IT’S NOT ALWAYS DEPRESSION!

IT’S NOT ALWAYS DEPRESSION!

Diminished activity, fatigue, weight gain and little interest in activities that once brought delight.

With normal laboratory findings, most doctors would diagnose depression.

It’s not always depression!

Other physical ailments presenting similarly make the history and physical pertinent, as well as understanding culture and the differences in the clinical narrative due to culture.

To simply say it is depression, without a thorough review of all symptoms, is to jeopardize the health of patients. Plus not appreciate the impact of culture on health outcomes.

Unfortunately, nowadays, that is the case. Most doctors don’t dig deeper and many have forgotten the relevance of a good history and physical. The latter now relegated to cursory scope on the chest and back.

Such is the state of medicine today in the United States! I know because I have been a physician for all my career.

The above symptoms are actually due to visual problems. Mine!

Diminished vision can affect ones ability to function. Presenting similar to depression as well as leading to secondary complications of depression.

[ Link to Visual problems http://www.health.harvard.edu/newsletter_article/the-quirky-brain-how-depression-may-alter-visual-perception ]

By not recognizing the primary problem as visual, misdiagnosis and unnecessary medications follow, as well as deterioration in vision and functional capacity.

Unfortunately, the medical textbooks do not tell doctors this. Many lazily believe those symptoms signal depression until stated otherwise, despite the fact that depression is a diagnosis made after other illnesses are excluded. This is not done, hence the massive over-prescribing of antidepressants.

[ Link with data http://www.drugwatch.com/2015/07/29/drug-abuse-in-america/ ]

Patients typically tell their stories to non-doctors at least 2 to 4 times before they see an actual physician. (And in many poor communities patients will not visit or see their doctor.) Still the narrative and details charted rarely reflect the patient’s complaints, leading to misdiagnosis. Here repetition of the patient’s history does not breed knowledge or accuracy.

Why does this happen?

In a nutshell, over reliance on technology to make the diagnosis compounded by a bureaucratic and arcane workflow. Also treating symptoms while ignoring the root cause.

Medical staff are often under-trained and over-worked. The importance of accurate charting (of the patient’s narrative) lost in time, ignorance and even arrogance.

The end result is this: many patients are over medicated and misdiagnosed.

The recent epidemic of opioid overdoses is an example where doctors treat symptoms without making diagnoses. Opioids were over prescribed, especially in Emergency Departments where toothaches were routinely treated with Penicillin and 15-30 pills of Percoset. Doctors became legalized drug dealers! One study showed in 2012, doctors prescribed enough narcotics for every person in the United States to have a 30 day supply.

Now the pendulum has swung in the opposite direction: pain is treated suspiciously. Everyone is an addict until proven otherwise.

What is the solution?

One solution is Community Medicine. Studies demonstrate that medical outcomes, or health outcomes, are determined in the community.

Over 50% of outcomes are determined in the community. That means lifestyle or culture is very important as well as the environment (which actually has a great impact on lifestyle) to managing diseases. Genetics accounted for 30% of health outcomes and a doctor’s office visit 15%.

Using technology to facilitate accurate diagnosis is good, but technology should not be the gold standard alone for diagnosing. The history and physical still remain pertinent and relevant. The absence of radiographic or laboratory findings does not exclude pathology.

Most importantly, doctors need to know the patient’s community, and be engaged with that circle, to understand and improve the health outcomes of their patients.

What do you think?

Do you have any other solutions?

Author: Angela Grant

I am a first generation Jamaican immigrant whose experiences and accomplishments were made possible by the courage, sacrifices and the heroic acts of many whose bodies have rotted away in unmarked graves. Those are my heroes. Their sacrifices and death paved the way for my children and I. Failure to Listen is a token of my eternal gratitude. Failure to Listen is a tribute those generations of unmarked graves occupied by people of all races whose ultimate sacrifice of life opened the door for me and others, THANK YOU. Failure to Listen https://failuretolisten.wordpress.com/ uses cultural lenses to appreciate and understand the relationships between current events and our values, beliefs and attitudes. Culture is everything without it we are nothing. Failure to Listen will take you on a journey to recognize the beauty of our differences as the seeds to creativity, innovation and resolving disparities. By sharing my personal and professional experiences, I hope to do justice to the perspectives of those who are rarely heard or listened to. This site is not to incite anger but rather to provoke thought. It is my hope that Failure to Listen will work to foster intergroup dialogues and motivate readers to step outside the box and get to know ALL PEOPLE. In the spirit of Martin Luther King, let's join hands and remember his famous speech about a dream... A small group of thoughtful people could change the world. Indeed, it's the only thing that ever has. -Margaret Mead

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