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Thread: Big Cracks in the system

  1. #1
    Ricu
    Guest

    Big Cracks in the system

    I'll open with the disclaimer that I work in critical care and not behavioral health so my viewpoint comes from from outside this area of expertise.

    Now that it's getting to be that wonderful time of year, we're seeing the more than the usual increase in OD's and suicide attempts and I gotta tell ya, we're keeping pace from the medical standpoint but not from the psychiatric at all.

    Yeah, I know, there are system operators and drug seekers out there in mass, but there are also many people who genuinely want or need help for legitimate conditions and can't get it. It hurts me to get someone through the first few steps of a life threatening crisis, medically stable, open to receiving help, only to turn them on to the street again because of a technicality. For example, a suicide attempt isn't really taken seriously if the individual has a measurable alcohol level. Other times, the very characteristics of a decompensated condition get misread and the individual is improperly treated, like when someone with a cycling bipolar condition or PTSD is'nt trusting, finds the bright lights and flurry of questions overwealming and tries to escape. Obviously a security watch or even restraints are in order because he has something to hide, needs a fix or doesn't want to be compliant. Really? Not always, and we should do a better job of differentiating early on. It doesn't take long to run a tox screen but I've seen four point leathers left on for hours. Is there a reason we're being punitive?

    I know psychiatric conditions are hard to manage and a large part of that may be patient dependent, but the medical profession doesn't seem to be working very hard at doing it's part, when comparing the efforts made to treat other, equally challenging conditions which also have large patient compliance factors, like cancer and heart disease.

    Indulge me a little here as I oversimplify a complex situation to make my point. I may be speaking of a relatively small number inside of a huge chronic population of people who quite possibly due to treatment methodology, remain relatively unfixable. It's been my experience that many medical professionals don't take psychiatric issues seriously or somehow believe that there is a voluntary component. In general, we will be more compassionate toward the morbidly obese cardiac patient who fails to follow the prescribed diet or who will buy cigarettes instead of Plavix, but will implicate the bipolar individual who doesn't want to take his TCAs because they make him feel dull or cause him to gain weight. Furthermore, the insurance industry doesn't effectively cover the necessary care if you can even find it.

    While I'm on a rant, why do we insist on overprescribing benzos and narcs to people who are prone to developing addictions, especially when they're not the appropriate or first line drugs to begin with? Because it's easier, and faster? Probably, and because it's the only treatment that DOES get reimbursed. See ya Saturday night in the ED after you wash the last of your Suboxone down with a fifth of rum. And the beat goes on...

    In closing, there is a need for more education about a poorly understood area of medicine followed by a change of practice. Along with this and for anything good to come from a practice change, a review of what insurance should reimburse for must happen. Finally, since I'm being wishful, let me ask society to adjust it's jaded view about what so very many of it's members are living with.
    Last edited by Ricu; 10-19-2010 at 07:40 PM. Reason: typo

  2. #2
    Senior Member
    Join Date
    Mar 2006
    Posts
    695
    I hear hear you. I'ts frustrating. I don't have an answer. But I wish Dr.s would try non narcotic pain rx like Tramodol, etc.
    I've had so many addicted pt. on Med surg who put the call light on exactly when the prn is due and they are in TROUBLE because they are addicted, i guess. AND I've had a few Pt.s who had drugs brought in for them by their junky friends. I figured it out when they got really sedated and thanks for Narcan. Then a drug screen shows results of meds that were not prescribed by MD. It's alot of added responsiblity for a nurse.
    They have been offered help via social services some go for it and some decline.
    I read about drug addiction w narcs, heroin, etc and once the dopamine high hits, people can't stop. It's very difficult
    Thanks for posting.

  3. #3
    Ricu
    Guest
    Thanks Kdog. It is a frustrating situation and for some reason, one that even seems hard for nurses to talk about.

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