(via MindHacks)
Издержки развитой капиталистической страховой медицины? Врачам тупо хочется заработать денег и они готовы лечить кого угодно и чем угодно?
Интересный комментарий некоего PJ, представившегося калифорнийским психиатром, в блоге Furious Seasons. Конечно, в этом блоге много комментаторов с антипсихиатрическим уклоном, и можно предположить подставу, но интересно.. А само сообщение - про человека, погибшего при попытке нелегально купить у драг-дилера.. сероквель.
I work as a psychiatrist in a community psychopharmacology clinic in an urban community in California. Our patients are, for the most part, low-income, minority residents with Medicare or Medi-Cal.
One of our full-time physicians sees upwards of 40+ patients a day (new and returning) and for at least half of his patients, regardless of diagnosis (of course, what kind of “diagnosis” can you give in a 5-10 minute initial evaluation?), he routinely prescribes Seroquel XR
300-600 mg/d and Abilify 20-30 mg/d. Occasionally, he’ll add on Ambien CR 12.5 mg/d for good measure. The prescriptions are usually given for a 30-day supply with 5 refills, and he asks them to come back in 6 months.
(BTW, can you guess which drug reps bring lunch to the office most frequently? Yeah, I thought so.)
I frequently see these patients when they return to the clinic and he’s not available… For more than half, they’re no longer taking their meds, and I need to do an entirely new evaluation. Patients are typically in mild to moderate distress (often due to financial, family, and/or legal problems, or drug/alcohol abuse– not to mention obesity, diabetes, and general poor health) and DO need attention, but I find the best thing to do is supportive care, referral to a PMD, and advising the patient of available community resources.
I can’t imagine how much Seroquel & Ambien we’re putting on the streets of our community, nor how much money we’re costing California & the US govt for indiscriminate Rx’es. The problem is, the system works IN FAVOR of this doctor; he argues that, like it or not, it’s the “standard of care” for this population, and besides, he has a mortgage to pay!! (I should mention we’re paid on a per-visit basis— we get paid the same whether it’s a 45-minute supportive therapy visit or a 5-minute prescription of these powerful meds.)
It has made me incredibly disillusioned about psychiatry, and about health care in general, but I feel impotent to change the situation.
