Rx for the right doc

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He just writes a syndicated newspaper column.  But this doc raises a critical issue when it comes to treating a mental health problem.

Peter Gott, M.D., isn’t a psychiatrist.  But in a recent column, a reader had been advised by his family doctor to take an antidepressant.  The reader worried about serious side effects.

Yes, Dr. Gott said, these medications, while generally safe,  have side effects, some unpleasant.    But before taking an antidepressant, the he advised the reader to consult a psychiatrist.  Why?  Because that specialist has lots more experience dealing with the side effects of these medications.

Maybe that’s not always the case.  After all, family doctors do regularly prescribe psychotropic medications.   Lots of them.  And people with depression, for example, more likely seek out the family doctor for help first.  So the family doctors aren’t lacking in experience.

There are two problems, though.   One is they don’t have the extensive training in a field that’s highly complex.  More important, they’re often so rushed, they don’t spend enough time with the patient to fully understand a patient’s mental health problems.

Research shows that family doctors miss a diagnosis of mental illness in about half the cases.  And when they get it right, they prescribe the wrong medication.  But the answer isn’t for the family doctor to routinely ship every person who seems depressed off to a psychiatrist.

A better approach comes from the University of Michigan’s Depression Center.  For the past year, the center has been overseeing a pilot program for family doctors in Flint, Michigan.   The program takes as a given the rush the typical general practitioner is to see each patient.  So this pilot program has assigned a nurse specialist to advise the family doctor and follow the patient’s treatment throughout its course.

If there’s a shortcoming to this program in Flint, it’s that so many people still fail to discuss mental health problems with the family doctor.  And they sure don’t want talk to a psychiatrist.   This powerful stigma means lots of people suffer when they could be helped.

But Dr. Gott’s open discussion of mental health is the sort of thing that can overcome the stigma.   Truly, there is help.

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