Screening all for depression

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Shikima

Shikima

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That's f'n ridiculous. Why don't we screen everyone for everything. God forbid somebody actually develop some resilience and sense of agency outside the purvey of our neoliberal, godlike omnipotence. That would be just.....unthinkable.

F@ck these screens for mood and suicide and whatever else. Anyone pushing that **** should be admitted to inpatient unit immediately. for like...months. transfer them to state for a while. cure them of their f'n nonsense.
 
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I posted in another thread about this stupid crap. The government and the administrators don't care if something works they just care that it sounds good. We implemented a two question screen for depression for every medical patient at our hospital as part of our quality care crap to make sure we don't get a penalty. No actual providers were involved in the decision or implementation and there is no policy about what to do when positive. We dot the i and cross the t so that we get paid and then we just do our job the same way we did before. I don't think it has generated more referrals but it may have led to more prescriptions for ssris for mild depressive symptoms by midlevels. I won't see that type of patient for about a year or so after their life is really messed up and their depression is moderate to severe. Kind of backwards if you ask me.
 
Nasrudin said:
That's f'n ridiculous. Why don't we screen everyone for everything. God forbid somebody actually develop some resilience and sense of agency outside the purvey of our neoliberal, godlike omnipotence. That would be just.....unthinkable.

F@ck these screens for mood and suicide and whatever else. Anyone pushing that **** should be admitted to inpatient unit immediately. for like...months. transfer them to state for a while. cure them of their f'n nonsense.
Click to expand...
But how do you really feel?
 
It's interesting to me how some healthcare policies are widely distributed and enforced and how some fall by the wayside.

As an example, with the ebola epidemic, every time I went to my doctor I was asked, as ridiculous as it was knowing me, if I had recently traveled to Africa. They asked a woman in front of me, who was probably 90 and in a wheelchair, and she said, "Oh yeah, just got back last week."

Somehow, someone had put the fear of God into healthcare workers that they were definitely going to ask that question.

As a counter-example, you would think doctors would keep your list of medications up to date, ask if you've had a tetanus shot as an adult, or sometime by the time you're 33 suggest you have a cholesterol test, especially when you're on medications that are known to cause lipid problems. I can attest I've never been inquired to about any of those.

I don't really have any theory to apply to this, except theory from a completely different field which is the development of nations. The intensity of intentionality with which a leader rules leads to drastically different results. Someone at the top caring actually does make a difference, in short. If a leader, or government, wants something done, they will make it important and find a way to do it.

If I were to guess, this recommendation will go the way of the adult tetanus booster, rather than the way of the ebola question.
 
When I started my policy with my current insurance provider, they did a depression screen on my first visit by asking me if I've 'recently lost interest in things normally enjoy'.
What's the problem with this? Won't they just refer to a psych if depression symptoms are suspected? Or is this a case of encroachment?
 
ChillDawg said:
When I started my policy with my current insurance provider, they did a depression screen on my first visit by asking me if I've 'recently lost interest in things normally enjoy'.
What's the problem with this? Won't they just refer to a psych if depression symptoms are suspected? Or is this a case of encroachment?
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depression is a primary care problem - the overwhelming majority of depression is treated in primary care. i certainly don't want to be seeing this kind of thing. the problem with indiscriminate screening is you get false positives and negatives, you will have more people inappropriate diagnosed and treated, and the mental health services are already overstretched to cope with this crap. see for more
 
I remember I was called for a consult because the CRNA student was doing a depression screening in pre-op, right before the procedure. It came back "positive" and then I got a frantic call if I'd come see the person.
 
Shikima said:
I remember I was called for a consult because the CRNA student was doing a depression screening in pre-op, right before the procedure. It came back "positive" and then I got a frantic call if I'd come see the person.
Click to expand...

haha!

RN's with consult power are the worst. Although not as dangerous as an ED doc with a bad attitude towards psych. So that their idiotic opinion has the delusional power of authority. At least with the former you can chuckle and say here's why I'm not coming to see that patient right now.

This idea of the supremacy of preventative health is really polluted. It's neoliberal cultural influence gone amuck.

OMH in New York has a motto. "Suicide. A never Event."

Great. OMH. Go screen the citizens of new york and round everyone up into a prison camp for the suicidal. Not be released until they pinky swear that they'll never so much as scratch their wrists with a paper clip. And only when there's 7 days of squeaky clean screens that will be administered Q 4 hours by our algorithmically programmed psych droids, to prove it.
 
Nasrudin said:
haha!

RN's with consult power are the worst. Although not as dangerous as an ED doc with a bad attitude towards psych. So that their idiotic opinion has the delusional power of authority. At least with the former you can chuckle and say here's why I'm not coming to see that patient right now.

This idea of the supremacy of preventative health is really polluted. It's neoliberal cultural influence gone amuck.

OMH in New York has a motto. "Suicide. A never Event."

Great. OMH. Go screen the citizens of new york and round everyone up into a prison camp for the suicidal. Not be released until they pinky swear that they'll never so much as scratch their wrists with a paper clip. And only when there's 7 days of squeaky clean screens that will be administered Q 4 hours by our algorithmically programmed psych droids, to prove it.
Click to expand...
They had a campaign at the local school that was titled "suicide 100 percent preventable". People with family members who had committed suicide were pretty angry about that one. The suicide rate in our community is off the charts, probably 5 to 10 times the national average and they use slogans and don't address any of the real precipitants. If they wanted a real program they could hire a psychologist with program development expertise to begin coming up with a strategy, but it is usually just window dressing. Real prevention in mental health means addressing poverty, childhood neglect and abuse, and substance abuse. All of which are interrelated with substance abuse probably being the least challenging to target as a society.
 
FYI: cms added "depression" as a metric for snf monthly assessments about 2-5 years ago.
 
I like how the USPSTF keeps coming out with guidelines that are supposedly based on a rigorous evaluation of evidence of the highest quality, yet the actual specialties and subspecialties (American urological association for PSA screening, ACOG for a number of things) wholeheartedly disagree and don't change standard practice.
 
HarryMTieboutMD said:
I like how the USPSTF keeps coming out with guidelines that are supposedly based on a rigorous evaluation of evidence of the highest quality, yet the actual specialties and subspecialties (American urological association for PSA screening, ACOG for a number of things) wholeheartedly disagree and don't change standard practice.
Click to expand...

Sounds like JHACO.
 
HarryMTieboutMD said:
I like how the USPSTF keeps coming out with guidelines that are supposedly based on a rigorous evaluation of evidence of the highest quality, yet the actual specialties and subspecialties (American urological association for PSA screening, ACOG for a number of things) wholeheartedly disagree and don't change standard practice.
Click to expand...

You are expecting specialists to get on board with the idea that bread and butter procedures and tests that ultimately lead to quite a lot of revenue generation are maybe super useful or necessary?

Expect gastorenterologists to die on the hill of "colon cancer screening for everyone always" in the face of literally any evidence that might come to light casting doubt on the utility of scopes.

As Sinclair Lewis put it, "it is difficult to get a man to understand something when his salary depends on his not understanding it."
 
clausewitz2 said:
You are expecting specialists to get on board with the idea that bread and butter procedures and tests that ultimately lead to quite a lot of revenue generation are maybe super useful or necessary?

Expect gastorenterologists to die on the hill of "colon cancer screening for everyone always" in the face of literally any evidence that might come to light casting doubt on the utility of scopes.

As Sinclair Lewis put it, "it is difficult to get a man to understand something when his salary depends on his not understanding it."
Click to expand...

I thought I made the sarcasm clear enough in my post
 
splik said:
depression is a primary care problem - the overwhelming majority of depression is treated in primary care. i certainly don't want to be seeing this kind of thing. the problem with indiscriminate screening is you get false positives and negatives, you will have more people inappropriate diagnosed and treated, and the mental health services are already overstretched to cope with this crap. see for more
Click to expand...

The VA/DoD system disagrees with you
 
HooahDOc said:
The VA/DoD system disagrees with you
Click to expand...

They may, but there is no way one could argue that the majority of "depression" is being seen in MH clinic, or even in the PCMHI service at most VAs. Still very much contained in primary care.
 
I was at 3 naval hospitals and psychiatry would only see active duty. Family medicine treated the rest. It might have changed, but I doubt it. At the VA, there is a good possibility of a NP treating them.
 
smalltownpsych said:
I posted in another thread about this stupid crap. The government and the administrators don't care if something works they just care that it sounds good. We implemented a two question screen for depression for every medical patient at our hospital as part of our quality care crap to make sure we don't get a penalty. No actual providers were involved in the decision or implementation and there is no policy about what to do when positive. We dot the i and cross the t so that we get paid and then we just do our job the same way we did before. I don't think it has generated more referrals but it may have led to more prescriptions for ssris for mild depressive symptoms by midlevels. I won't see that type of patient for about a year or so after their life is really messed up and their depression is moderate to severe. Kind of backwards if you ask me.
Click to expand...

I'm jumping into this thread late, but I couldn't help but respond to this based on my experience that I'm having in the psych ED right now.

Our medical ED has incorporated a suicide risk screening questionnaire that gets asked of all patients regardless of complaint. It's a 5- or 6-question survey where each positive (i.e., "risk-increasing") answer is +1 point. Our psych ED includes what is effectively an ED-focused consult team that decides which patients are sent for further evaluation to the psych ER, which can be handled by the consult team, and which don't need to be seen.

The responses to various score ranges are algorithmic, such that low scores (say, 1-2) are treated with a "psych activation" - i.e., the patient shows up on the list of patients to be seen by the triage team. Roughly 10-20% of patients coming through the ED give at least one positive answer, resulting in a "psych activation" list of 15-20 patients, if not more, at any one time to be seen. The highest scores automatically get a patient placed on 1:1, which requires a psychiatrist to evaluate the patient in order to clear. In many cases, the nursing staff use high suicide screens to justify calling the local hospital police to detail the patient without a warrant until they can be seen by a psychiatrist (which are granted by the officer 95% of the time), again requiring a psychiatrist to fully evaluate the patient - a process which is frighteningly routine given how easily both the nursing staff and police officers disregard the rights of our patients.

Great intentions, but I have found this screening program to be nothing but a headache. The knee-jerk responses place a huge burden on the consult team when simple commonsense would dictate that this patient does not, in fact, require a psychiatrist, a 1:1 sitter, or a warrantless police detention. It results in many patients that are clearly malingering being sent to the psych ER (rather than being evaluated and subsequently discharged by the triage team) thanks to asinine policies that remove medical decision-making and clinical judgment and replace them with a flowchart of "how do I treat the patient with a psychiatric history" in addition to having people that have little to no psych training effectively determining the disposition of a patient based on said flowchart.

Sadly, I find that most nights I've spent working on this consult team are spent undoing ridiculous journeys down the "how to treat the patient with a psychiatric history" yellow brick road than focusing limited resources on patients that could truly benefit from the help. I'm not sure that the "powers that be" could have executed a suicide screening program more poorly.
 
NickNaylor said:
I'm jumping into this thread late, but I couldn't help but respond to this based on my experience that I'm having in the psych ED right now.

Our medical ED has incorporated a suicide risk screening questionnaire that gets asked of all patients regardless of complaint. It's a 5- or 6-question survey where each positive (i.e., "risk-increasing") answer is +1 point. Our psych ED includes what is effectively an ED-focused consult team that decides which patients are sent for further evaluation to the psych ER, which can be handled by the consult team, and which don't need to be seen.

The responses to various score ranges are algorithmic, such that low scores (say, 1-2) are treated with a "psych activation" - i.e., the patient shows up on the list of patients to be seen by the triage team. Roughly 10-20% of patients coming through the ED give at least one positive answer, resulting in a "psych activation" list of 15-20 patients, if not more, at any one time to be seen. The highest scores automatically get a patient placed on 1:1, which requires a psychiatrist to evaluate the patient in order to clear. In many cases, the nursing staff use high suicide screens to justify calling the local hospital police to detail the patient without a warrant until they can be seen by a psychiatrist (which are granted by the officer 95% of the time), again requiring a psychiatrist to fully evaluate the patient - a process which is frighteningly routine given how easily both the nursing staff and police officers disregard the rights of our patients.

Great intentions, but I have found this screening program to be nothing but a headache. The knee-jerk responses place a huge burden on the consult team when simple commonsense would dictate that this patient does not, in fact, require a psychiatrist, a 1:1 sitter, or a warrantless police detention. It results in many patients that are clearly malingering being sent to the psych ER (rather than being evaluated and subsequently discharged by the triage team) thanks to asinine policies that remove medical decision-making and clinical judgment and replace them with a flowchart of "how do I treat the patient with a psychiatric history" in addition to having people that have little to no psych training effectively determining the disposition of a patient based on said flowchart.

Sadly, I find that most nights I've spent working on this consult team are spent undoing ridiculous journeys down the "how to treat the patient with a psychiatric history" yellow brick road than focusing limited resources on patients that could truly benefit from the help. I'm not sure that the "powers that be" could have executed a suicide screening program more poorly.
Click to expand...
I'm surprised more don't give at least one positive answer, although people learn pretty quickly to deny anything that could lead to an increased hassle. "I came in here because of my sprained ankle and now I have to wait to see a psychiatrist? I already told them I don't want to kill myself, I have just been feeling bad about my breakup last week."
 
A patient told me today, "I want a pill I can take when I'm anxious. I don't want anything I have to take every day, nothing that's addictive or that will make me tired.."

Such a reasonable request ....

Sent from my iPad using Tapatalk
 
NickNaylor said:
I'm jumping into this thread late, but I couldn't help but respond to this based on my experience that I'm having in the psych ED right now.

Our medical ED has incorporated a suicide risk screening questionnaire that gets asked of all patients regardless of complaint. It's a 5- or 6-question survey where each positive (i.e., "risk-increasing") answer is +1 point. Our psych ED includes what is effectively an ED-focused consult team that decides which patients are sent for further evaluation to the psych ER, which can be handled by the consult team, and which don't need to be seen.

The responses to various score ranges are algorithmic, such that low scores (say, 1-2) are treated with a "psych activation" - i.e., the patient shows up on the list of patients to be seen by the triage team. Roughly 10-20% of patients coming through the ED give at least one positive answer, resulting in a "psych activation" list of 15-20 patients, if not more, at any one time to be seen. The highest scores automatically get a patient placed on 1:1, which requires a psychiatrist to evaluate the patient in order to clear. In many cases, the nursing staff use high suicide screens to justify calling the local hospital police to detail the patient without a warrant until they can be seen by a psychiatrist (which are granted by the officer 95% of the time), again requiring a psychiatrist to fully evaluate the patient - a process which is frighteningly routine given how easily both the nursing staff and police officers disregard the rights of our patients.

Great intentions, but I have found this screening program to be nothing but a headache. The knee-jerk responses place a huge burden on the consult team when simple commonsense would dictate that this patient does not, in fact, require a psychiatrist, a 1:1 sitter, or a warrantless police detention. It results in many patients that are clearly malingering being sent to the psych ER (rather than being evaluated and subsequently discharged by the triage team) thanks to asinine policies that remove medical decision-making and clinical judgment and replace them with a flowchart of "how do I treat the patient with a psychiatric history" in addition to having people that have little to no psych training effectively determining the disposition of a patient based on said flowchart.

Sadly, I find that most nights I've spent working on this consult team are spent undoing ridiculous journeys down the "how to treat the patient with a psychiatric history" yellow brick road than focusing limited resources on patients that could truly benefit from the help. I'm not sure that the "powers that be" could have executed a suicide screening program more poorly.
Click to expand...

WTF?! God forbid an ER resident learns what to do with a patient that feels down because it's the middle of winter and they haven't seen the sun in 2 months.

Why is it in academics common sense is the first thing to go? Speaking from my own experiences so far as well.
 
MLT2MT2DO said:
WTF?! God forbid an ER resident learns what to do with a patient that feels down because it's the middle of winter and they haven't seen the sun in 2 months.

Why is it in academics common sense is the first thing to go? Speaking from my own experiences so far as well.
Click to expand...
Don't blame 'academics'--this has the stink of Joint Commission-driven, top -down, mandated "quality" measures all over it...
 
Because of the explosion of the number of required forms, we are reassessing how new forms and policies are made so we can stem the tide. Unfortunately making a policy policy has been challenging. So we did the logical thing. We created sub committees to look at other system’s policy policy so we can review these. I think I may write a policy policy review paper. I think I will label the conclusion paragraph the “policy policy policy”.
 
MacDonaldTriad said:
Because of the explosion of the number of required forms, we are reassessing how new forms and policies are made so we can stem the tide. Unfortunately making a policy policy has been challenging. So we did the logical thing. We created sub committees to look at other system’s policy policy so we can review these. I think I may write a policy policy review paper. I think I will label the conclusion paragraph the “policy policy policy”.
Click to expand...

We get e-mails when policies are updated, and one of these e-mails a couple of months ago included a "Policy on Policies." Before that e-mail, I would've laughed at the idea that such a thing might exist. Now a piece of me is dead inside, never to return.
 
We still have mandatory Ebola screening questions for every patient. That's right- Ebola, not Zika.
 
It's part of our EMR's "meaningful use" as per our lovely federal government. So are questions about dialysis, dementia screening (I mostly see kids), weight, diet,and exercise.
 
"Anxiety" is how I get **** done. Why does everyone want a pill for it to go away? 🙂
 
My mom is a very fit and active 68. She gets really annoyed when she goes to the doctor and they ask her all kinds of questions about if she's fallen recently.

Last time she told me, "I tripped over a loose brick when I went jogging a few weeks ago and face planted, but when they asked at my physical if I'd fallen recently I lied."
 
MacDonaldTriad said:
Because of the explosion of the number of required forms, we are reassessing how new forms and policies are made so we can stem the tide. Unfortunately making a policy policy has been challenging. So we did the logical thing. We created sub committees to look at other system’s policy policy so we can review these. I think I may write a policy policy review paper. I think I will label the conclusion paragraph the “policy policy policy”.
Click to expand...

hahaha! nice.
 
milesed said:
It's part of our EMR's "meaningful use" as per our lovely federal government. So are questions about dialysis, dementia screening (I mostly see kids), weight, diet,and exercise.
Click to expand...
Don't get me started...so it's not "meaningful" enough that we use a fully electronic record for all ordering, documentation, and billing unless you've completed X checklist and recorded Y...:boom:
 
As a psychologist, I have more than anecdotal evidence that people tend to talk/disclose to paper more than to providers directly, but of course, this is not how these screenings are typically administered. Most of the "pop hot" of depression or PTSD screens end up being are terrible therapy patients/therapy candidates.

VA Mental health clinic cup over floweth, people wonder why....
 
erg923 said:
As a psychologist, I have more than anecdotal evidence that people tend to talk/disclose to paper more than to providers directly, but of course, this is not how these screenings are typically administered. Most of the "pop hot" of depression or PTSD screens end up being are terrible therapy patients/therapy candidates.

VA Mental health clinic cup over floweth, people wonder why....
Click to expand...

This is true. Screening for drugs and ETOH - no way man. On paper, they're buying on the street and drinking 1/5 a day like it was water.
 
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