I'm Back...
Let me start this blog with a statement from a recent CNN story on prescription drug abuse (http://www.cnn.com/2012/11/14/health/gupta-accidental-overdose). In the United States, we now prescribe enough pain pills to give every man, woman and child one every four hours, around the clock, for three weeks.
We have a population of 311 million people – you do the math. (Don’t bother, I already have. The number is: 39,186,000,000 billion).
This is just the pain-killers.
Why? I feel in large part this is due to the limited training our physicians are receiving in medical schools across the country on mental health and particularly with regards to addictions. Having been a preceptor for a medical school in the Boston area I can tell you first hand that the training is roughly thirty hours. Yup, that’s right thirty hours with most of that academic rather than clinical with patients. Ask them the next time you see them. I feel confident their answer will blow you away.
Not to mention the number of patients PCP’s see every day in order for their practice to survive.
Do you really want your PCP to be prescribing you a psycho-active prescription with that limited a background?
The insurers may think this is fine. I mean, after all, the person is an M.D. right? The real reason they do not mind this practice is that it saves them the cost of having the person referred to a specialist, a psychiatrist, a psych nurse practitioner.
Even in the case of say, anti-depressants, are you making sure they are connected to a therapist? It might be nice if they have an unbiased person that can detect changes from appointment to appointment (for better or for worse).
I am sitting in a conference right now being put on by Harvard Medical School in conjunction with the world renowned McLean Hospital and they are espousing the view that PCP’s do not get enough education on addiction and mental health (I’m on my lunch break, don’t worry, lol).
Soooo, what are we going to do about this????
In the case of PCP’s prescribing psycho-active drugs I would like to see an across-the-board policy whereby before writing ‘said script,’ the patient is given a urine tox screen. Does it not make sense to see what if anything is already on board and the amount? By doing this across-the-board one would find it difficult to claim they are being discriminated against due to a past or current addiction history. Scripts would be for one month at a time with a new tox screen being done before a new script is given. Scripts would be for one month at a time.
The prescribing PCP at the time of the first script would provide the patient with numbers and agencies where they can obtain a therapist.
Before the next script could be written (second one) the patient would be required to provide proof they are currently in therapy. The patient would have to have signed releases so both therapist and prescriber can communicate and update each other.
