60 Minutes is perhaps the best news show ever. It is a staple of American life, or at least my life. The courage of reporting and trying to show both sides of a story seems to be the policy. Last Sunday, Katie Couric exposed a serious issue for people that visit psychiatrist's.
Apparently, a young girl (age 3 I believe) was behaving in an odd way according to her parents and they sought psychiatric help. The psychiatrist seemed like a nice person that was trying to help them. A diagnosis of Bipolar disorder was made in the child and medications were prescribed. According to the story, the parents gave more medication than the doctor recommended and the child died. Nothing for a parent could be worse than losing a child. Still, the parent or parents were charged with murder and the mom is now behind bars. The details are no doubt greater than what was in the show.
Katie interviewed the mom and a psychiatrist in Boston who has done a tremendous amount of research into Bipolar disorder in children. He is a well known doctor in child psychiatry circles and is clearly an authority. In terms of moving knowledge forward, he is doing his best. A psychiatrist in Oregon was interviewed also. His contribution to the story was his experience with children in his practice that take numerous medications for Bipolar disorder. Some of these children had their diagnosis changed and were prescribed fewer medications with good outcomes. Bipolar disorder may occur in children although it is probably infrequent. Options other than medications might be reasonable considering the lack of study using medications in children this young. I am assuming that talking or behavior therapy were not offered although I may be incorrect.
The whole story is important as another example of "who's to blame." Psychiatrists that prescribe medications not approved for children are taking a big risk with their patients. Still, as the expert from Boston argued, something needs to be done now and not always when all the data is in. I would argue that as long as patients can appreciate the risks and controversy, they can at least make informed decisions. If the doctor feels that he would proceed with the treatment in his/her own children, it is a viable option. All of the options take time to explain however, and not everyone can understand things quickly.
My position is to wait after explaining my perspective for up to a week until the parents or patient can digest the discussion and return to ask further questions. The risk of treatment must be less than the risk of the condition at least. All of this takes time, and many doctors are asked to see patients quickly to cut costs and see more patients, encouraged by the insurance companies so they can make more money or control care. Most insurers will pay for 15 minutes of a psychiatrists time and make the doctor jump through lots of hoops if he or she would like more time to talk to the patient. It is the principle reason I have gone into a practice where the shortest visit is 30 minutes and I usually recommend 1 hour. I don't call my sessions medication management either. The sessions are to discuss psychiatric management, talking therapy and other options. Not just medications. Medications are an important aspect of treatment when it is necessary, although it can't be the only approach to consider.
It was not emphasized in the show, although hurrying lends itself to making mistakes in psychiatry and other branches of medicine. This perspective may not be a factor in this tragedy, although I would be surprised if it didn't play some role. With more time to talk to the parents, consider other approaches and diagnoses, maybe this tragedy might have been averted. It is not to blame anyone, just to offer another explanation for what happened to a little girl, that is now not with us anymore. Too much emphasis on using medications and not enough time to assess patients. Like all tragedies, there are many factors that must come together for it to occur. Let me know what you think as I don't intend to blame anyone.
2 comments:
Devastating....
I wish that someone could explain to me how you can even make a diagnosis of Bipolar Disorder in a three year old. I don't get that. I think many people are looking for a label and a quick fix and our society delivers both of those readily, especially with children.
Using my own experiences with the Canadian medical system, which is different than in the US of course, I can honestly say that 15 minutes is not long enough to discuss a wart on your finger let alone some kind of behaviour or psychiatric problem.
I think most psychiatrists up here that I have seen are careful, when you are in their office but obviously with the number of patients they see how can it really work?
I would even go so far as to question whether a child should be prescribed medication for something like Bipolar Disorder without first really trying the alternatives. We are all lulled into thinking that the meds are safe and effective...I don't know...read the cautions and the lists of side effects. My favorite was one that listed "sudden death" as a possibility. At the time, being suicidal, that didn't bother me much.
I have one child that may be experiencing mood problems closely related to my own. Medication will not be an option for him at all until he is old enough to make an informed choice and I am satisfied that the problems are not behavioural. There is no blood test for Bipolar Disorder, and how you get an objective picture of what is truly going on with mental illness in children is beyond my comprehension. That is only my personal view, having been on several of the medications myself.
I truly beleive that most people are born well. I have always wondered how psychiatry looks upon the population, as well or sick. Three years old is really young, was the time taken to explore the home life and caregiving skills of the parents? How do you do this in 15 minutes? I wish the insurance companies understood this.
Psychotherapy....if this is truly being delivered by a psychiatrist then time is required. I see a psychologist instead as they design their practices for this time. 1.5 hour sessions are not unusual and group work can be up to three hours or be in the form of workshops. I just don't see how, whether Canadain or in the US any psychiatrist can devote that kind of time and energy to one patient given how the system is structured.
My psychiatrist, as well meaning as he was, even with one hour sessions, prescribed medication that rendered my suicidal. He had no time to follow up propely, even when I had legitimate questions about the meds, vitamin defficiancies created by the meds and interactions. I had to diagnose myself, something I can do because of my background in research biology. Most people can't do this and I am not sure that anyone should have to.
I have nothing but compassion for the parentls in this case and for the psychiatrist as it is a terrible way to develop an awareness around the system, the drugs and limitations.
About change: if the medical proffession truly wants to see change they can make it happen. To use the situation politically is one thing but to truly effect change one has to act.
I blame no one and I blame everyone for that little girls death. Her death says a lot about our society as a whole.
I could not agree more. Thanks for your perspective. We need to spend time and consider options other than medication first.
Post a Comment