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?

Does Technology Improve Healthcare or Access?

Does Technology Improve Healthcare or Access?

This article  (1) stirs my mind. By itself, it is food for thought about the future of American healthcare and the future of those unable to access advanced technology because of insurance coverage.

In the US healthcare arena, Medicare is the gold standard. Being the largest payer, as well as the Government, Medicare dictates what is covered and what is not.

Commercial insurers either try to meet Medicare standards or exceed them, to compete in providing health coverage to employers.

Access to advanced technology that is changing healthcare, allowing it to be delivered anywhere, is not available to everyone with insurance.

The elderly who are on Medicare have the worst coverage, with most of this advanced technology that is beneficial to them not covered. No coverage means no access. Medicare sets the standard for coverage of healthcare services.

Others who do not benefit from advanced technology that is transforming medicine, moving it to the communities where outcomes are determined, are Black & Brown communities. Impoverished neighborhoods in urban areas.

Only recently did Medicare lift the limitation on telemedicine to include care in patient homes. Still Most Black & Brown communities do not receive such access to telemedicine, where transportation limitations can make doctor office visits a hardship.

The above is an example of structural racism. In addition, Black & Brown community hospitals are under-staffed and the staff poorly screened. As well as not offering many technologies available in rural hospitals, such as telemedicine in the home. Other limitations include Black & Brown communities still lacking smart phones, which could deliver such services.

[ What is the penetration rate of smart phones in Black communities?  Anyone know?]

Doctors are leaving impoverished, homeless, mentally ill and Black & Brown communities behind. Without access to immediate life saving measures these communities are dying off. Infant mortality rates for Black women, despite income, are similar to that of a developing nation. Infant mortality is a standard indicator of health.

We need doctors to advocate policies that benefit patients and not drug and medical device companies. Doctors also need to stop letting insurance companies dictate patient care.

Please do share your thoughts.

  1. New Rules For Our Health’s Digital Future

    http://techcrunch.com/2016/01/02/new-rules-for-our-healths-digital-future/?ncid=tcdaily

Second Part in Series on How Doctors Kill Patients


Part One:  FFT: Are White doctors misdiagnosing Black patients? https://failuretolisten.com/2015/12/29/fft-are-white-doctors-misdiagnosing-black-patients/