I was watching an episode of Dr. Drew On Call, where they were having a discussion about the May 23, 2014 spree shooting in Santa Barbara. This article is not about spree shooters (I won’t even say his name), or the details of that horrific event. It isn’t even about Dr. Drew. This article is about a sentiment that I am hearing over and over in the media and was said very forcefully by Dr. Drew: it is the sentiment that patients and families need to trust their doctors.
I clicked onto the show just in time to see a panelist complaining about the spree shooter’s ex-psychiatrist. I am not here to blame that psychiatrist or psychiatry. But I thought she brought up an excellent point. The shooter had written in his manifesto that he discontinued care with his psychiatrist over a year ago, because he didn’t want to take the drug the psychiatrist prescribed. After the appointment with the psychiatrist, the shooter looked up the drug on the internet (this is where I should say that I will not name the drug either, because this is not an article about that particular drug or its merits), and decided it was “the absolute wrong thing.” The panelist wanted to know why the patient was on the internet looking up the drug and trying to learn about it for himself. Why did the psychiatrist not explain the risks of taking this drug to him? My own question would be, Why did the future-shooter not feel comfortable asking the psychiatrist to prescribe something else?
Dr. Drew actually looked physically angry when the panelist questioned the thoroughness of the psychiatrist. In fact, he didn’t even address what she said. He only said that the family should have used their “leverage” (aka: withholding financial support) to convince the patient to do what the psychiatrist ordered. He stated that patients and families should trust their doctors, insisting that taking the drug would have been better than turning into a mass murderer.
I don’t understand this attitude! Why should the shooter have trusted this doctor? We are talking about a doctor who neglected to mention the side effect profile of the drug. It wasn’t like the shooter was being prescribed an antacid. It was an atypical antipsychotic with a high side effect profile. It is a risky drug, and the patient should have been warned about this beforehand. Why did the doctor not “trust” the patient with this information? Why couldn’t he trust his own patient to make the right call after explaining the risks of NOT taking the medication? And as I pointed out earlier, another drug could have been prescribed if the patient still disagreed with the doctor’s decision. Why did the patient not feel he could contact the doctor to discuss the issue?
Maybe I’m Biased
Certainly, I have experienced many moments where I felt, or even knew, a doctor was not being totally upfront with me about diagnosis or treatment. This colors my feelings on the issue. Perhaps the shooter’s psychiatrist did everything right in his case…or perhaps not.
I hear on the news that our mental health laws are failing the mentally ill. The severely mentally ill often don’t have access to treatment, and can be prone to violence as a result. But this shooter did have access to treatment. By all accounts, his parents were willing to pay for it. He just didn’t want the treatment. This is why the ideas of forced care and public registries documenting all severely mentally ill persons are being thrown around on TV sets everywhere.
Instead of talking about forced treatment and creepy registries, why can’t doctors first learn to trust their patients? Trust patients to listen; trust that they can hear about all the scary side effects of their medications; trust them to know their own conditions; and trust that they will trust an upfront doctor.
Of course, I am biased and coming from a patient’s perspective. More than one physician may read this article and think I am totally off. But, as doctors, they have their own biases, and maybe it is time for them to become more objective about themselves.