Friday, 12 October 2007

Stopping Medication

Just to tease my favouritist blogging GP, commenting on Secondary Care stopping medication that with hindsight is inappropriate . . .

. . . I was referred a lady with Behavioural and Psychological Symptoms of Dementia. She bit, kicked and punched care staff in her nursing home. She pushed other residents out of the way, causing a fracture in one old lady.

After initiating galantamine and promazine, she improved. A week later on review there was no hostility (not even verbal hostility) and all was well. A month passed. The home was happy. Her husband was happy.

She had a review by her GP who halved her promazine from 4 times a day down to 2 times a day (just morning and night). I know this because the GP 'phoned me to ask for a prompt review this week since she's now screaming like a banshee and flailing at folk with her walking stick through the afternoon and evening when she's no longer receiving her promazine.

Sometimes, just sometimes, us mental health folk do get it right and it's best not to rock the boat :-)


Jan said...

The consultants in this neck of the woods seem to be of the opinion that GPs couldn't pour piss from a boot even if the instructions were printed on the sole. Ah, sweeping dismissals, doncha just love 'em?

The Shrink said...

I love my GPs, they're almost all hugely reasonable (and take directives and guidance as just guidance, tempering it with common sense).

I s'pose that's reflected in the GP, who sensibly tries to minimise polypharmacy, knowing me well enough to be able to 'phone and 'fess up to cocking up :-)

Dr Andrew Brown said...

You old flatterer!
(It works every time with me.)

Of course we don't like it when consultants stop medication we started, but generally we're happy to take their word that it's for the best. And certainly when it comes to psychiatry I'm very happy to take advice.

Jan said...

I think the low opinion of GPs hereabouts is probably a function of the lack of contact. Professional networks, human minds and parachutes only work when they're open. In a neighbouring patch, where frequent consultant/GP contact is the norm there's a much better mutual opinion and, surprise surprise, the people they all care for get better treatment.