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Unread July 16th, 2004, 02:23 PM
JustBen JustBen is offline
Join Date: Jul 2004
Posts: 58
Default Do GP's Overprescribe?

I have friends and family members who've received SSRI prescriptions from their primary care physicians based on a twenty-second "diagnosis" -- which consisted of the doctor simply asking the patient if they felt sad. Unfortunately, I've heard this story too many times from too many people to believe that it's an isolated incident.

I support the idea of primary care physicians getting involved in their patients' mental health care, but am I alone in noticing that many of them seem desperately underqualified to do so? Does anyone else recognize the tendency for GPs to prescribe when they should refer? I have a relative that works in a Family Care office, and her impression is that the situation is widespread, and that it exists becase doctors simply don't have the time to diagnose correctly, and that they're heavily influenced by drug reps. Thoughts?
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Unread July 27th, 2004, 06:48 AM
James D James D is offline
Join Date: Jul 2004
Location: Australia
Posts: 8
Default Re: Do GP's Overprescribe?

Hi JustBen.
I've seen plenty of occasions where clients have been prescribed antidepressants and anxiolytics from their GP (physician) without adequate psychological assessment. There are lots of stories out there about prescriptions made for patients that lead to further problems (e.g. benzodiazepine dependence), reinforce the medical model of treatment (contra psychological intervention), and fail to enhance the individuals sense of self-efficacy. I always cringe when I see someone prescribed Xanax (alprazolam?) for example!
However, for all the questionable experiences/stories i'm sure there are GP's out there who do a really good job. I know that in Australia we have many GP education programs around mental health issues to attend to GP's knowledge and skill base.

A full psychological assessment by an appropriate professional is key, in my opinion. The program i'm involved in works with frequent users of the emergency department at 2 local hospitals. My role is to do psych assessments, collaborate with GP's and services already in place, make referrals to other service providers (e.g. psychiatrists), provide short term psych intervention if needed, etc. Hopefully this approach will reap rewards for all concerned.

GP's should certainly refer clients when the issues are significant. Many people with significant psychological distress don't come in contact with psychologists nor psychiatrists. Lots of these cases could be picked up in primary care, but if you don't ask then you won't find anything out. GP's are in a prime position to pick up on a range of disorders, after all they're the front line workers. So hopefully GP education and increased collaboration with mental health workers will help the situation.

As for the power of the drug companies......... well advertising works doesn't it! From previous work I have seen prescriptions for certain antidepressants come in waves. Could be a figment of my imagination! I'm sure the drug companies would have the stats to say whether their influence works. No doubt it does cos they keep on advertising, putting on lunches and handing out free pens! I understand antidepressant use is climbing all the time.........

All factors, like brief consultation times, education, advertising, etc have an influence on GP prescribing.
The answer??? Only psychiatrists can prescribe psychotropic medication?? Only physicians with special mental health training can prescribe?? Other physicians can only prescribe after consultation with psychologist/psychiatrist?? Or is prescribing to too many better than prescribing to too few??

Its beneficial to use professional expertise whenever possible and not overstep boundaries. I'm not about to do a heart transplant after all!
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Unread July 27th, 2004, 08:32 AM
JustBen JustBen is offline
Join Date: Jul 2004
Posts: 58
Default Re: Do GP's Overprescribe?

Thanks for your response, James. A lot of people read my original post, but I was starting to wonder if anyone was going to respond. As you point out, "full psychological assessment by an appropriate professional is key" and to my mind, that ought to be stressed in the GP education programs. Most GPs, after all, have no problem referring to cardiologists or gynecologists, but when the problem is psychological in nature, many GPs feel perfectly comfortable pulling out the prescription pad instead. I wouldn't take away psychotropic prescription priveleges for GPs, but I would make it clear that in most cases treatment of mental disorders is beyond their scope, and that they should refer rather than prescribe.
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Unread December 24th, 2004, 03:12 PM
Joel Pomerantz Joel Pomerantz is offline
Join Date: Dec 2004
Posts: 7
Default Re: Do GP's Overprescribe?

I know a GP (pediatrician) in my city who only prescribes stimulant medication to treat ADHD if the parents and teachers involved commit to a rather sophisticated double-blind study where the medication is interspersed with placebos over the course of a month or so and the parents and teachers fill out rating scales every step of the way! I have a lot of confidence in working with this doctor- unfortunately most do not have the patience or time or skill to be so thorough and rigorous- and that does worry me. The one thing about stimulants is that despite what the naysayers say- their actual safety record is pretty darn good - much more is known than say, about the relatively new SSRI's especially in regards to the effects on kids...
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Unread January 2nd, 2005, 07:53 PM
George Neeson George Neeson is offline
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Join Date: Jul 2004
Location: Elizabethtown, Ontario, Canada
Posts: 195
Default Re: Do GP's Overprescribe?

Yes they do over medicate and it is not just GP's please. The people most guilty of drug over use are psychiatrists (not all) who use SSRI's, SRNRI's and benzodiazapines like candy. Let me also tell you that the medical profession and the drug industry will also not inform the patient that many SSRI's appear to be "addicting" (a lot of side effects when withdrawn) and that they work by decreasing all affect (good and bad feelings) putting the patient in a chemicaly induced oblivion. These drugs should be used with great care and for much shorter time periods and not just to relieve a period of necessary human distress that follows naturally from various life situations. I do not know if a true "cost effectiveness study" even could be done that would take into account the cost of the medications, reduced productivity, increased accident rates (as in motor vehicle accidents), and continuance of the symptom manifestation because the root problem is not addressed ... it is just held over until the next occasion when the inferiority feeling vibrates (from an Adlerian perspective). There is a much more carefully limited use for some of these drugs but have you ever seen a rage reaction in an angry depressed person on an SSRI such as is being reported at this time with reference to Prozac?
George Neeson M.D.
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