tag:blogger.com,1999:blog-8489009971732520747.post8479760229989890640..comments2024-03-24T07:19:28.136+00:00Comments on Lake Cocytus: Medicines ManagementThe Shrinkhttp://www.blogger.com/profile/10009039342346247138noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-8489009971732520747.post-15824738447959085112010-03-14T21:31:18.232+00:002010-03-14T21:31:18.232+00:00Thank-you for this excellent explanation. It was a...Thank-you for this excellent explanation. It was a very helpful post.The Girlhttps://www.blogger.com/profile/02368935358031860432noreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-24413650526319829192010-03-11T18:28:44.743+00:002010-03-11T18:28:44.743+00:00Agreed.
Seems I've spent most of my career he...Agreed.<br /><br />Seems I've spent most of my career helping patients stop meds they assumed might have been doing something good. Most of them do fine (or better!) with less, different or none.moviedochttps://www.blogger.com/profile/03617061594621924756noreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-56989127016552481222010-03-11T18:19:10.606+00:002010-03-11T18:19:10.606+00:00Moviedoc, of course. The patient has a say. Bu...Moviedoc, of course. The patient has a say. But as medics we're obliged to offer what's appropriate for clinical need, not offer what's requested. We try and marry the two, but if a medication's not clinically indicated we can't offer it.<br /><br />Obstetricians have been successfully sued for offering elective c-sections to women who requested them, because they weren't clinically needed, thus shouldn't have been offered/undertaken, even though the women really wanted them.<br /><br />As such, if a drug's shown to be useful, I'm fine with it's use. What I'm not fine with is continuing a drug that's not shown to be useful, simply to be seen to be "doing something" since that's unhelpful all round.The Shrinkhttps://www.blogger.com/profile/10009039342346247138noreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-24469254378651819762010-03-11T06:35:37.461+00:002010-03-11T06:35:37.461+00:00I agree to an extent with your skepticism of medic...I agree to an extent with your skepticism of medication efficacy, but does the patient not have any say at all? Most patients come to me because they want medication, and either psychotherapy has failed already or they don't want it. I offer them choices. Some drugs, like benzos and often stimulants I frequently refuse to prescribe, but there is usually a chance that something will be tolerable and effective. I also tell the patient that if they get better while taking meds they should not assume it was the med, in fact why not give yourself credit, then you have to decide whether to stop just to see if you relapse. <br /><br />Again, the patient should have a say in this. It their mind, their body.moviedochttps://www.blogger.com/profile/03617061594621924756noreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-16039800974745064832010-03-10T16:54:25.403+00:002010-03-10T16:54:25.403+00:00DeeDee, where there's evidenced beenfit, we...DeeDee, where there's evidenced beenfit, we're all happy and the drugs should be continued. To "yank" them would arguably be unethical. An appropriate intervention's been initiated to help manage a health need, the intervention's shown to be successful, so there's no good reason to stop it. You're happy (you've got good support from your drugs) and as a shrink I'm happy (the drugs have been shown to make a substantial, meaningful difference for the better) so all's good!<br /><br />Xavier, de rien!The Shrinkhttps://www.blogger.com/profile/10009039342346247138noreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-26005028347925995302010-03-10T02:40:47.722+00:002010-03-10T02:40:47.722+00:00What a truly excellent explanation, merci beaucoup...What a truly excellent explanation, merci beaucoup Shrink!XEhttps://www.blogger.com/profile/02522455400636588309noreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-21741390156010161692010-03-09T21:52:34.302+00:002010-03-09T21:52:34.302+00:00Hmm well I remember that conclusion on anti-depres...Hmm well I remember that conclusion on anti-depressants, but I was only ever dxed with "moderate" depression (because I could get up and walk around and go to M&S for chocolate and stuff - actually I was way too good at the getting up to no good part which was why I was so often in hospital) but I can definitely tell you that anti-depressants, when the right one came along, worked like night and day, and it was DEFINITELY not a placebo effect. (Nor was the mania caused by another anti-depressant). Or the improvement due to lithium...<br /><br />Or perhaps you mean severe as in "severely batshit" not the strict medical term meaning "cannot get out of bed, won't wash or eat" or whatever...<br /><br />I get very twitchy at anything that suggests my pills might be yanked from me. I like my pills, and I want to keep them. (The irony of a patient insisting that she wants to keep taking her medication does not escape me).Unknownhttps://www.blogger.com/profile/12140096021612716740noreply@blogger.com