Health and Medical News and Resources

General interest items edited by Janice Flahiff

Why clinical decision making in psychiatry is difficult

English: medications

English: medications (Photo credit: Wikipedia)


From the post by JULIA FRANK, MD on October 17th, 2012 at


All psychiatrists do is push drugs!”

I have heard this repeatedly, from students, wary patients, even family members who don’t pick up on a carefully worded hint that they just might benefit from getting help.  For some reason, no one makes the same complaint about infectious disease specialists, or oncologists, though I wager that the success rates of our drug treatments are roughly equivalent.


As a psychiatrist, I try to treat people with diseases, not diseases that happen to occur in people, but combining drugs with other modes of therapy requires a daily, even hourly balancing act. Add the effects of pharmaceutical marketing, especially direct to consumer advertising (followed by direct potential litigant recruitment)–some days I don’t want to get out of bed.

Beyond a general temptation to rely on drugs as the primary mode of treatment, psychiatrists feel particularly pressed to use the newest, most expensive drug. Many psychiatric patients receive their care in publicly funded clinics, under excruciatingly tight budgets. Having free samples to distribute allows us to provide a few patients with high end drugs. Clinical decision making in psychiatry is difficult because of our lack of objective measures of response. Newer psychotropic medicines do sometimes work where older ones have failed. The side effects of newer medications typically differ from those of older ones, though the overall burden of adverse consequences is arguably the same. These background forces are invisible. In the clinical moment, the selection of a particular remedy is often based more on nonmedical influences—the patient’s response to advertising, the clinic’s necessary concern with costs—than upon the prescribing professional’s careful assessment and detailed discussion with a patient.

Aggressive pharmaceutical marketing has exacerbated the problem of responsible prescribing…


Although radical reform is still a long way off, section 6002 of the Patient Protection Affordable Care Act requires manufacturers of drugs, devices, supplies and biological materials that are covered under various federal health programs to disclose on an annual basis the payments (of various kinds) they have made to physicians and teaching hospitals.



October 18, 2012 - Posted by | health care, Psychiatry | ,

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