SSRIs and the PDR; doctor's smarts and training

agree, I 100% support universal health care or a public option

but I also support a patient deciding their health care path based on the advice of a doctor, unless there is a real danger involved - not a war on drugs type concern

 

Allergy meds, doctors did not believe how bad my hives were, I actually ended up being lucky and my hives were in full swing when I saw a doctor declining my meds on an actual visit, he took pictures and put in my file after that, but I had to beg to get my meds before that - because the doctor assumed I wanted them to get high or something, now I take a OTC and it works, but back then those did not exist, I took them prescription for a while, then they went OTC - best thing ever for me

I no longer have to convince a doctor I am telling the truth and need meds to get them, hoping they believe me

 

Fair enough, but one example can't be extended to a whole country. I'm talking about public health.
Some doctors are better than others, like in any profession. But if you encountered a biased doctor who made assumptions about you, it doesn't mean that the whole nation should have regulations that would allow people to bypass medical advice and self-medicate.

 

You were the one who brought up the war on drugs, not me. I said, licensing of medical professionals to issue prescriptions has preceded the "war on drugs" by centuries, as it is driven by different considerations.

 

if I pay you, you are only to be concerned with my health, not the public health and deny me drugs because you think I might just want them to abuse them because some in society might

sleeping pills would be an example as well, I tried to get them once, was denied, never tried again - but maybe someday I will doctor shop, but the whole process sucks, I hate the game, it's stupid

I speak from my own experiences, they are valid to me as they are real life

I also fear if I was in pain, a doctor may not prescribe pain pills, how would I prove I was in pain, would the doctor be more worried about the government or my pain? we hear cases where people are denied all the time - all because some in society abuse pain meds

 

Because many drugs are prescription because of the "war on drugs", be honest

if marijuana ever becomes legal here, I may try that as a sleeping pill as it would be easier to get then a sleeping pill, no permission needed

as you can see, I try to use OTC when possible, as it's just easier, even if a safer option may exist as prescription, it's just less hassle

 

True for when I am with my patient, but public health regulators have a job that is different than mine. And theirs makes sense, too.

Abuse of sleeping pills can be extremely harmful and can actually worsen insomnia. Not only they lead to tolerance, dependence, and fading effects with rebound insomnia, but the disruption in the sleep cycle and change in the kind of brain waves that the sleeping-pill induced sleep will have, can lead to other detrimental consequences. Confusion in the morning and falls have resulted in broken bones. Car crashes during morning commute with people under the residual influence of sleeping pills or having rebound REM bouts have killed people. Sleeping pills are a prime example of why these medications must remain prescription medications because self-medication with sleeping pills, very often leads to disaster.

My forty years of experiences with real patients are real life too.

This is true. The opiate crisis in America is a stain for the medical profession given that some doctors were accomplices in what big pharma did. And now there is a backlash that went too far in the other direction, like backlashes often do. I hope the pendulum will settle into a happy medium at some time in the future.

 

yes, and that is the advice you should give to your patients and if they still want to take them, they should be able too

your assumption that all people will abuse them is wrong, let them try them, if they work great, if not, they see you again and ask to try something else

at least you're admitting things can go to far in denying medications

 

The vast, vast, vast, vast majority of drugs that are prescription have NOTHING to do with the "war on drugs" as they are not drugs of abuse, but simply, powerful medications with significant side effects and meant to treat diseases that are complex enough that lay people would be utterly unable to successfully self-medicate with.

What you said is precisely why I say that regulation is needed. A lot of people would go for the self-medication "less hassle" option if you made a doctor visit optional.

 

and those drugs that should be prescription I have no issues with, the many that should not be prescription is where the issue is

if someone wanted to take a chemo drug just because for example, I can see that being regulated and denied

getting the meds you need should not be a hassle, you should not have to beg your doctor for them, that is my point, your driving people to do that, find alternatives that are less hassle

I pay people like you for advice, not to have to beg and pled for you to help me

when a doctor refuses to help someone or makes it too much of a hassle, they will search for alternatives

 

Again YOU are making assumptions about me and putting words in my mouth. Please quote the specific part where I said that ALL people will abuse them. You can't because I never said it; I merely pointed to the detrimental consequences. While this discussion is interesting, I'm growing frustrated with you putting words in my mouth.

 

Your idea of what should or should not be over-the-counter differs than mine. Like I said, I've seen too many people damaging their kidneys because they self-medicate with a lot of ibuprofen for minor joint pain without being aware that NSAIDS (the class of medications to which ibuprofen belongs) are pretty much poison for kidneys. Our list of OTC medications if anything is too generous and exposes people to unnecessary risks. If you make sleeping pills OTC too, I guarantee that the issue of insomnia will get worse, not better in the population, and you'll see an increase in fatal car crashes and broken bones.

 

yes, and that is why doctors should be trusted for advice, doctors lose that trust by denying people medications they need and want

by your logic sleeping pills should be banned for everyone, one can buy some sleeping pills OTC, but they make you drowsy the next day, the better safer stuff is prescription, I have tried the OTC, as a programmer that was not something I want as it leaves you in a haze the next day

 

But you are advocating for entirely bypassing the need to seek advice. Again, this would lead to disaster. And also you can't require me to give you a prescription if I firmly believe it will be detrimental to you. Patient autonomy should go a long way but not to the extent that it would invalidate my oath, "do no harm." A patient can't force me to give him/her a prescription, and that's for a good reason.

Sure, I'm admitting that the opiate issue went too far. I am a reasonable person and have no trouble whatsoever recognizing that my profession doesn't always get things right. After all we are all humans. But the regulations going too far, are again, issued by public health officials, not by individual doctors.

 

"But you are advocating for entirely bypassing the need to seek advice."

but doctor, your not listening to me, do you do that to your patients too?

I said I would be ok with requiring people get advice for certain drugs

I said "nope, in fact I said I encourage seeing a doctor for advice, then you decide based on that advice for yourself - I am even for requiring one to get advice before buying"

you said "Again, you are very irritating in putting words in my mouth"

you seem to be doing the same....

 

Again, you are very irritating in putting words in my mouth (which will make of my answer to you, the last one; I'm tired of this). Where did I say EVERYONE??? Specific quote please.

Sleeping pills should be very sparingly used, when other measures (what we call "sleep hygiene") have failed; that use should be well-supervised and minimized to the smallest effective dose; the kind of sleeping pill also needs to be tailored to specific needs taking into account speed of absorption, peak action, half-life (how fast it's eliminated), drug-drug interactions and whether or not it's meant to treat insomnia that falls into difficulty to initiate sleep or early awakening. Also, best is to treat the underlying cause of insomnia rather than masking the problem with sleeping pills. These are some of the good practice elements that should guide the treatment of insomnia, and again, lay people are not equipped to understand it all.

"By my logic" is a logic informed by sound knowledge of pharmacology and therapeutics, and 40 years of real life experiences with patients. I am NOT wrong about what I'm saying.

"Denying people medications they need and want" - I've encountered THOUSANDS of times occasions when these medications people THINK they need and do want, are extremely unreasonable and detrimental. Again, thankfully patients can't force me to prescribe to them, things that would violate my "do no harm" oath.

Bye now. See if you learn to debate a point without putting words in your interlocutor's mouth.

 

One more: no, you never said "requiring." You've been advocating the entire time for a doctor visit being optional. If you eliminate all medications from the list of prescription medicines, that's precisely what you'll do: you'll make of a doctor visit, something optional.

If your problem is with the size of the list of OTC medications, that's another issue. Like I said, as it is, it is already too long. It should be shortened. You want it extended to things like sleeping pills: grave mistake.

Anyway, over and out. Good bye.

 

so when do you think the benefits outweigh the risks you described? as the risks are still there, so at some point you find them acceptable risks

"Bye now. See if you learn to debate a point without putting words in your interlocutor's mouth."

yes, says the one putting words in my mouth, that I have clearly over and over corrected you on - I have never advocated not getting medical advice, yet you keep saying that is what I am saying

 

it's right in the quote of mine I posted, that you are replying too

"I am even for requiring one to get advice before buying"

so how can you say that?

I encourage getting advice, but then I advocate that the patient decides for themselves based on that advice, otherwise your not getting advice, the doctor is deciding for you and telling you why, that is not advice

 

OK, fair point, I hadn't noticed that you had changed your phrasing, but that means, you're moving the goalposts. Here is what you started saying:

"I think people should be able to self prescribe
be smart to get a doctor's opinion"

Be smart is far from being required. And self prescribe presupposes not even needing a doctor: you go to a pharmacy and you write your own prescription for yourself even though you're not a licensed professional? Because that's what "self prescribe" means.

 

Each situation is different. A medication can be safe for a given patient and unsafe for another one, depending on co-morbidity, drug-drug interactions, age, speed of metabolism, etc. Again, lay people are not equipped to understand all the implications.

Still, I never said stuff like assuming you are a drug abuser, saying that EVERYONE this or that, that ALL this or that, and you repeatedly put those words in my mouth. So, you saying that I'm doing it too, is the pot calling the kettle black.

I have to go now; about to start my work day.

 

that was from post # 15, so I said that I would not mind requiring people to get advice early in the discussion

that other comment is compared to the current system we have now, I would though support a change as long as it gave the people the choice, rather then the doctors or the government choosing for them

the current prescription system has problems that need fixed

you go to the pharmacy, show you got advice from a doctor on that medication and they fill it... simple

the doctor has you sign off on their advice and if you do not follow it, they are not legally liable

I think fear of being sued is also harming the medical profession as too many sued over logical guesses, let the patient make the guess and less lawsuits as the patient plays a role in their own care

 

but the risks are still there, you mentioned driving while taking sleeping pills, so what makes you prescribe to someone even though that risk exists

"Car crashes during morning commute with people under the residual influence of sleeping pills"

at some point, you feel the benefit is worth the risk, I am just asking when would that risk be acceptable to you

if you just advised of the risks, and the patient decides, it would be on them, if you decide for them and that crash happens, then it's on you

 

Not entirely uninteresting. But it would suppose a very well informed citizenry, which is very far from being the case. Just by participating here (not just this thread; the forum at large) I've heard the most absurd notions about Medicine; lay people have a way of THINKING that they have good knowledge of these issues and think that common sense is sufficient, when Medicine is a VAST applied science and living human organisms are EXTREMELY complicated, with organs being inter-dependent on each other and metabolisms being unique to each individual in many ways. Not even after a full-blown medical education we're equipped to face all the factors, let alone a lay person. Again, your view of this is a bit romantic... what you are saying SOUNDS good but would easily lead to unintended consequences and disaster.

 

Had a little break until 11 so I'm responding to this.

For example, I'd aim for a sleeping aide with a short half-life that would have dissipated by the morning, and would verify if the person is taking anything else that has drug-drug interactions with the agent, and if the person has metabolic issues that would prolong that half-life (these days we can do genomic testing to verify that).

---------

Regarding your idea, like I said the informed consent process where you explain to the patient the risks and benefits and allow the patient to make a decision already exists. But you can't force me to prescribe a medication to you that I believe will be harmful, and would violate my "do no harm" oath. You seem to think that the doctor must give you something if you think you need it and you want it. That is not wise.

No more time, now. It's 11. See ya.