If You Have to Ask…

February 10, 2010 at 8:20 pm 1 comment

Recently while sifting through the vast number of articles linking antipsychotics to metabolic symptoms and adverse effects like rapid weight gain, high blood pressure and diabetes, I stumbled upon a question posed by a doctor to Psychiatric Times. Apparently his concern over whether or not to perform basic tests to assess the health of his patients qualifies as an “ethical dilemma.”

I’m a psychiatrist in private practice and do not have a secretary or nurse. One of my patients who has bipolar II depression is undergoing psychotherapy. I have prescribed an atypical antipsychotic for this patient. The drug’s manufacturer recommends periodic checks for metabolic syndrome—which means (among other things) checking the patient’s blood pressure, weight, and BMI via measurements of his waist circumference.

I am willing to weigh patients undergoing psychotherapy and check their lab test results and blood pressure, but I am uncomfortable making physical contact to check waist circumference. Instead, I discuss with patients how to take care of themselves, and refer them to a primary care physician.

Is it appropriate to touch such patients for clinical purposes? If not, could I be blamed if a patient has an MI secondary to high blood cholesterol levels if I haven’t been monitoring these parameters?

Does touching a patient in this setting constitute a boundary violation?

Not only does he rely on the drug’s maker to inform him of the need for metabolic testing, he’s not sure whether it falls within his scope or even the boundaries of decency. On top of that, his principle concern seems to be whether he could be blamed if his neglect of physical indicators ends in a patient’s heart attack — and really, what doctor needs that kind of hassle? I get that some sensitive situations can arise when dealing with emotional well being and touch but if that’s the case, shouldn’t he already have a close working relationship with a real doctor for when the situation arises? Maintaining physical health should be mandatory for continued pharmaceutical intervention. I find it strange that he’s more comfortable prescribing high risk drugs than he is assessing their affect on his patients. He may as well just come out and ask if there’s any way he can keep prescribing but get off the hook with that whole pesky “health” thing.

Psychiatric Times doesn’t appear to have answered the question but I found it worth mentioning all the same that it was asked. There is a link instead to a podcast about the ethics of praying with patients.

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1 Comment

  • 1. Marian  |  February 11, 2010 at 5:04 am

    Somehow this relates to the question if non-medical professionals like psychologists should be allowed to prescribe psych drugs. Personally, I can’t even see why they would want to. Just as it is beyond me why someone who obviously can’t do without prescribing these substances absolutely wants to practice psychotherapy as well.

    I admit that in some few cases psych drugs may be a (very) short-term solution, when the fat’s in the fire. But in a long-term perspective – and when we talk neuroleptics we almost inevitably talk long-term, “maintenance” use – what good it could do to feed someone consciousness-reducing substances and at the same time ask them to engage in a kind of treatment that ought to be consciousness-enhancing. Something isn’t quite right here.

    If this guy doesn’t think better of his own abilities as a therapist than that he still needs to keep his clients in a neuroleptic-induced daze, he simply isn’t fit to practice therapy, IMO.

    Another aspect is that he doesn’t only violate his clients’ boundaries by touching them. For numerous reasons he violates their boundaries the moment he labels someone and writes a prescription. But I guess, that has never crossed his mind.

    Apart from that, you’re probably right: he just wants to get off the hook. Just as prescribing drugs the way he does alongside with offering psychotherapy is a clear expression of wanting to get off the hook (as a therapist).


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