Trust Issues

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“Doc! His wife is on the phone, screaming obscenities, and says wants to talk to you. Apparently he tried killing himself last night.”

Oh, no…

I was wary. 

She was not my patient. They were in the midst of a bitter, ultra nasty divorce. I could not share information with her. Why was she calling? 

There had to be an ulterior motive.

“Please find out what she wants.” I did not want to talk to the woman if I could avoid it.

A few minutes passed while I worked on other patient medication refills. Eventually the secretary stuck her head into my office.

“Uh, doc? She says she is going to sue you for malpractice.” My heart started pounding.

“Really? Why?”

“She says you are responsible for her husband’s attempted suicide because of the medication you prescribed….”

Right. 

And the accusations, since dismissed by the court, that he was molesting the children had nothing to so with it? The revelation that she had had sex with other men repeatedly in the bed she shared with him did not affect him one iota? And the newest allegations of marital rape held no sway over his state of mind?

His life was falling apart when he came to see me. He was at risk of losing his job, his kids, everything. I had known him for a couple of years, watched him get married and become a wonderful young man and father. He was broken that day. He sobbed, begging me to help him.

We picked an SSRI. I don’t remember if it was Paxil or something else.

At the time I told him that he had to also start counseling and he would have to return to see me in two weeks time. 

Now this.

I sat in my office knowing I had done the best that I could but not being able to shake the feeling of guilt, nonetheless. Was it the drug? Did I do something wrong? 

He survived but he was not the only one with this story. I saw it with other drugs in this class. It has since become a well established fact that these medications cause an increased risk of suicide in teenagers and young adults.

Then, this article came out last week in the Atlantic. The data from a 2001 clinical trial paid for by Glaxo, the pharmaceutical company marketing the drug Paxil, was reexamined and showed that not only was Paxil not effective, it was not safe. The increased risk of suicide was hidden, labeling it as other less serious side effects.

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98 thoughts on “Trust Issues

  1. There are certainly trust issues with so many of these drugs. The pharmaceutical folks need to be more transparent. I know of several young folks who were negatively affected by so-called therapeutic Rx’s. The suicide risk has been real for some time now. Tragic. These are the patients who don’t need further complications from medicine. Thanks, Doc.

    Liked by 1 person

  2. Oh lord, I often wonder about the truthfulness of some drug applications. So much interpretation of testing results is subjective. Paxil has been well received too – generating over $1 billion per year in revenue – bastards. You know when deliberate decisions are made to harm people for profits, the executives should be subject to the same laws as other murderers – life imprisonment or death, depending on the jurisdiction. I hate that about our legal system – white collar workers often get away with harming others deliberately for profit.

    I am so, so sorry Victo, that you prescribed the medication in good faith only to discover it was harmful. That must really shake your faith in the drug companies. Never mind the poor bastard who got it and had his problems compounded instead of ameliorated. Bastards, bastards, bastards.

    Anyway, so not your fault Victo – you acted in good faith – let the perpetrators pay for their indiscretions.

    Liked by 1 person

  3. 😦 How sad, for me personally, sad that we rely so heavily on medication thinking it will solve all the issues. How sad to feel so helpless. How sad we we as society do not have proper community support. I am watching with horror as a myriad of doctors are evaluating a 10 year old girl in my extended family, who is going through a very hard due to issues in the family. She will most likely be on a drug that will ease the symptoms on the outside, but deep inside – the pain does not change, but bursts through other venues. 😦 Sorry you have to be in the middle of a really bad system.

    Liked by 3 people

  4. I feel for you. When I was working as a therapist, I would often have spouses or other family members try to talk to me. If I didn’t have that essential piece of paper known as a consent for exchange of information, OR the if my client wasn’t in immediate danger of harming him/herself or others, it was a “no go.” I would get, “But I’m his wife!” (Usually in passionate indignation.) I would have to say I know that and if your husband (or wife, son, daughter…) wants to sign a release, we will talk then. It is never easy. Then there are the times people threaten to sue. Sad to say, you always have to review your chart at that point. Taking care of people is risky business.
    Then there’s this matter of pharmaceutical companies lying or playing down risks. The makers of Simbalta did a similar thing. I don’t know if they ever got fined for it. Wouldn’t it be nice if people could just act with integrity!
    There are countless studies out to show that just therapy or just meds are not nearly as effective as the combination of the two. I do know people who take a natural approach. Many are very successful. ST. John’s Wart is second to none when it comes to treating moderate depression. IT does have some side effects and contraindications, but probably not as serious as some of the meds out there.

    I retired from mental health practice 3.5 years ago; I’m not sorry: It’s good to be out of the fray.

    You likely did nothing wrong with this gentleman. It does make people feel better if they can put the blame on you. Keep taking good care of people.

    Liked by 1 person

  5. I was prescribed Paxil in sixth grade for depression. I may have lasted 1 week, maybe 1 1/2. I hated it! I was more depressed on it (if possible). For me though, it was th tiredness. I couldn’t stop yawning (not exaggerating. There was a class I liked where the teacher commented about me finding her class so boring because of the constant yawning. I told her it was a medication I was on,but I don’t think she believed me. I was slugging around not able to focus or pay attention to anything or anyone. I struggle with constant fatigue, but that was a new level I hadn’t realized existed.

    Liked by 1 person

    • I have patients that did seem to benefit from Paxil and other meds in the drug class. Some didn’t. Everyone is different. We metabolize things differently and experience different side effects. Stuff like this makes me question everything, though.

      Like

  6. Oh boy. Have you heard of the major lawsuits around resperidal? (Sp?) The more I read, learn and see, the I’m convinced that medical marijauna is much safer. I don’t use it. Have tried it but I don’t like it. Ha!

    Liked by 1 person

  7. Drug companies are not the only to blame here. People demand a magic pill. Working through issues with Cognitive Based Therapy takes work. More work than most people want to do. And sometimes, there is no fix. Just a reality check in the end and no relief of pain. That is what people want. The want to swallow something to make the pain go away. And with all magick, there is a cost…a price you pay. its called side effects.
    Drug companies spew their chemicals out because people demand it. “Make me skinny, make me happy, make me well.” People will pay for those little white pills with the hope of salvation.
    Having said that, the government is supposed to protect us…its called the FDA…I think we will look back and see so many future revelations that this drug caused this mutant strain of disease and so on….. Much like back in the 50’s when they prescribed a drug to prevent miscarriages, and then the next lineage came out sterile. (raising hand)
    I believe more in the properties of herbs and plants, but I do not know enough about it all. I also believe in other alternative therapies that are not evasive, like healing touch and aromatherapy.
    But I am also grateful for the modern knowledge and medicines out there. They keep me moving. My last shot was with a new product and every time I try something new, it comes with a cost. This one cause a reaction of elevating my blood pressure (190/94) and remained high for three weeks. Not sure what else was damaged,….like my heart. Still running tests. It was a risk, I knew it going in and I took it. Not going to blame anyone. it is what it is.

    Liked by 1 person

  8. I just heard this report on the news today. It was a lengthy report, for radio news, and even-handed. My mother was prescribed the drug, but after a couple of years (!) decided she didn’t want to be on it. So, she stopped taking it without telling anyone. We landed in the ER with that one, but no permanent harm was done. She went off the drug, too, and found herself feeling much better without it.

    Liked by 1 person

  9. 1) On behalf of every secretary who has had to take those calls because the boss doesn’t want to deal with it…. um, thanks. 😛
    2) Thank god for HIPAA which sometimes helps get us out of these messes. Not your patient? Sorry, can’t talk about it with you.
    3) As far as the SSRI? You did your best. You can only do so much.

    I wrote on Carrie’s blog just the other day that Big Pharm is not our friend. Who here is shocked that drug reports are if-y? Really? Anyone have their hand up? I am not a conspiracy buff, but the USDA is not there to protect us, either.

    Don’t beat yourself up. In two months there will be another report, another study, that contradicts all of it again.

    I do hope your patient is ok.

    Liked by 1 person

    • I thought about you as I was typing this story. “I wonder what Laura will say about taking that phone call?” ;-P Yes, HIPAA can be a pain in the backside sometimes but it can work for us, too. Drug studies are silliness. That is becoming increasingly clear. I really did have faith in the process once. Now? Not so much.

      Like

      • I am not going to “like” this comment, because it is sad, aggravating, frustrating and so much more when good people get disillusioned, get their fires doused, and just get tired of the constant battle of that nameless, faceless “system”. I know you’re still in there swinging, but I also know (through reading your words) that it comes at a cost.

        (On the lighter side, yeah… fielding icky calls for the doctors….why we make the big bucks.)

        Liked by 1 person

  10. Take it frm someone who was suicidal, and still takes meds for depression and anxiety, nothing you did or dn’t do would have stopped him if he made up his mind. Let go of guilt. You are not to blame.

    Fondly,
    Elizabeth

    Liked by 1 person

  11. I have done a lot of research on this issue. The one statistic that I recall is that, after the boxed warning significantly cut the number of young adults and adolescents treated with SSRIs, the suicide rate WENT UP 18%. It gives me pause.

    Liked by 1 person

    • Here is a link to a summary of that data in case anyone wants to read it: https://www.afsp.org/news-events/in-the-news/op-ed-black-box-warning It is critical for physicians to be able to know about side effects in order to adequately counsel patients about the risks. To hide that is criminal. I have that suicide risk talk with all of my patients now. But you can bet if someone walks into my office like that, they still get a prescription for a medication and a referral for counseling. A similar backlash occurred after the WHI study showed an increase in heart disease, strokes, Alzheimer’s, and breast cancer associated with hormone replacement therapy. All of a sudden doctors everywhere were ripping little old ladies off of their lifelong HRTs and 80 year olds were going through menopausal hot flashes and mood changes. All because the rate of these issues increased from 4 in 10,000 people to 6 in 10,000 people.

      Liked by 2 people

      • The response from providers mystified me. Read the study. Talk to your patients about the risks. If the benefit outweighs the risk, then the choice is obvious. None of that was happening. The news reports didn’t help. 50% increased risk sound much more sensational and alarming than going from 4 to 6 in 10,000 people….

        Liked by 1 person

  12. I am a psychologist and have seen these SSRIs and SNRIs not work well. I cannot prescribe, but I talk to all my patients about their medications. That’s part of my job. I work a lot with people with trauma and sometimes I have seen doctors prescribe naltexone for PTSD and that seems to work better. There is also genetic testing that can be done to help doctors determine which psychiatric medications work best for a particular patient and THEN the patient gets better quicker. Also, that genetic testing is covered by most insurances. Just my 2 cents worth at 0630.

    Liked by 1 person

  13. For what it’s worth, I have no trouble believing that The Constant Gardener is a true story. There is scant morality in drugs marketing.

    As a doctor, all you can do is your best, which you did. Try not to beat yourself up. Take care and God bless.

    MTM

    Liked by 1 person

  14. It’s really hard to *like* this story. I wish this was an isolated case, but it’s not. The carelessness and outright deception used in the presentation of research data is frightening. I hadn’t considered it from the doctor’s perspective though. The implications for you would be horrible.

    Liked by 1 person

  15. Pingback: Trust | Mark Bialczak

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