had side effects said they told their primary care doctor about them, close to 20 percent also reported that their doctor did not do anything in response.
Almost half of all patients surveyed reported having had side effects, which caused 55 percent to stop taking their antidepressant and 17 percent to skip doses
Seventy-one percent of the physicians said treatment decisions were made jointly with the patients, but only 54 percent of patients concurred. Only 36 percent of patients reported that their doctor asked about their preferences or willingness to tolerate certain side effects before making a decision about which antidepressant to prescribe.
"This data reveals a serious disconnect in the patient/physician relationship," commented Drew Pinsky MD, a participant in the survey. "The most important tool we have to monitor progress during the treatment process is open and effective communication."
Ultimately, responsibility for proper care is in your hands. Try to think of your brain as being every bit as important as your heart and act accordingly.
poster:stjames
thread:296715
URL: http://www.dr-bob.org/babble/20040105/msgs/297346.html