Physicians: Prescribing Less May Improve Outcomes

Feb. 23, 2011— -- With a few exceptions, when physicians talk, they recommend. Take this. Try that. They satisfy the expectation that automatically comes with a patient's visit or phone call. The physician is compelled to make a recommendation -- a pill, a device or a procedure. Both the physician and medical supplier financially benefit. But is your doctor's advice always in your best interest?

Not always.

In a 2000 JAMA publication, Julie Magno Zito of the University of Maryland and her coauthors stated that there had been an explosion in psychotropic prescriptions for pre-schoolers without adequate safety and long-term studies and generally without FDA approvals.

Dr. Joseph Coyle of Harvard Medical School editorialized on this "troubling change in practice."

Likewise, in a 2001 JAMA article, Dr. Chunliu Zhan of the Agency for Healthcare Research and Quality and his colleagues found that American elderly patients are often overly and inappropriately medicated.

And, there are medical errors. Reports from the Institute of Medicine and HealthGrades indicate that there have been 400,000 to 1.2 million error-induced deaths in the United States from 1996 to 2006.

Excessive medications and procedures, adverse events and medical errors are endemic to medicine. In the early 1990s, surgeons were encouraged to perform quadruple bypass surgery for heart disease. Recent studies now suggest the surgery was, in many cases, a waste of time and money, improving neither morbidity nor mortality.

Surgeons are not the only medical professionals who misdiagnose and perform unnecessary procedures. In fact, no one in the medical industry is a bigger offender when it comes to mistreatment than those of us in psychiatry.

With psychoactive diagnoses and medications, I'm currently seeing a trend among doctors prescribing adolescents with stimulants for bogus reports of ADD. In the most common occurrence, the doctor misses the diagnoses of daily marijuana abuse, alcohol abuse and oxycodone abuse.

Many doctors fail to perform a simple urine drug screen, treating instead the residual drug-related symptoms of inattention, lack of motivation, poor academic performance and forgetfulness with amphetamines, antidepressants or antipsychotics.

At worst, kids receive all three medications together, which is dangerous in immeasurable ways. This also happens to adults.