what's your benzo speech?

[whopper]

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Just my opinion that is not evidenced-based but experienced-based.

The initial decision making process for less experienced mental health practitioners is to satisfy patients. As the more experienced people know, our job is to get people better, not simply satisfy them. Just like a cardiologist will have to tell his overweight, smoking, hyperlipidemic, out-of-shape patient to clean their act up or face the consequences of likely dying much sooner, often times we have to tell our patients we will not give them benzos long-term or anything else along those lines, even if they do not agree with us.

Ours is a patient population that as a whole is more likely to have poor decision making skills. (Of course there are exceptions). Actually ours and perhaps ER doctors are the most along these lines vs. other fields of medicine. While cardiologists are often stuck in this same position, at least the common knowledge of laymen is more caught up with the doctor's recommendations. Everyone knows smoking and cheesecake is bad for you. Not everyone knows that benzo usage long-term is usually not a good idea.

The point is, because medstudents and residents often times have a harder time differentiating between healing and enabling, making someone better vs. simply just making them happy, when these practitioners give out meds, they must fight that initial built-in directive in our brain to satisfy the patient more so than other fields.

As a resident, my initial feeling was to give out benzos to everyone, because that's what they wanted and I wanted happy patients. Only after appropriate instruction and reading the evidence did I realize that impression was wrong. I had to actively fight that impression for months before I was able to balance the uneasy feeling with what I knew was logically correct.

I agree with the above comments that not giving out benzos cannot be a black and white thing,......but the bottom line is if you're doing correct practice, if you do give out benzos long-term, they should be to a very small percentage of patients, the person making the decision to administer them (the patient or the guardian) must have been warned of the long-term risks, that several alternatives have been tried first and failed, they should not be used to treat symptoms that are considered a normal response to the given stressor, the prescribing doctor has to strongly consider the patient is possibly abusing the medication, and once a particular dosage is reached, they will not be increased except under exceptionally strange circumstances.

 

[ghost dog]

The problem with many of those validated inventories is that they're still based on self-report. Malingerers can exaggerate on self-reports.

You might be surprised.

When I have pts fill out a brief pain inventory, and then ask them verbally about their pain I will get one of 2 outcomes:

1. The written / verbal responses agree, and I am more likely to give creedence to the self report. Even in this case, I get some interesting answers, as a pt will inadvertently tell me something that lets me know that opioids aren't doing the pt any favours. For example, if a pt states they are obtaining dramatic pain relief, but can't tie their own shoes / perform any meaningful ADLs , then opioids are likely not indicated here.


2. The written / verbal responses do not agree, and I am now thinking something is rotten in Denmark.

This is why I like standardized indices. They are a time efficient way of obtaining pt information.

Then throw in a UDS.

You can apply the same thinking to benzos.

 

[nitemagi]

You might be surprised.

When I have pts fill out a brief pain inventory, and then ask them verbally about their pain I will get one of 2 outcomes:

1. The written / verbal responses agree, and I am more likely to give creedence to the self report. Even in this case, I get some interesting answers, as a pt will inadvertently tell me something that lets me know that opioids aren't doing the pt any favours. For example, if a pt states they are obtaining dramatic pain relief, but can't tie their own shoes / perform any meaningful ADLs , then opioids are likely not indicated here.


2. The written / verbal responses do not agree, and I am now thinking something is rotten in Denmark.

This is why I like standardized indices. They are a time efficient way of obtaining pt information.

Then throw in a UDS.

You can apply the same thinking to benzos.

I agree and I actually like self-report inventories as well for screening purposes. But I recognize that both verbal and written accounts are self-reported, and thus only a single source of info. Flags are much more easily raised if they can't even be consistent with their reporting, but many of our self-report measures lack clear "ceiling" or "floor" scores that would suggest their rating of sx's is outside the level reasonably to be expected from anyone.