Interesting note about MD and DO

[DD214_DOC]

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Today in psychology, we began discussing the overuse of psychoactive stimulants in treating ADD/ADHD and how a contributing factor to the high number of people who "have" ADD could be contributed to the way MDs practice.

It's no secret that many MDs, and perhaps DOs, extend beyond their boundaries. We have GPs and OB/Gyn's prescribing psychoactive drugs for their patients. My girlfriend was prescribed effexor for anxiety -- by her Gynecologist! That is absurd.

It's a known fact that psychopharmacologics are most effective when supplemented by behavioral therapy, whether it be CBT or BMod. The drugs simply treat the symptoms, but the therapy treats the problem. I find it atrocious that MDs are not only practicing beyond the scope of their certification, but also ignoring the root causes of psychological problems such as anxiety or ADD. This has caused me to see the importance in the DO philosophy.

Then again, would a DO do the same thing?

 

[Shinken]

Unfortunately, I believe many DO's would do the same. There are many DO's out there that in practice are essentially the same as an MD (not entirely a bad thing). Remember that the vast majority of DO's train in allopathic residencies.

I agree with you that if you go to a DO school, you should at least strive to live by the ideals of osteopathic medicine. After all, that's the only "real" thing that sets DO's apart from MD's. Very few people buy into the whole OMM thing, so if you're not using OMM at all in your practice, at least try to live by the often-criticized "Physicians treating people, not just symptoms" motto.

I'll be starting med school next year. Perhaps this message will be kept in the SDN server for the next few years and when I'm practicing I'll read it and laugh at my own stupidity. But I hope not.

 

[Robz]

now...I don't remember where I read it but wasn't there a thread on here about DO's actually prescribing MORE medications than their MD counterparts?

 

[WillowRose]

I see nothing wrong with a GP (or even a gynecologist) prescribing meds for depression or anxiety. Most mental illnesses are grossly underdiagnosed anyway and part of that could be attributed to the stigma (ugh...that word again) of going to a psychiatrist.

Simply looking at the number of family dr's prescribing prozac does not tell you if those patients are also receiving other types of therapy as well. All you know is that the family dr is not the one providing it. Personally, I think behavioral therapy is way over-rated in chronic conditions. The symptoms of depression or anxiety often stem from the imbalance more than the situation. I know I didn't bother continuing treatment until I found a psychiatrist who could treat the underlying problem.

For some people, in transient situations, talking to a counselor is all that is necessary...getting through a divorce, death, etc or managing a family situation. However, chronic problems aren't going to be fixed with a 1 hr appt. every week.

JMO,
Willow

 

[raining4days]

Any doctor can give you a prescription. I can get my prescription from my psychiatrist or my family physician. It's called "saving money." Don't blame it on doctors, blame it on the health system/insurance/whatever.

If I need only a prescription note (even if it's just a refill)from my psychiatrist, I have to pay for a twenty minutes "consultation" (aka $150-200). So, when I go to my family physician, I kill two birds with one stone: my prescription + health check/whatever..... since it costs $40-50 dollars to see him. Maybe your girlfriend is doing the same thing. I would probably ask for a prescription if I go see a gynecologist.

 

[moo]

I agree with the above post. There's nothing wrong with a GP prescribing medications for mental illness. And why the distinction between DO and MD? A DO GP would probably prescribe just as much as an MD. I sure hope you don't have this idealistic idea in your head that DOs really do "treat the underlying disease and not the symptoms."

As a future MD I take offense to the fact that DOs often claim that they are the only ones to "treat the underlying disease." We've had classes on preventive health, cultural sensitivity, even a "site visit" to an alternative health clinic of oriental medicine. Sure, we treat the symptoms but that's because we don't have any other modalities to treat the underlying disorder. Do DOs have the answer to everything? I doubt it... otherwise 70% wouldn't be entering MD residencies.

And MD psychiatrists (as well as DOs) are very well-trained to provide therapy to their patients. So all this argument between MD and DO and who uses more therapy, etc. is really pointless.

 

[bigmuny]

It is not beyond any physician's scope(except pathology, radiology perhaps) to write for anti-depressants. Of course, doing therapy should be left to those trained in it. Therapy, unfortunately, is expensive to administer and requires that the patient be highly motivated in order to be successful. As you will see, few patients are motivated enough to make a go of therapy.

 

[Doctor Bagel]

speaking of general mental illness issues, i don't see any problem with primary care physicians prescribing drugs for issues like anxiety and depression. however, it would be nice if they referred their patients for counseling as well. i think this notion that people need to be on drugs like prozac for the rest of their lives partially stems for the fact that most people rely soley on their pcp's for treatment.

the really bad thing about mental illness, though, is that lots of primary care doctors either ignore it or diagnose it and do nothing about it. i work in the disability field, and i would say the mental illness is a huge factor with lots of our people who are on claim. however, doctors seem much more willing to prescribe potentially addictive painkillers for likely somatic issues than to deal with the mental health stuff. i've seen medical files where doctors staight up note that their patients suffer from anxiety or depression, and absolutely nothing seems to be said or done about it--seriously, writing a prescription is better than nothing. i'm hoping that these are more old school physicians and that newer doctors are becoming more attuned to these issues.

 

[DD214_DOC]

The problem is that these physicians aren't trained to properly diagnose psychiatric disorders. Did all of you simply ignore the inexplicable high number of children who take stimulants for ADD/ADHD who probably don't need it?

Writing a prescription without a proper examination because a patient mentions they have anxiety problems is unethical and bad medicine. As future physicians, it worries me that you don't realize this. A GP or, God forbid, an OB/Gyn may mistake bipolar disorder for mild depression, chronic depression, or a myriad of other similar yet difference psychiatric problems and simply prescribe some meds to fix the symptoms. A month later their patient commits suicide.

Having a license to practice in a particular field of medicine is not a license to practice all medicine. Would you want your GP or OB/Gyn prescribing heart medications for a minor heart problem? Would you see a neurologist for a bad knee? Would you want a pathologist to deliver your first child? Or a psychiatrist to perform an appendectomy?

Many psychiatric disorders go undiagnosed because patients aren't referred to psychiatrists. The primary care physician decides to play Shrink instead. Not only could these physicians be improperly diagnosing patients, they also are not providing the full scope of treatment options. They are simply writing a script to alleviate the symptoms, and forgetting about the problem.

Also, I imagine most patients never receive any therapy to supplement medical problems because they are never told to see a mental health specialist.

 

[Idiopathic]

Our Psych class is one of the most intesnive around (so I have heard), and we spend quite a bit of time talking about pharmacology. One of the great quotes I have heard since I started was the following:

"You cant manipulate away atrial flutter or schizophrenia"

Of course DO's prescribe drugs for their ADD/ADHD/Bipolar/GAD/OCD patients. They would be neglectful not to. But we are taught that many FP's miss psych diagnoses often, because the most common place for psych conditions to present is at the family doc.

 

[exmike]

You should check up on physician licensing. As far as I know, physicians are licensed to practice medicine, and thats it. Anything else is board certification, state certification, etc. Thus, any doctor can pretty much do anything he wants. Thats why board certification is so coveted. It ensures that the doctors are proficient in their field of practice. General licensure is all you need to practice medicine.

Originally posted by JKDMed

Having a license to practice in a particular field of medicine is not a license to practice all medicine. [/B]

 

[DD214_DOC]

Originally posted by exmike
You should check up on physician licensing. As far as I know, physicians are licensed to practice medicine, and thats it. Anything else is board certification, state certification, etc. Thus, any doctor can pretty much do anything he wants. Thats why board certification is so coveted. It ensures that the doctors are proficient in their field of practice. General licensure is all you need to practice medicine.

I meant certification. Ergo, just because a path is a doc doesn't mean he has the right to perform surgery or deliver babies.

 

[bigmuny]

Actually, any doc with a medical license has the right and is legally permitted to perform surgery or deliver a baby or whatever they want or feel comfortable doing. Certification in a particular field has nothing to do with your practice rights. However, if a pathologist were to open up shop doing bypass surgery, and screwed it up.....well there would be a line of lawyers at the patient's house begging for an opportunity to take the case.

 

[moo]

Originally posted by bigmuny
Actually, any doc with a medical license has the right and is legally permitted to perform surgery or deliver a baby or whatever they want or feel comfortable doing. Certification in a particular field has nothing to do with your practice rights. However, if a pathologist were to open up shop doing bypass surgery, and screwed it up.....well there would be a line of lawyers at the patient's house begging for an opportunity to take the case.

Exactly. For example, are you saying a GP can't prescribe an anti-coagulant for your thrombosis, or do you have to go to a hematologist everytime you want an anti-coagulant? What is the role of the GP in the medical system then? Just to prescribe antibiotics and to refer his patients to other docs? Heck I could train a dog to do this. This would make for a very inefficient system. And GPs ARE allowed to perform surgery, and many do, especially in small towns and rural areas where a surgeon isn't readily available. And I believe we (DOs and MDs) are trained well enough to therapy (after all we do take behavioral science and it is part of the boards).

 

[fishy424]

I'm going to try and find some middle ground here, if possible!

I recently wrote an article on managed care and suicide, and in doing my research found published papers reporting that an alarming number of suicide victims saw their GP in the weeks preceding the act. Thus pointing to the thought that it is important for non-psychiatrists, especially GP's to be sensitive to their patients mental well-being.

I would think it vital that all physicians be on the lookout for signs of mental illness, and then treat up to their abilities. After all, its important to start addressing important health issues as soon as you can.

But I agree with the originial post that knowledge of one's boundaries of expertise is imperative. I agree that on the surface a GYN prescribing Effexor for anxiety seems out of place. (Effexor is not a first line therapy for anxiety due to possible higher SE's than other antidepressants) It is potential instances like this, where a physician can overstep their reach to do more harm than good. A good clinician would hopefully know when to rely on their referral partners.

By the way, I don't think the issue of overprescribing psychostimulants is an MD vs. DO problem... likely more an issue of good information and overall poor prescribing practices.

 

[DD214_DOC]

I'm not saying they CAN'T, I'm saying they SHOULDN'T.

 

[Tbonez]

Ok, Here we go again. Lets hit a couple of basic points about DO/MD and their practice scope.
#1. DO's emphasize holistic care. This DOES NOT MEAN that MD's do not practice holistic care.
#2. DO's emphasize primary care. This DOES NOT MEAN that they only are good at primary care, or that MD's aren't good at it.
#3. DO's learn OMM in medical school. This DOES NOT MEAN all DO's use it, believe it works, teach it to others, etc.
#4 A doctor is a doctor. It is perfectly legit for a gyn to prescribe psych meds in appropriate context, and inappropriate for those outside the pt./provider relationship to speculate. You graduate w/ a license to practice medicine and surgery. You learn some psych in med school. You do not learn coronary bypass in med school.

So what have we learned. Basically, there is almost NO difference in the two newly graduated physicians, except that DO's have more primary care emphasis (depending on the institution), and MD's have perhaps more specialty or research emphasis (again depending on the instititution).

MD/DO school preference often has little to do with grades, MCAT, LOR's, etc, but often more to do with location of the school, family situation, etc.

Example: I have a 32O MCAT, a 3.9 sci, and a 3.8 overall GPA, and am CHOOSING to attend a DO school given the fact that the education, opportunities, etc. are nearly equal, but my wife will have a better job that allows her to work 9-5, no weekends, and thus a better situation for us, having two kids.

If I felt there were any substantial difference in the degrees, we would move only 2 more hours away and attend an MD school.

my .02

 

[fabiolablake]

Originally posted by JKDMed
My girlfriend was prescribed effexor for anxiety -- by her Gynecologist! That is absurd.

I don't think that is too absurd. Antianxiety drugs are relatively safe and don't have too many side effects, usually. I had an orthopedic surgeon write a prescription for oral chancers.

 

[WillowRose]

If my mom happened to have an ear infection when she saw her gynecologist, he often wrote a script for the antibiotics. It's no big deal.

As far as if I was a FP and had a patient come to me needing anti-depressants or anti-anxiety drugs, I'd prescribe them and then encourage them to seek therapy from a psychiatrist. Better to get them on the meds sooner rather than later. If that pt committed suicide the following week, I'd be upset. But I would also understand that the pt had a mental problem and maybe it was diagnosed too late or maybe the pt didn't share everything with me. Even shrinks aren't gods....they can't read the pt's mind and they don't know when you're holding back.

I think in *many* cases, the FP is in the best position to note and diagnose mental illness because he sees the patient more than other specialists. If it isn't the garden variety depression, there are always referrals and consults. It's been said before...dr's are licensed to practice medicine. If you don't feel comfortable addressing mental issues, then refer your patient. But it is not necessarily unethical or absured for another doctor to write the script himself.

Willow

 

[dan0909]

Originally posted by WillowRose
If my mom happened to have an ear infection when she saw her gynecologist, he often wrote a script for the antibiotics. It's no big deal.

Willow

Ur mom tells you about her gynecologist visits?

 

[Robz]

Maybe she said she was going there...and came back with a bag from the drug store?

 

[WillowRose]

Oh yeah...mom & I would walk along the beach talking about that "not so fresh" feeling...

Sheesh!

I was well aware who her gynecologist was. He delivered me..known him since I was born. And she mentioned on several occasions that he would prescribe medication for her unrelated to his specialty because she happened to be in his office. Not hard to look at a prescription bottle and see the name of the dr on it.

 

[stomper627]

You guys are forgetting the main reason GPs do so much.....
It is because insurance companies wont pay for the specialists without pre-authorization, or at least seeing the GP first, or without completing their "algorythm" for proper patient management.
As far as "all these kids on drugs"....doctors are being forced into the situation by parents and teacher who do not want to parent or teach.
The problem lies in the system....not the messengers.
stomper