NOTE FROM Ann Blake-Tracy (www.drugawareness.org):
“Why don’t psychiatrists notice when patients experience medication side
effects?,” I should remind you of the comment made by the psychiatric nurse who
attended one of my lectures a couple of years ago. After listening to me discuss
the potential side effects of SSRI antidepressants she stood and said, “Dr.
Tracy we never get to hear what you have shared with us here tonight, but I know
it is true because I am on Lexapro and have suffered nearly every one of the
side effects you mentioned. But you do not know what is going on out here. At
least 75% of the doctors and nurses I work with are on these drugs! The drug
reps are telling them they are in a stressful profession and will surely end up
suffering depression as a result so they need to get started on these drugs now
in order to help prevent that.”
the memory so strongly as to cause “amnesia” as a frequent side effect, if you
cannot even remember who you are, how do you remember what your patients
need?”
remind one another and then they attribute it to old age setting
in.
the patients‘ side effects they have forgotten what those side effects were that
they were to report. Of course these drugs also produce much more business
for the doctors by producing side effects and bringing patients back in for
follow up treatment so there is also a financial incentive to not report and
give the drugs a bad record. No matter the reason it is clear that the
situation is causing a very serious situation for patients and public safety in
general.
patients who were in ongoing outpatient treatment for depression
over six weeks. The authors compared what the patient reported on a
standardized scale of 31 different side effects (Toronto Side
Effects Scale; TSES) with the information recorded by the treating psychiatrist
on each patient’s chart. The main finding: A stunning disconnect between
psychiatrists and their patients. The average number of side effects
reported by the patients on the TSES was 20 times (!) higher than the number
recorded by the psychiatris. When the investigators concentrated on
those side effects that were most troubling to the patient, patients still
reported 2 to 3 times more side effects than were recorded by the treating
psychiatrist.”
Why don’t psychiatrists notice when patients experience medication side
effects?
Published on April 20, 2010
A rich scientific study raises more
questions than it answers.
This point is exempified by new work conducted
at Rhode Island Hospital and published in the Journal of Clinical
Psychiatry.
The investigators followed 300 patients who were in
ongoing outpatient treatment for depression over six weeks. The authors compared
what the patient reported on a standardized scale of 31 different side effects
(Toronto Side Effects Scale; TSES) with the information recorded by the treating
psychiatrist on each patient’s chart. The main finding: A stunning disconnect
between psychiatrists and their patients. The average number of side effects
reported by the patients on the TSES was 20 times (!) higher than the number
recorded by the psychiatris. When the investigators concentrated on those side
effects that were most troubling to the patient, patients still reported
2 to 3 times more side effects than were recorded by the treating
psychiatrist.
The authors summarize their provocative findings in mild
language, “The findings of the present study indicate that clinicians do not
record in their progress notes most side effects reported on a side effects
questionnaire by psychiatric
outpatients receiving ongoing pharmacological treatment for depression.”
Obviously
all is not well in the state of Demark. Although the findings concern the
treatment of depression, they raise broader questions about the doctor-patient
relationship.
Why is there such a massive disconnect between what
psychiatrists and patients report, on something so basic as whether prescribed
medications are having untoward effects? Do psychiatrists not ask enough
questions about side effects? Do psychiatrists not dig deep enough into
patients‘ responses? Are psychiatrists hearing what patients say, but not
documenting it in their notes? Or is the problem more on the patient side? Are
patients reluctant to speak candidly to their doctors about side effects (i.e.,
yes, I am having problems with sexual functioning)? Or do patients freeze up and
forget their experiences when asked in the heat of the moment (it is easier to
respond to a standardized list of side effects using pencil and paper)? Or is it
the situation that is to blame for this disconnect? Are patient-doctor
interactions in this day and age simply too rushed to insure efficient or
effective transfer of information?
Whatever the explanation,
psychiatrists appear to believe that patients are having fewer problems with
medications than they truly are. It is hard to see how psychiatrists can act in
the best interest of their patients if they do not know what their patients are
experiencing!!!!
The researchers recommend the use of a self-administered
patient questionnaire in clinical practice to improve the recognition of side
effects for patients in treatment. This study reveals a chasm of
misunderstanding between doctors and patients. This recommendation is a
sensible, but baby, step towards narrowing
it…
