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Unread July 27th, 2004, 06:48 AM
James D James D is offline
Join Date: Jul 2004
Location: Australia
Posts: 8
Default Re: Do GP's Overprescribe?

Hi JustBen.
I've seen plenty of occasions where clients have been prescribed antidepressants and anxiolytics from their GP (physician) without adequate psychological assessment. There are lots of stories out there about prescriptions made for patients that lead to further problems (e.g. benzodiazepine dependence), reinforce the medical model of treatment (contra psychological intervention), and fail to enhance the individuals sense of self-efficacy. I always cringe when I see someone prescribed Xanax (alprazolam?) for example!
However, for all the questionable experiences/stories i'm sure there are GP's out there who do a really good job. I know that in Australia we have many GP education programs around mental health issues to attend to GP's knowledge and skill base.

A full psychological assessment by an appropriate professional is key, in my opinion. The program i'm involved in works with frequent users of the emergency department at 2 local hospitals. My role is to do psych assessments, collaborate with GP's and services already in place, make referrals to other service providers (e.g. psychiatrists), provide short term psych intervention if needed, etc. Hopefully this approach will reap rewards for all concerned.

GP's should certainly refer clients when the issues are significant. Many people with significant psychological distress don't come in contact with psychologists nor psychiatrists. Lots of these cases could be picked up in primary care, but if you don't ask then you won't find anything out. GP's are in a prime position to pick up on a range of disorders, after all they're the front line workers. So hopefully GP education and increased collaboration with mental health workers will help the situation.

As for the power of the drug companies......... well advertising works doesn't it! From previous work I have seen prescriptions for certain antidepressants come in waves. Could be a figment of my imagination! I'm sure the drug companies would have the stats to say whether their influence works. No doubt it does cos they keep on advertising, putting on lunches and handing out free pens! I understand antidepressant use is climbing all the time.........

All factors, like brief consultation times, education, advertising, etc have an influence on GP prescribing.
The answer??? Only psychiatrists can prescribe psychotropic medication?? Only physicians with special mental health training can prescribe?? Other physicians can only prescribe after consultation with psychologist/psychiatrist?? Or is prescribing to too many better than prescribing to too few??

Its beneficial to use professional expertise whenever possible and not overstep boundaries. I'm not about to do a heart transplant after all!
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