Sunday, October 23, 2011

Rerun: Smart Meds Strategies - No, This Is Not An Oxymoron

From Feb this year ...

Following is a chopped version of a new article on mcmanweb. The article, in turn, is based on three or four posts published here over 2009 ...

During the first months of 2009, I ran three successive reader polls  on my blog, Knowledge is Necessity. Let's pick up on the action in my  second poll:

"How do you rate your meds in managing your illness?" I asked my readers. The results, quite frankly, astonished me.

One half responded that meds were their single most important  tool and one third that their meds were "important, but no more so than  their other tools." In other words, four in five patients put meds at  the top of their list, either as a solo act or with a dance partner.

Obviously, if meds are so important to patients, then they must be working like gang-busters, right?

Not exactly. No, in fact. Make that unequivocally no. The month  before, I polled my readers on how well they were doing. One in four  replied they were "in crisis or close to crisis." Four in ten reported  they were "stable but not well." Just one in five said they were on the  way to recovery, and only 14 percent responded that they were back to  where they wanted to be or better than they ever could have imagined.

Thus, a full six in ten of those who responded to my poll  indicated that they were in pretty bad shape while more than eight in 10  reported feeling short of well.

Put the two poll findings together and you can appreciate my  astonishment: 82 percent who rate their meds as their number one  management tool vs 14 percent who are actually well. What is wrong with  this picture?

Time For Another Question

"How well have your meds worked for you?" I asked in my third poll.

Only 14 percent answered, "very well." The overwhelming rest (86 percent) had reservations.

Thirty-six percent  - about one-third - responded, "conditionally  well." In other words, your meds may not be perfect but they were  meeting your expectations. When you add in the "very well" group, fully  half you reported satisfactory results with your meds.

So, can we put a positive spin on the results? No.

One in five (19 percent) told me their meds were "rather  problematic." In other words, these people weren't happy with their  meds, but were experiencing some benefit.

Nearly one in five (17 percent) responded that their meds were  "very problematic" and 11 percent told me their meds were "a complete  disaster." Added together, nearly one-third have given an unambiguous  thumbs down to your meds.

Interpreting the Results

Let's go negative first:

The fact that more than eight in ten of you - yes, you - reported  that your meds are not working "very well" - for whatever reasons -  speaks volumes. Consider that most of those in the "conditional" and  "problematic" groups are more likely headed down than up (based on very  clear trial evidence that less than a partial response to meds is a very  strong predictor of relapse).

Add to that the fact that the "complete disaster" group is  running in a virtual dead heat with the "very well" group and we are  talking very low levels of customer satisfaction.

The only way we can put a positive spin on the results involves  seeing possibilities in the "conditional" and "problematic" and even  "disaster" groups. Suppose, for instance, half of those in the  conditional group were to graduate to "very well." Likewise, suppose we  could get similar conversion rates from the "problematic" and "complete  disaster" groups. Then three-quarters of you would be happy customers.

How is that possible?

The meds are the one constant in this equation. The two variables  are you and your psychiatrist. First imagine a smart patient working  with a smart psychiatrist. Now picture a naive patient placing his or  her trust in a lazy and indifferent psychiatrist. Are we likely to see  dramatically different outcomes?

I rest my case.


Smitty said...

Now, to ask the question. What does it take to be a great or even good psychiatrist?

What are our criteria as patients?

What are the criteria that psychiatrists value to be good, even great?

Cathy K. said...

I would really value an exploration of Smitty's questions. I feel fortunate in that at the moment, the meds I'm on seem to be helping me function way better than I ever have before; but there's room for improvement, and obviously a lot of that will come from my work with my therapist. Still, with this fairly fresh diagnosis (just a few months ago), I have much to learn; and Smitty's questions seem as pertinent as the valuable information in this post.

John McManamy said...

Hey, Kathy and Smitty. You got it. I'm writing a post in response to your questions write now. :)

Smitty said...

Means a lot to me that you did this today, John. I thank you.

John McManamy said...

Hey, Smitty. I'm so glad you took the trouble to ask these questions. You really got me thinking. :)