Letters from the Front Lines

Mark Foster, DO
32
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I saw a patient recently, a 35 year-old woman who needed a refill of her Zoloft.  She been started on it four years prior, after the birth of her first child when she had been overwhelmed with a fussy infant at home.  She told me that she hadn’t wanted to start on medicine, but her obstetrician insisted on it.  “Post-partum depression is a disease,” she said, “and you need this medicine.”  Up to this point in her life, she had never battled with any mental health problems, and even then she was not suicidal or in acute distress, rather just sad and lonely and overwhelmed by this major life transition.

Trusting her doctor, she started Zoloft and noticed that she seemed to feel a little better.  A year and a half later, she wanted to come off the medicine in order to get pregnant again, and so she just stopped taking it.  She experienced a terrifying rush of physical and mental withdrawal symptoms within three days of stopping it.  She believed this to be a recurrence of the illness, which confirmed her need for the medicine, so she resumed it.

She continued taking it, became pregnant, and took it throughout pregnancy, because her obsetrician was too concerned about her mental status deteriorating off of medications, and reassured her that it was safe in pregnancy.  When her baby was born with a heart defect, she was told this was not due to the Zoloft.  However, she has since seen advertisements for class-action lawsuits against Zoloft for causing precisely that.  This has led to an intense source of guilt for her, and confusion about what was told to her by her obstetrician, whom she trusts.

She is done having children now, and so when she came to see me, she was not thinking of stopping the medicine.  Her family practice doctors had assumed the supervision of her medicine, and she needed a refill.  She wondered if she needed a higher dose because it wasn’t working well any more.  The stressors of having two children, one with a serious heart issue, were large, as well as serious financial and marriage pressures.  However, she was already on the highest dose of Zoloft.  She then wondered if she should switch medications.

She was a new patient to me, and at this point, I told her my concerns about the lack of long-term effectiveness of SSRIs generally, and the potential for harm and increasing depressive symptoms.  I told her that there were a number of common and devastating side effects, including weight gain (she had gained 50 pounds), sexual dysfunction (she reported an absent libido which was hurting her marriage), and stomach problems (she had been diagnosed with irritable bowel syndrome within the year).  We discussed that if the medicine wasn’t working well anymore, and if these common side effects were occuring, then perhaps we should consider coming off the drugs slowly, under supervision, and bolstered by a program of integrative lifestyle interventions.  She was caught off guard, but expressed interest in exploring this plan.

Then she said something that has become distressingly common for me to hear:  “How come no other doctors ever told me about the side effects, or that I could come off of it?”

Indeed.  Why is it so easy for doctors to push patients onto the medication highway, and so difficult to help them exit it?  Why aren’t we more aware of how some of our patients are being negatively affected by these ineffective drugs?

Although I have strong personal feelings about the quagmire that has been created by our drug-intensive mental health paradigm, I am generally cautious in how I approach unsuspecting patients with this paradigm shift.  Patients and providers are all engulfed in the system together, and it’s tough to see beyond it.  If it’s possible to gently rock somebody’s boat, that’s what I’m trying to do, but not in a way that will increase a patient’s distress.  Some people send clear signals that they aren’t ready to engage in such a paradigm shift, and for them I make a few alternative recommendations, perhaps refill their medicine for a month, and then recommend that they follow up with another doctor who better fits their value system.

But is what I’m doing so radical?  It’s not like I’m sharing new information.  I’m merely communicating out loud the side effects that appear on the drug inserts, as well as the evidence compiled in Anatomy of an Epidemic that points to the next ineffectiveness and harm of long-term drug use.

In the visit with this woman on Zoloft, she and I counted that there had been at least five different prescribers who had refilled or increased her medicine over the previously four years.  According to her, none of them had ever hinted that stopping the drug might be possible, or even desirable.

In fairness, many patients feel they are doing well on the medications, and report few or no side effects.  But many patients do poorly on them, and yet are never advised to stop them or to explore alternatives.  Why?

Primary care physicians prescribe greater than 75% of all antidepressants in America.  Below, I’m posting a partial list of potential barriers that would prevent us (and patients) from recogniznig side effects or recommending withdrawal from harmful and ineffective psychiatric drugs.

 

Barriers to primary care physicians advocating safe withdrawal from psychiatric drugs.

Providers:

  • May be unaware of side effects.
  • May assume somebody else in the system will address withdrawal from drugs.
  • May have inherent bias about the effectiveness of their treatments.
  • May receive biased information exclusively from drug reps.
  • May not be informed about effective alternatives.
  • May not be informed about appropriate withdrawal techniques.
  • May underestimate the level of harm inflicted on their patients.
  • May underestimate the resolve and the resilience of their patients.
  • May be wary of backlash from psychiatrists, employers, and the mental health community.
  • May be wary of malpractice suits should a patient’s condition worsen.
  • May be too embedded in the medical model to see beyond it

 

Barriers to patients withdrawing safely from psychiatric drugs.

Patients:

  • May be unprepared or unwilling to make a change.
  • May not be in a life position to make a change.
  • May be physiologically dependent on drugs.
  • May be psychologically dependent on diagnoses.
  • May have had prior bad experiences withdrawing.
  • May lack financial, social and intellectual resources.
  • May have been convinced by other doctors, counselors and family members that they need to remain on the drugs for life, and that to come off of them is irresponsible.

 

These lists are incomplete, but they are daunting and reflective of the mess we find ourselves in.  How are we ever going to see our way out?

To me, it starts with honest information., and this is something always in my control.

  1. What are the medications actually doing?
  2. What are their known side effects?
  3. What is their long-term effectiveness?
  4. What are effective alternatives?

 

We won’t change the system overnight.  But each provider can ask and answer these questions with our patients, who come to us one by one in the exam room, and we can give them true informed consent, always remembering our oath to Do No Harm.

Or as the Dalai Lama said: “Our prime purpose in life is to help others.  And if you can’t help them, at least don’t hurt them.”

Those are words that all primary care physicians would do well to remember the next time you are sitting down with a patient who is simply asking for a refill of her Zoloft.  Maybe she’s doing fine.  But maybe she’s not.  Better spend some time finding out why.

Best regards,

Mark

32 COMMENTS

  1. Thanks so much for this post. If only more family practitioners were at all close to you in addressing this issue. It seemed like the informed consent was completely inadequate in the prescribers before you, but maybe the prescribers themselves were inadequately informed. I think primary care physicians need to be oh so much more cautious in prescribing psychiatric medications; even when indicated, they are the psychiatry’s equivalent of doing surgery. This is a major intervention. We need more integrated care where psychiatrists work with PCPs and vice versa. The other obstacle we have is that it is less stigmatizing to get psych meds from PCPs, but on the other hand it is even way more risky than getting them from psychiatrists.

  2. It’s not just primary care physicians. I am a 49 year old woman attempting to reduce my dosage of Seroquel and Neurontin. I was diagnosed at 37 with Bipolar II, which was later changed to a Bipolar I diagnosis by a psychiatric ARNP. I gained over 100lbs on Seroquel, and had a gastric bypass. Five years after the gastric bypass, I was put on ever increasing dosages of Seroquel (which I had stopped and changed to Risperdal at one point) for “increased anger and agitation”.

    I have very, very, slowly decreased from 800mg of Seroquel to 650mg today. I will continue to decrease my dosage until I am off this evil drug. My current psychiatric ARNP does not support this. I have regained 75 lbs of the 120lbs I lost after the surgery. I hope to lose this weight.

    Eventually, I want off the Neurontin too. Thanks for an excellent post, and for giving me hope.

    • Nancy,

      Hang in there as you continue to lower the doses until you’re able to get totally free of these nasty things. More power to you! It’s said that people have to dothis on their own since their wonderful professionals refuse to help them and insist on keeping them on the toxic drugs.

    • What? How can they justify giving that amount to someone? The most I have taken is 300mg for seroquel and that was onerous enough. The first few hours after you take this drug, are just grim. Bleak thoughts autonomically assail your mind. Sometimes I lie on my bed for hours ruminating on death, accompanied by equally morbid ruminations on time. The experience is of a morbid idee fixet for the first few hours.

      Yet you try to distill into comprehensible verbal form those nightmarish few hours of existential anguish, and the psychiatrist just stares non-plussed at you, impossible as it is to communicate successfully to someone what it feels like when your interlocutor has no experience of the drug.

      It’s probably the kind of mindset that inspired Edward Munch to paint his more expressionistic works, and it is all drug-induced. Horrible, and for some reason it makes you fearful of closing your eyes, even though the sedative is making you do just that.

  3. Thanks again for posting Dr. Foster! Several bloggers and responders have raised this issue, globally called “Informed Consent” Truly informed consent is rarely offered or given for all the reasons and more you’ve outlined in your piece. This should be an ethical obligation all physicians take very seriously in my opinion. It’s a two way street. Physicians needs to be informed and those seeking services need to be informed. Anytime a physician and someone seeking services sits down for a discussion, two experts are in the room. Presumbably one is an expert in “medicine” while the other is an expert on themselves. Power has to be equal for consent to take place.

    • Before offering Informed Consent about the dangers of withdrawing from medication, doctors should darn well know how to supervise a taper — which they don’t.

      They’ll all warn patients not to quit suddenly — and keep them on medication unnecessarily for years, because they don’t want the responsibility of tapering them off.

      • I knew I wasn’t going to get any help with this from the doctor, so I went to my pharmacist. He was very helpful in telling me how to go about tapering off the toxic drugs. From his reaction, this is not an unusual request made of him. Thank goodness he was willing to help me do it properly.

          • “can anyone verify that this is a safe option?” Well, I don’t know what “safe” means in context with something where such a lot of individual factors play in as in tapering off psych drugs, but there’s also a pharmacologist (pretty close to a pharmacist, educationally) employed where I work, and he does both educate people about the drugs they’re prescribed, and help them get off them, if that’s what they want. His profound knowledge of the biochemical mechanisms of action of these drugs has helped many to make a more informed consent, and also to come off. Oftentimes to the annoyance of the prescribing psychiatrist. He has been asked/threatened to shut up.

          • I found a compounding pharmacist who helped me toward my now completed benzo taper. I was able to use a suspension liquid he made for me as the base and it took me over one year. It was one of the most difficult things I’ve ever done but I can say I am 11 months benzo free. I also had the online support of an awesome benzo group who helped validate my taper and withdrawal.

            When I was on psyche meds the doc changed them like a roller coaster ride. He was either clueless or didn’t care I was having nasty drug side effects and/or withdrawal symptoms.

  4. I agree, psychiatrists are hardly any better in warning their patients about difficulty withdrawing, knowing anything about tapering at a rate the individual can tolerate, or even identifying withdrawal symptoms.

    I’m not just ranting about this, Steve. I’ve got hundreds of cases. You can see some at http://tinyurl.com/3o4k3j5

    The questions Mark Foster asks in his article, I ask myself every day. Why don’t doctors know how to get patients off these drugs?

    It’s not rocket science, although it can be more complicated than “half for a week, half again for a week, then you’re off.” Patient peer support sites have had to fill the vacuum to help people taper off psychiatric drugs safely. When are doctors going to own up to their responsibility?

  5. Great post Mark.

    From a patient point of view I think the word “dependent” needs careful scrutiny and personal ownership, in the issue of informed consent? The rationale is that informed of all possible outcomes, the patient will choose the best option for their long term health, and will resist the temptation of immediate and sort term relief? If this is the reality of human functioning, why do we still take up smoking by the millions?

    In my own journey, I’ve had to face up to a tendency to simply react and chose the easiest immediate option for distress relief, rather than invest my energy in the effort involved in lifestyle change and self-awareness.

    Easier to pop a pill than go for a five mile walk. Easier to pop a pill than make the dietary changes necessary for a healthier metabolism. Easier to be advised by an “expert” than pursue a better self-awareness through the efforts of self education.

    We all like to adopt a posture of reason, when perhaps we are far more reactive than we care to admit? Why do most Doctors find it easy to prescribe medication and shy away from the efforts involved in alternatives?

    Is the average Doctor any more self-aware of their need for anxiety relief during a Doctor-Patient encounter, than the average patient? (write a script – mumble a few soothing words – usher out of office – anxiety of the moment relieved?)

    Our we paying the price of a reasoned intelligence which stands in denial of our unconscious emotional reactions, as the motivating influence in our lives? Consider;

    “A person can have a well functioning intellect but intellect is intimately fused with his emotional system, and a relatively small part of his intellect is operationally differentiated from his emotional system. He can accurately “know” facts that are personally removed, such as mathematics and the physical sciences, but most of his intellect is under the operational control of the emotional system, and much of his total knowledge would be more accurately classified as an intellectual emotional awareness, without much differentiation between intellect and feelings.

    The person at this level of differentiation does not commonly have a clearly formed notion of fact, or differences between truth and fact, or fact and feeling, or theory and philosophy, or rights and responsibility, or other critical differentiations between intellectual and emotional functioning. Personal and social philosophy are based on the truth of subjectivity and life decisions are based more on feelings and maintaining the subjective harmony.” _Murray Bowen.

    Bowen predicted that our innate and systemic emotional re-activity and easiest option need of anxiety relief would come to a head in the middle of this century. That we would be forced to come to terms with our innate nature, and give up much of our postured pretense, to intelligent and reasoned actions.

    In recovering from over two decades of dependent awareness and a “cognitive” (I think therefore I am) understanding of my bipolar type 1 condition, its the innate and unconscious reactions of my nervous system that I’ve had to gain a felt awareness of, in finding ongoing relief from my internal Dis-Ease.

    I’ve had to learn and practice an embodied self-awareness to overcome a trauma conditioning of my nervous system, and understand that most of my cognitive process is dedicated to the maintenance of “subjective harmony” as Bowen points out, rather than any deep personal insight.

    Does a new paradigm in mental health, require a new paradigm of self-awareness rather than a new way of delivering health care?

    • Exactly. How many people these days actually sit down and evaluate their lives on a daily basis? I suspect very few. Instead we are on our i-phones texting, sitting in front of the computer on the internet, playing a role-laying video game, watching that idiot thing called a television (through which we receive our “progroming from big business and the media), anything and everything to keep from looking at our lives in an honest evaluation of what we need to do for our physical and emotional health. You’ve obviously done a lot of difficult work for yourself and are reaping the benefits. Thanks for sharing your ideas and your experiences.

      • Hi Stephen:))

        Agree with your comments although the “programming” is a contentious issue. Robert asks a very valid question in his book about the illusion that the pharmacology era is a vast improvement on previous era’s.

        The easy “cause & effect” assumption is the power of advertising and brain washing, whatever that means? Yet is there a bigger picture concerning the nature of human attachment & dependence?

        What isn’t addressed in the “us vs them” debate about treatment, is what brings the individual before the good Doctor in first place? Is the epidemic of mental illness symptomatic of a society in distress, perhaps because we’ve lost our way in our assumptions about the mind and the fundamental purpose of our subjective thought, (homeostasis?) both personal & group.

        I do believe that the new paradigm is unfolding beyond the headline debates and the rank & status of the medical hierarchy. There are other branches in the tree of knowledge where ancient wisdom’s are converging with new science discoveries about how the body/brain/mind actually works.

        What got lost in Descartes iconic statement for modernity “I think therefore I am” was the body & nature. We fell in love with the mind, without being aware of its essential function in maintaining group harmony within an exploding population.

        Yet the wheel turns turns & ancient awareness is moving to restore balance in the emotional system we call society, hence the now gold standard use of mindfulness to ground the mind in all forms of therapy. Consider;

        “As a society, we have largely abandoned our living, sensing, knowing bodies in the search for rationality and stories about ourselves. Much of what we do in our lives is based on this preoccupation. Like Narcissus, who fell in love with his own reflection, we have become enamored by our own thoughts, self-importance and idealized self-images.

        Have we fallen in love with a pale reflection of ourselves? In gazing at his own reflection, Narcissus lost his place in nature. Without access to the sentient body, nature becomes something “out there” to be controlled and dominated. Disembodied, we are not part of nature, graciously finding our humble place within its embrace.

        “Deepening awareness is a challenge. It isn’t a challenge because my parents didn’t love me enough. It’s a challenge because it’s a challenge. I don’t need to take it personally. I’ve spent years excavating my past, sorting and cataloguing the wreckage. But who I really am, the essential truth of my being, can’t be grasped by the mind, no matter how acute my insights. I’ve confused introspection with awareness, but they’re not the same. Becoming the worlds leading expert on myself has nothing to do with being fully present.”

        When asked if he wanted another beer in a Parisian Inn, Descartes replied “I think not!” But did he disappear?”

        Exerts from: “In an Unspoken Voice.” by Peter Levine, PhD.

  6. “Does a new paradigm in mental health, require a new paradigm of self-awareness rather than a new way of delivering health care?”

    I say yes! If “patients” no longer interpret their thoughts/emotions/behaiors as “illnesses” needing “treatment” in a mental health or health system, they won’t go. So fundamentally, one of the quickest ways to effect the system is for “customers” to stop going. Don’t buy what’s being sold.

    • But it’s very difficult to get people to listen. Many people would rather think of themselves as being “ill” than do the hard work it takes to keep themselves functioning healthily. I share with many people about how dangerous the drugs are and try to give them places they can go to read for themselves and the response I get is, “Oh, I haven’t got time for that,” or “What am I going to do otherwise without the pills?” This is a valid question and you need to be ready with answers for it. It’s like people have no control over their own lives and they think you’re the crazy one for even bringing things like this up for discussion. It’s almost like people don’t want to know; they’d rather stick their heads in the sand and pretend that things will be hunky dory while all the time the ship is sinking with them on it.

    • One of the things I’ve noticed about doctors of all specialties is that they seem to be spending less and less time with each person in their care. They want you to quickly describe your symptoms, they jerk out their script pad, and hurridly jot down a script for a med of some type and tell you to come back in two weeks, or whatever and out of the room they run. I had a young family practice doctor who was wonderful when I first started with him. He spent time with me and his other patients and actually listened to what we had to say about what was going on with us. As time went on he got more and more patients because word spread about how good he was. His practice developed into a huge clinic which has three branches in our city now and guess what? It’s almost impossible to get in to see him and if you do it’s a matter of him rushing itno the room where you’ve been waiting for 45 minutes, he doesn’t even apologize for being late, you can tell he’s in a hurry as he keeps looking at his watch and you know he wants you to hurry, he pulls out the pad writes hurridly, hands the script to you and runs out of the room to the next patient. He’s just like all the rest of the doctors now. what a shame.

  7. Doctor,

    Great post. It’s good to know that there are still some doctors out there who actually sit down and analyze all of what is going on in the effort to do something about all the problems. Thanks, and keep asking the important questions. You need to somehow influence your fellow doctors and I think posting like this is one way to do so. Keep writing!

  8. Dear Dr Foster
    Ive been reading you posts on MadinAmerica possibly for as long as you’ve been contributing. I was very moved by your own experiences during the time you “retired” from your clinic. You demonstrated grace and courage in your reaction to this, and helped me to arrive at my own career decisions. I am curious about how your approach is being received by the other physicians in your practice. Have attitudes changed at all over the past 18 monthes?

  9. I agree that with Primary care Doctors (general practitioners) they may simply have acquired prescribing approaches based on limited/bias information, and this impacts informed consent.

    However, in my own experience, the “experts” themselves (i.e. the Psychiatrists) I would argue it’s much worse than poor “informed consent”, it’s outright misinformation and lying to patients:
    a) Patient is told they have a biological illness;
    b) Patient is told the medication works to *correct* a chemical imbalance in the brain;
    c) Patient is told that have to accept they need to take medication for the long term if not for the rest of their lives;
    d) If patient refuses to accept this, it’s further evidence of their illness, and is a further justification to deprive them of their civil rights (e.g. prolongued involuntary hospitalisation).

    This to me is just lying, and for the life of me I don’t understand how psychiatrists can genuinely believe they are meeting their medical ethics obligations.

  10. Dear Mark,

    Your alternative, independent and clear voice and position as a primary care physician are so appreciated. We spend so much time focusing on psychiatry, and perhaps rightly so, but you really do sit on the front lines of the psychotropic prescription/patient interface. So much more needs to be done to target this vast and diverse community of prescribers.

    As another commenter mentioned, I would add to your list of significant barriers that the belief in the chemical imbalance theory is still prevalent among GPs, even the more progressive ones.

    My D.O. is quite progressive, she spends an average of 30 to 45 minutes with each patient, performs osteopathic manipulation, prescribes amino acid and other supplementation, and was trained in a bio-psycho-social model and did a psychiatric residency with a psychodynamic analyst. She is a certified yoga instructor and regularly recommends yoga, body work and acupuncture in addition to lifestyle and dietary changes. She looks for underlying allergies. You get the idea. She’s a forward-thinking integrative med doc.

    She now offers neurotransmitter testing (as part of her amino acid supplementation protocol), which we did with my 9 year old who has struggled with anxiety and panic.

    When the urine test came back, my daughter’s dopamine levels were significantly elevated according to the company’s baseline. My DO recommended a full battery of amino acids and a retest. She also recommended we consider a short stint of Risperdal to “break the cycle” of anxiety and dopamine elevation.

    Luckily, I had just begun reading Robert Whitaker’s book and have had a healthy skepticism of medical model all my life. I knew enough to know that Risperdal was a BIG gun for a reasonably well-functioning 9 year old child. I declined the prescription.

    Before I left, my doc, who is also a family friend, went to reassure my daughter.

    “This is good news,” she said to her. “Now we know why you are struggling. It’s not your fault. You have a chemical imbalance that makes you feel this way. We can fix it. Just like your grandfather who has diabetes.”

    If our progressive, well-educated family docs are still buying into this tired and unproven theory, we are in real trouble.

    This same doctor, who has many rural practice patients, has also confessed that most of her patients are not willing to make the lifestyle changes required to avoid medication, and so she prescribes.

    When we add in the reality that most family docs and PAs spend 10 minutes or less with a patient, it is unclear how we can surmount the illusion of a quick fix that psychotropic medications promise.

    I’m not sure you could even fit a side-effects discussion into that 10 minutes, much less evaluate a patient’s overall health (mental/emotional, physical and lifestyle).

    Talk about barriers… Guess that’s what we are doing here!

    Thank you for daring to make a difference in individual lives and among your peers.

    • Jennifer,

      With all due respect, any doctor who believes that neurotransmitter testing is legitimate is not progressive in my opinion. It just another way of giving legitimacy to a false chemical imbalance theory.

      And to offer Risperidal is adding insult to injury big time.

      By the way, I am not condemning you as I know when you are seeking answers for your child, you’re in a tough situation.

      AA

      • AA, thank you for your comments. Since reading Mad in America, I have been perplexed by the amino acid and supplementation approach as well.

        If the chemical imbalance theory is not defensible, then even “natural” approaches that purport to raise or lower neurotransmitter levels would seem to be chasing the same red herring.

        Perhaps there is a good argument for amino acid supplementation. At the very least, aminos are probably much less harmful than their psychoactive prescription counterparts. Maybe a safer way to get the placebo effect? (though not as cheap)

        Interestingly, an adult friend of mine took this same neurotransmitter test in the hopes of transitioning off antidpressants to amino acid supplementation, only to discover that her serotonin levels were the lowest her docter had ever seen — despite daily “boosts” of citalopram. Which lends credence to the question Robert Whitaker raised after his review of the literature… (paraphrasing)

        Does long-term use of SSRI’s cause iatrogenic depression by disabling the brain’s natural ability to produce serotonin?

        And does that question lead us into the same trap? Does it matter that serotonin levels are low or depleted? Or does that question reintroduce the chemical imbalance theory?

        Very perplexing. Especially for me, as a mother and lay person. Thank goodness so many sharp minds and hearts are trying to figure these questions out. Until then, proceeding with caution, informed collaboration, and a whole-person approach to wellness seems the most prudent course of action.

  11. So are we going to keep blaming the doctors, whether family physicians or psychiatrists, when even so many of the “good” ones at the start, are overwhelmed by the system(s) we have in the USA and the desire for quick fixes? Please spread the blame, then maybe we can all work together.

    • Steve, I can’t agree with you more!

      What I may not have made clear, but was trying to say, was that our mental health care system and societal expectations set us all up for failure, despite our best intentions, intellect and passion for healing.

      I don’t think spreading the blame is the answer. Finding solutions, together, seems more productive and hopeful.

      If we take the broadest view, this isn’t even a mental health issue, is it? It’s a human issue. It’s about how we regard our own and others’ suffering, the role suffering plays, how willing we are to sit with our own pain and others, and what we are willing to do about it.

      Thank you for broadening the discussion with your insightful blogs.

    • Dr. Moffic,

      Just because a doctor is overwhelmed by the system doesn’t justify them going to the prescription pad come heck or high water.

      And if they are so pressed for time, then why do they insist on prescribing a drug even when the patient says they don’t want it?

      You know Dr. Moffic, with all due respect, I thought initially that people were very unfair regarding their comments regarding what you had written. But now I understand their frustrations.

      You keep doing the yes but routine and I find that very frustrating.

      On a related note, hospital kept making excuses why the infection rates were not controllable. Their excuse was essentially “sh-t happens in hospitals”. While alot of work still needs to be done, that attitude is no longer acceptable.

      Until you and your colleagues take the attitude that your current practices are totally unacceptable and stop making excuses as Dr. Foster did, things will not change.

    • “Overwhelm”, hm. The pharmacologist I mention above, who’s employed at my work place, uses to point out a very thought-provoking fact, regarding “overwhelm”, when it comes to psych drugs, which is that the average specialist in medicine has to know several hundred drugs and their effects on the human body. The average specialist, with the exception of psychiatrists. They only have to know about 100 different drugs, and their effects. “Overwhelm”??? I’d say that’s rather “underwhelm”.