Forensic Shopping Investigation IV: Buying Happy

Posted Feb 16 in Work tagged , , ,

Ever wondered how hard it is to get some antidepressants from a Doctor? Do you have to be referred to a psychiatrist? Do you have to see the Doctor a few times? Anti-depressants, I always thought were the last line of defence against depression, the most invasive of remedies, only prescribed after careful consultation and assessment. I was wrong – very wrong. It took me just 8 minutes and 32 dollars, with a GP I had never met before. I find this staggering, here’s what happened on Forensic Shopping Investigation IV.

I walk into a bulk-billing doctor at 8.45pm, after a quick wait I’m called into his office. I walk in looking rather dishevelled – my normal self, in my normal clothes, but very unkempt. The Doctor is a skinny, quiet, polite, and somewhat disinterested character. What follows is both hilarious and scary, and best captured in script form. To really understand what actually happened I suggest you mimic the Doctors behaviour, and finger type each of my answers into your computer before asking the next question. Also if you can, imagine the Doctor asking most of the questions whilst looking at his computer – not me.

Dr: What can I do for you?

Fritz: I’m depressed. I have been for a few years, and I want to go onto medication.

Dr: (type, type type) Do you cry?

Fritz: (Slightly startled, as it’s a pretty weird follow up question) Ummm, yes.

Dr: (type, type type) How often, every day?

Fritz: Often.

Dr: (type, type type) Is there a reason why….is there a history of mental illness in your family?

Fritz: No.

Dr: (type, type) Are you paranoid? Do you hear voices?

Fritz: No. I am not crazy.

Dr: (type, type type) Have you received treatment in the past?

Fritz: I saw a psychologist a few years ago, but I haven’t had medication.

Dr: (type, type type) You definitely need medication.

Fritz: And there you have it. I have no idea why he came to that conclusion. I didn’t ask, and he didn’t tell me. I am stunned and find it incredulous. I don’t say anything and the Dr continues as he prepares the script.

Dr: I want you to take one of these every day and come and see me again in one week. We will then create a mental health plan. We will refer you to a psychologist.

He gave me a script, said a few reassuring nothings and then I was out the door. So if you want to get your hands on some ‘Efexor-XR’ and you’ve got 10 minutes to spare you too can have some. No referral to a psychiatrist. No assessment for self-harm or suicide. No assessment of immediate stressors or immediate action needed. No investigations into possible less invasive treatments. No assessment of social supports in my life. No assessment of another possible diagnosis.(i.e. manic episodes, anxiety). No assessment as to if I needed drugs or not. No challenge to my desire to get drugs. No interest as to why I thoughts drugs were the answer. No explanation how the drugs prescribed work. No explanation as to the impact or side effects of the prescribed drugs (which wiki lists as; Hypertension, Vivid/Abnormal dreams, Akathisia, Decreased libido, Apathy, Constipation, Headache, Nausea, Insomnia, Sexual dysfunction, Dry mouth, Dizziness, Sweating, Decreased Appetite, Abnormal ejaculation, Irritable Bowel Syndrome, Fatigue, Vertigo). This appears to be utterly crap health care.

I am not against anti-depressants, they help some people, some of the time (although based on this experience it’s likely they are massively over-prescribed). Nor am I against Doctors (of the MBBS kind), although I find it weird that they are the only profession in the world that is not expected to manage their diary properly – why do they always keep us waiting? Further, I have nothing against the individual Doctor I saw – it’s not his fault – he was doing the best he could, and seemed pleasant enough. However, my issue with what happened is simple ‘quality control’. Mental health is a serious, delicate issue, and ideally would be assessed and managed in a professional, respectful manner. What I experienced was totally inadequate. Putting someone on anti-depressant medication so easily, so flippantly, isn’t right. Anti-depressants should be seen closer to a last resort, rather than happy pills given to anyone who asks. Once on anti-depressants it can be difficult to come off them. Further, they may not treat the underlying cause of the depression. Again, it’s not that they are all bad, it’s just that they can be good, or very, very harmful – and should only be prescribed with utmost care.

Everyone from fast food chains, to banks, to my local café have actions in place to ensure there is a quality service delivered to its clients. They conduct mystery shopping. They conduct market research. They incentivise their staff when they perform the service in the right manner. What does the Australian Medical Association (AMA) do to ensure, once educated, Doctors deliver a quality service – do they do market research? Do they conduct mystery shopping? Do they incentivise Doctors on quality of service? Whatever they do – it wasn’t working when I saw the doctor.

I’m not depressed, and I haven’t been for many years. Based on my experiences tonight I consider myself very lucky.


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Comments

  1. thewinchester

    Feb 17th, 2010

    As a long-term sufferer of a mental health condition and has taken the time to properly understand it, I'm utterly disgusted at this GP's poor diagnostic practices in relation to depression.

    The number and types of 'probing' questions asked would not have been sufficient to achieve an appropriate diagnosis of any mental health condition listed within DSM-IV or ICD-10 Chapter V.

    I personally would consider his prescription of Schedule 4 drug in such a lax manner to be a potential breach of law, let alone basic duty of care towards the patient.

    Also, as a mystery shopper with significant years on the trot and a wide group of contacts spread across Australia who are in the now, I'm confident in stating categorically that at least in the last five years no portion of the medical industry has conducted any form of mystery shopping, experience evaluation or similar on the medical profession.

  2. Bowan

    Feb 17th, 2010

    Sweet jesus that is scary. He probably hasn't even looked at a DSM IV in his life.

  3. Fritz Bachen

    Feb 20th, 2010

    @thewinchester thank you for your contribution. What was interesting was that teh actual Doctor was a nice chap, and clearly trying to do his best – however, he obviously had no idea what-so-ever in what to do. Unfortunately, however I have to agree with Bowan – if he was familiar with the DSM-IV he certainly wasnt putting it into practice.

  4. Anonymous

    Feb 21st, 2010

    This really upsets me. So few doctors know what they are talking about and we had a culture that revered them – although thats rapidly changing.

  5. Jeremy B.

    Feb 21st, 2010

    Fritz – as always your Forensic Shopping is simple and brilliant. Although – one small thing – doctors don't create waiting; unplanned sickness creates necessary delays and poor office management create unnecessary ones (we have to wait for planes too)

  6. Anonymous

    Feb 22nd, 2010

    Criminal behaviour?

  7. Mac

    Feb 22nd, 2010

    The oddest thing about this is the question 'Are you paranoid?'.

    Is that seriously a good way of finding out if someone suffers from paranoia ? I'm not an expert but the few people who I've known who suffered from it wouldn't have thought they were paranoid … they just saw conspiracies everywhere.

    I know it's trendy to sneer at the Rorschach tests now, but that was one of the advantages.

    If someone looked at one of the inkblots and describes it as " a face and it's looking at me. It doesn't like me" you can be pretty sure that they are paranoid.

    The alternative way (asking "Do you think people talk about you when you aren't there? Do you think they are out to get you?") doesn't always work.

    Look at Richard Feynman's experience at getting diagnosed as paranoid:

    "Do you think people talk about you?" he asks, in a low, serious tone.

    I light up and say, "Sure! When I go home, my mother often tells me how she was telling her friends about me." He isn't listening to the explanation; instead, he's writing something down on my paper.

    Then again, in a low, serious tone, he says, "Do you think people stare at you?"

    I'm all ready to say no, when he says, ''For instance, do you think any of the boys waiting on the benches are staring at you now?"

    While I had been waiting to talk to the psychiatrist, I had noticed there were about twelve guys on the benches waiting for the three psychiatrists, and they've got nothing else to look at, so I divide twelve by three — that makes four each — but I'm conservative, so I say, "Yeah, maybe two of them are looking at us."
    He says, "Well just turn around and look" — and he's not even bothering to look himself!

    So I turn around, and sure enough, two guys are looking. So I point to them and I say, "Yeah — there's that guy, and that guy over there looking at us." Of course, when I'm turned around and pointing like that, other guys start to look at us, so I say, "Now him, and those two over there — and now the whole bunch."

    He still doesn't look up to check. He's busy writing more things on my paper.

  8. @BenDawe

    Feb 25th, 2010

    Thanks Fritz – this is a little scary.
    It reminds me of my dealings with a major bank. I wanted to borrow around 270K for renovations. I got the OK in one meeting and two follow up emails. I then contacted a friend who is in banking – he gave me a 20 minute dressing down about living beyond my means! The bank did not look hard at the servicability of the loan – only the value of our home. Not happy Jan!

  9. Fritz Bachen

    Feb 27th, 2010

    Jeremy B thanks – but I disagree – I think the wait is casued by financial greed, and cramming patients in rather than by medical emergencies. But I guess thats for another day.

    Mac – love it. You're right it was a very weird question – he just didnt know what to say.

    BenD perhaps for another day

  10. Anonymous

    Oct 19th, 2010

    I think easy access to antidepressants has a lot to do with the culture of medical litigation. Just say you were depressed and you committed suicide between your first and second appointment. Your family would try to sue the doctor for 'not doing anything'. Sure they may not win, but the emotional trauma caused by such an incident is just not worth it. Much easier to give the patient what they want and to be seen as 'doing something'. It's just the way the world works and as a health care professional, I always try to cover my backside. It's just a part of working in healthcare in 2010.

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