Do Doctors Tend To Blame The Patient When They Don't Have An Answer?
I suppose I'll never forget what happened to one of my patients during the early days of my practice. I received a frantic call from my patient's niece who had just learned that her aunt, who had entered the hospital for something else, was now confined to a padded room at a psychiatric hospital where she was kept stark naked in order to avoid the possibility of an attempted suicide. Fortunately, I possessed two advantages, which permitted me to assist this unfortunate individual. First, I was fully aware of her medical history and of that of her family. Second, the head of the psychiatry department was a medical school friend. I advised him that this woman, similar to several relatives, was extremely sensitive to medication, and had never displayed depressive tendencies. Therefore, it would be advisable to discontinue her psychotropic drugs to see if she continued to demonstrate suicidal tendencies. He complied immediately and the result was that this unfortunate woman was released from the hospital the following day without evidence of depression. She lived a normal life, without mental disease, until she passed away many years later. We must not blame the physicians who saw fit to incarcerate this patient under these circumstances in order to protect her, but the true culprit in such cases is insufficient knowledge of a patient's and her family's susceptibility to medication. The answers to medical enigmas are frequently extremely elusive. However, the blame for this inability to find an answer must not be automatically shifted in the direction of the patient in order to escape responsibility.
This tendency to snow a patient under with psychotropic medications, which may or may not be the proper approach, was discussed in an editorial written by Doctor Jellinek of Massachusetts General Hospital for the January 2003 Archives of Pediatric and Adolescent Medicine. He quite appropriately entitled his article "Mirror, Mirror on the Wall: Are We Prescribing the Right Psychotropic Medications to the Right Children Using the Right Treatment Plan?" His remarks were sparked by the publication in the same issue of an article by Zito et al called "Psychotropic Practice Patterns for Youth: A 10-Year Perspective." Jellinek puts the problem in perspective by noting the glaring fact gleaned from this study that "2 to 3 times more children were receiving psychotropic medication of all types in 1996 than in 1997, with the most rapid increase since 1991." He adds the disturbing thought that this is taking place at a time when this data is "a reflection, an imperfect mirror, of the scientific, clinical, financial, and system changes" brought on "in the context of dramatic changes in the health care delivery system secondary to managed care cost controls."
If you're wondering how these findings relate to our tendency to blame the patient for our deficient capabilities, Jellinek goes on to note that Zito's group found 6% of the children were getting at least 1 psychiatric medication during the final study year. "Can we rationalize such a high percentage and an accelerating trend?" he asks. He then attempts to justify these figures with rationalizations about recent trends in treatment, increasing recognition of disorders, increasing tendency to diagnose severe disorders, the contribution of mental illness in parents, stress created by poverty, and the current tendency to use medication in preference to psychoanalysis.
At this point one begins to wonder whether our inability to control this ever accelerating trend might really be due, in large part, to our tendency to find a quick, easy way out via medication rather than to analyze and correct the underlying causes. Evidently, much of this tendency towards a "quick fix" might be placed at the doorstep of the managed care environment in which we now find ourselves almost totally immersed. To put it bluntly, perhaps we are "putting the cart before the horse" by blaming the patient instead of the system due to our own impatience to get results without thorough analysis and investigation.
The squeaky wheel is sure to get,
Gobs of oil to quell the noise,
But you can safely place your bet,
That the quiet girl will get the boys
Things are different when you're ill,
It's quite alike, yet not the same,
Without a doubt, you'll get a pill,
But don't complain, or you'll get the blame.