The Onion knows us all too well...

[OldPsychDoc]

http://www.theonion.com/articles/physician-shoots-off-a-few-adderall-prescriptions,35718/

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[nancysinatra]

This is so true! My hospital is starting this thing now where they send "satisfaction surveys" to all the patients. Rumor has it our pay will eventually be based on the ratings.

 

[deleted314290]

Those are HCAHPS surveys and are a product of medicare, who is trying to tie reimbursement to quality of service provided. It's one of the mandates in the ACA so this will be the norm as soon as they figure out the details. Moral of the story? Don't piss off your patients and don't be surprised when these ratings are leveraged against you.

 

[PistolPete]

Ugh… and how is this expected to work with our substance abusers, stimulant/opioid/benzo seeking population?

 

[Leo Aquarius]

Yay! Just what psychiatry and all of medicine needs - doctors promoted or fired based on patient satisfaction, because as we all know THE BEST MEDICAL DECISIONS ARE THOSE THAT MAKE PATIENTS HAPPY!

In this new age of Jimmy Fallow business strategies, satisfaction surveys are perfect for measuring, say, sales people. Go tell your hospital management that.

 

[nancysinatra]

How does this satisfaction guaranteed stuff jive with the claim of some state medical boards that they are going to crack down on pill mills?

 

[heyjack70]

so, can we get that doctors union together

 

[Shikima]

Ugh… and how is this expected to work with our substance abusers, stimulant/opioid/benzo seeking population?

Fire them for treatment non-compliance.

 

[nancysinatra]

so, can we get that doctors union together

Please! Let's do it!

 

[sunlioness]

Yup. My pay is already partly tied to patient satisfaction scored. At least in theory. They haven't found a workable way to do it yet, so they're assuming all our patients are satisfied.

 

[nancysinatra]

This whole trend is going to backfire big time. Patients don't know enough about health care to know when they're getting good care or not. The "happiest" patients are going to be the ones who get antibiotics for every virus, an MRI for every pain, vicodin and methadone and adderall and ritalin and xanax refilled x3 at every visit. Don't forget tramodol. And the malingerers and people with Munchausens are going to love this policy.

 

[Leo Aquarius]

This whole trend is going to backfire big time. Patients don't know enough about health care to know when they're getting good care or not. The "happiest" patients are going to be the ones who get antibiotics for every virus, an MRI for every pain, vicodin and methadone and adderall and ritalin and xanax refilled x3 at every visit. Don't forget tramodol. And the malingerers and people with Munchausens are going to love this policy.

Yep. The entire health care landscape will shift. The result will be more addicts and malingerers receiving unnecessary care, taking up beds and meds that the real sick people need. Way to go hospital managers! (There's a reason you guys weren't smart enough to get into medical school.)

 

[Jester25]

The patient with a memory so bad she couldn't even give me a history but said her Xanax monotherapy was stabilizing her Bipolar disorder would love this policy. Of course I didn't see her the second time after our "Xanax talk".

 

[Ibid]

All feedback is good feedback. Its a source of information you might not get with out asking for it. Hospitals are obviously not the same as fast food joints but that doesn't mean you shouldn't elicit feedback from your "customers". It's not about suspending your critical faculties :-(

 

[Leo Aquarius]

Obtaining feedback from patients is important. When the promotion and demotion of doctors are based on patient satisfaction, as you can imagine problems can arise. Just go ask the doctors in the emergency medicine forum. That's all we're saying.

 

[jakeislove]

I question the insight and judgement of whoever thought payment decisions should be made based upon scores from patients.

 

[shan564]

I recently saw a patient whose PCP was prescribing 30mg of Adderall BID for "concentration problems." Turns out he had schizophrenia and his "concentration problems" were actually thought disorder. He was never referred to a psychiatrist.

 

[birchswing]

I think a patient who is informed that a treatment option will not be helpful in the long-term but wants it anyway for a "good time" is in the minority. There is a big movement, sometimes to the extreme, for things to be all natural, etc. these days. You have to consider that there are patients who will also score doctors negatively for just prescribing painkillers and sedatives in order to get rid of a patient rather than investigate a problem or treat more carefully. And there are such doctors. The data isn't worthless; it just has to be looked at carefully. Whether it's looked at carefully or not is the big question. When I worked at Apple, excellent was the only acceptable score on a survey, which customers do not know (good is not good; only excellent is good). And customers always review the last person they talked to. So a customer could be treated poorly by 5 reps and end up with you as their last point of contact. No matter how hard you work to help that customer, they might think they're reviewing someone else and give you a bad score. It's a bureaucratic system that doesn't take any of that into account. I would assume something less monolithic than Apple could figure out those problems, though.

 

[michaelrack]

I think a patient who is informed that a treatment option will not be helpful in the long-term but wants it anyway for a "good time" is in the minority.

But the patient who is informed that a treatment option will not be helpful in the long-term but wants it anyway for "to feel less bad right now" is in the majority

 

[birchswing]

But the patient who is informed that a treatment option will not be helpful in the long-term but wants it anyway for "to feel less bad right now" is in the majority

I just don't see that. I mean both of us are basing this on our personal experiences. I'm around people who don't want to be on drugs, who are wary of taking antibiotics because of antibiotic-resistance, etc. You don't see a lot of pro-pharma posts on Facebook. I obviously can't quantify it. But if anything, I think people are more distrustful of doctors than in the past. I hear people say things like, "Oh, the dentist gave me codeine, but I didn't take it and was fine." I see more interest in people wanting endoscopies and colonoscopies without sedation (the US is rare in that it sedates people for colonoscopies to begin with). We've moved away from child-birth that was done under a great deal of anesthesia to less and less to people doing it without any at all.

And with regard to psychiatry, I think there is an awareness of the addictive properties of both stimulants and sedatives. There's a desire for alternatives. There's a service called BenzoDocs specifically for people addicted to benzodiazepines to find doctors who are "benzo wise," which is a term in the benzodiazepine community for doctors familiar with how to handle a benzo withdrawal. In the community I belong to for benzodiazepine withdrawal, there is an awareness among patients that many doctors are not educated about benzodiazepines—which is the exact opposite of your experience with patients. Outside of my current psychiatrist with whom I have found some help manage my withdrawal, all of my doctors in other fields say things like, "Well, they're not bad if they're prescribed by a doctor" or "Well some people with anxiety need them," which is exactly what said to me throughout the years by psychiatrists. There are many doctors who still don't know that benzodiazepines make people with anxiety get worse—physically and mentally. I have never come across a person with anxiety who has gotten better over a long period of time on benzodiazepines, yet the myth persists among doctors, including psychiatrists I've seen, that they are a good long-term treatment for anxiety.

So to go back to the topic at hand, if I were back in time and a survey came up in front of me regarding a psychiatrist who was not knowledgable about benzodiazepines, saw no need for me to go off of them, and didn't know how manage a withdrawal, and even worse, was not willing to learn when presented with the Ashton Manual, I would have given him or her a bad rating. And I'm a real person. And there are more real people like me. I'm a real person who as a child detested drugs and would never have taken drugs of abuse. And I have never taken benzodiazepines other than prescribed. But the drugs have abused my body and mind, nonetheless. So, this idea that the source of prescription of abusive drugs is instigated by a drug-seeking patient who will write bad reviews isn't true for me. Who would I be today if I had never seen a psychiatrist in my life? I have no idea; I might be worse off, but I highly doubt it. But I know for sure that I would not be on benzodiazepines.

My treatment now is not for any of my original indications I had as a child. Although it's never explicitly stated, my primary treatment is to address the "treatment" (benzodiazepines) I have received for so many years. In no other area of life would someone have something broken without reparation and then go as a supplicant to find another person in the field to help fix the brokenness without acknowledgement that the brokenness was caused by a practitioner in the field itself. It is my problem, but there is an absurdness in what is never spoken in session: that it wasn't my problem until it was given to me, and I am seeing people in the same field now to help solve the problem, yet the origin of it is never discussed. It's simply as if it fell out of the sky, and no one is responsible for the work and pain but me.

I don't doubt that over a long enough period of time, doctors will stop prescribing benzodiazepines as first-line, indefinite treatment without giving informed consent as to the physical tolerance and health problems they cause. But it hasn't stopped yet. And when it does stop, it won't be with a class action lawsuit. There will be acknowledgement of wrongdoing. It will fade very, very slowly. In fact, benzodiazepine prescriptions went up in the US between 2002-2007, so who knows if it even is fading at the moment. The people who have been hurt by it are the ones who will continue to have to beseech the very field that made them sick to help them get better. And they will be the ones who suffer in a withdrawal worse in severity and lethality than heroin withdrawal. I would like them to give survey feedback to the doctors who prescribed recklessly. The problem is that if you rooted out such psychiatrists, at least where I live, there wouldn't be nearly any left. But to be honest I'm not sure if the public would be much worse off. I know a woman who was recently prescribed Xanax for the first time in her life when she recently went to see a psychiatrist, to take every day. I frankly think she'd be better off with no help rather than that kind of help. And if I had a way of offering my overview of the state of psychiatry in the area where I live, that's what I would say.

I want to add in writing this that as I've gotten to know about you all participating in this forum that I have not come across any poster who is under the misconceptions regarding benzodiazepines that unfortunately so many people in the non-Internet world seem to be under.

EDIT: Corrected name of service from BenzoWise to BenzoDocs:

http://www.benzodocs.com

This is how I found my psychiatrist. Before consulting with other patients to find a psychiatrist who would help me withdraw from prescribed benzodiazepines, I had no other options. Doctors would tell me to stay on the same dose, increase the dose, or that I could go off in a week or two (after being on them for over half my life, 15 years) to see if my anxiety returned (not even acknowledging or understanding the fact that such an acute withdrawal would present effects far greater than any anxiety disorder).

That web-site is an example of patients helping each other find doctors who help them get off of addictive drugs. That's why I want to present the counterview to this idea that patients are drug-seeking and will reward doctors who hand out drugs like candy.

 

[Ceke2002]

so, can we get that doctors union together

Wait, you guys don't have Unions? Wow, I mean I know Unions aren't as popular in the US as they are in Australia, but I would have thought people in the Medical profession would have had more clout to insist one was set up for them, considering the importance of the work you do. My Psychiatrist has a Union supplied therapist he can see to help reduce issues of stress and burn out, it's just considered to be part of keeping practitioners healthy and better able to do their jobs.

 

[Ceke2002]

http://www.theonion.com/articles/physician-shoots-off-a-few-adderall-prescriptions,35718/

How to get prescribed Amphetamine based treatments in Australia as an Adult patient with ADHD.

• Go to a GP and get a referral to a Psychiatrist
• Undergo a full Psychiatric evaluation, which may include a lengthy interview process (preferably with provided proof of a previous childhood diagnosis of the condition), brain scans, and computerised type tests (exactly the process I went through to be re-diagnosed at the age of 27).
• Once satisfied that the case is legit, the Psychiatrist then has to make an application to the Commonwealth Department of Health to be given permission to prescribe a restricted substance.
• If the application is successful they will be sent a contract outlining the exact parameters both the Doctor and Patient must agree to. The contract is then signed and lodged with the Commonwealth Dept of Health.
• Prescriptions are then allowed for a maximum of one year, before a reassessment and reapplication must take place.

This was back in the late 90s. They've recently changed the laws to make it even harder to get a diagnosis and subsequent prescriptions as an Adult. Now you need two independent Psychiatrists to provide both an assessment and an application.

 

[michaelrack]

I just don't see that. I mean both of us are basing this on our personal experiences. I'm around people who don't want to be on drugs, who are wary of taking antibiotics because of antibiotic-resistance, etc. You don't see a lot of pro-pharma posts on Facebook. I obviously can't quantify it. But if anything, I think people are more distrustful of doctors than in the past. I hear people say things like, "Oh, the dentist gave me codeine, but I didn't take it and was fine." I see more interest in people wanting endoscopies and colonoscopies without sedation (the US is rare in that it sedates people for colonoscopies to begin with). We've moved away from child-birth that was done under a great deal of anesthesia to less and less to people doing it without any at all.

And with regard to psychiatry, I think there is an awareness of the addictive properties of both stimulants and sedatives. There's a desire for alternatives. There's a service called BenzoDocs specifically for people addicted to benzodiazepines to find doctors who are "benzo wise," which is a term in the benzodiazepine community for doctors familiar with how to handle a benzo withdrawal. In the community I belong to for benzodiazepine withdrawal, there is an awareness among patients that many doctors are not educated about benzodiazepines—which is the exact opposite of your experience with patients. Outside of my current psychiatrist with whom I have found some help manage my withdrawal, all of my doctors in other fields say things like, "Well, they're not bad if they're prescribed by a doctor" or "Well some people with anxiety need them," which is exactly what said to me throughout the years by psychiatrists. There are many doctors who still don't know that benzodiazepines make people with anxiety get worse—physically and mentally. I have never come across a person with anxiety who has gotten better over a long period of time on benzodiazepines, yet the myth persists among doctors, including psychiatrists I've seen, that they are a good long-term treatment for anxiety.

So to go back to the topic at hand, if I were back in time and a survey came up in front of me regarding a psychiatrist who was not knowledgable about benzodiazepines, saw no need for me to go off of them, and didn't know how manage a withdrawal, and even worse, was not willing to learn when presented with the Ashton Manual, I would have given him or her a bad rating. And I'm a real person. And there are more real people like me. I'm a real person who as a child detested drugs and would never have taken drugs of abuse. And I have never taken benzodiazepines other than prescribed. But the drugs have abused my body and mind, nonetheless. So, this idea that the source of prescription of abusive drugs is instigated by a drug-seeking patient who will write bad reviews isn't true for me. Who would I be today if I had never seen a psychiatrist in my life? I have no idea; I might be worse off, but I highly doubt it. But I know for sure that I would not be on benzodiazepines.

My treatment now is not for any of my original indications I had as a child. Although it's never explicitly stated, my primary treatment is to address the "treatment" (benzodiazepines) I have received for so many years. In no other area of life would someone have something broken without reparation and then go as a supplicant to find another person in the field to help fix the brokenness without acknowledgement that the brokenness was caused by a practitioner in the field itself. It is my problem, but there is an absurdness in what is never spoken in session: that it wasn't my problem until it was given to me, and I am seeing people in the same field now to help solve the problem, yet the origin of it is never discussed. It's simply as if it fell out of the sky, and no one is responsible for the work and pain but me.

I don't doubt that over a long enough period of time, doctors will stop prescribing benzodiazepines as first-line, indefinite treatment without giving informed consent as to the physical tolerance and health problems they cause. But it hasn't stopped yet. And when it does stop, it won't be with a class action lawsuit. There will be acknowledgement of wrongdoing. It will fade very, very slowly. In fact, benzodiazepine prescriptions went up in the US between 2002-2007, so who knows if it even is fading at the moment. The people who have been hurt by it are the ones who will continue to have to beseech the very field that made them sick to help them get better. And they will be the ones who suffer in a withdrawal worse in severity and lethality than heroin withdrawal. I would like them to give survey feedback to the doctors who prescribed recklessly. The problem is that if you rooted out such psychiatrists, at least where I live, there wouldn't be nearly any left. But to be honest I'm not sure if the public would be much worse off. I know a woman who was recently prescribed Xanax for the first time in her life when she recently went to see a psychiatrist, to take every day. I frankly think she'd be better off with no help rather than that kind of help. And if I had a way of offering my overview of the state of psychiatry in the area where I live, that's what I would say.

I want to add in writing this that as I've gotten to know about you all participating in this forum that I have not come across any poster who is under the misconceptions regarding benzodiazepines that unfortunately so many people in the non-Internet world seem to be under.

EDIT: Corrected name of service from BenzoWise to BenzoDocs:

http://www.benzodocs.com

This is how I found my psychiatrist. Before consulting with other patients to find a psychiatrist who would help me withdraw from prescribed benzodiazepines, I had no other options. Doctors would tell me to stay on the same dose, increase the dose, or that I could go off in a week or two (after being on them for over half my life, 15 years) to see if my anxiety returned (not even acknowledging or understanding the fact that such an acute withdrawal would present effects far greater than any anxiety disorder).

That web-site is an example of patients helping each other find doctors who help them get off of addictive drugs. That's why I want to present the counterview to this idea that patients are drug-seeking and will reward doctors who hand out drugs like candy.

Perhaps I overstated things by using the word "majority". One of my points I was trying to make is that patients addicted to prescription benzo's (and opiates) are often taking them to avoid negative states (dysphoria) rather than to have a "good time". A lot of the patients I see on chronic benzo's don't realize they have a problem. Of course, I only do weekend psych ward coverage and don't have a regular outpt practice, so I see a skewed population.

 

[smalltownpsych]

Perhaps I overstated things by using the word "majority". One of my points I was trying to make is that patients addicted to prescription benzo's (and opiates) are often taking them to avoid negative states (dysphoria) rather than to have a "good time". A lot of the patients I see on chronic benzo's don't realize they have a problem. Of course, I only do weekend psych ward coverage and don't have a regular outpt practice, so I see a skewed population.

We do see a skewed population in psych and in various aspects of medicine; however, I do think that the culture in the US tends to support an overreliance on medications to 'fix everything". My parents' generation grew up in an era where medicine was solving some of our major health concerns with antibiotics and vaccines. They have a lot more optimism and faith than my generation where medicine is struggling to find solutions to the major health concerns of our time. The psychotropics are even more recent developments and the efficacy of these has been consistently overstated by the pharmaceutical companies and the media so it is no wonder that our patients overvalue these medications.