New research reveals that patients are often not given fully informed consent before being prescribed antipsychotics. The article, published by the Journal of Mental Health, reports on the challenges and realities of the prescribing process of antipsychotics (APs) for people with psychiatric diagnoses.
The article is written by John Read, professor of clinical psychology at the University of East London. Read examines how APs are prescribed from the perspective of patients:
“Even allowing for some forgetting by the respondents of what they were told, it seems the majority of prescribers are breaching the basic ethical principle of informed consent. The fact that hardly any of the 757 people were told about diabetes, sexual dysfunction, suicidality, potentially shortened life span, neuroleptic malignant syndrome (which is a life-threatening reaction to APs involving rapid onset fever and muscle rigidity), and none were told about withdrawal effects or reduced brain volume, might reasonably be described as negligent.”
The relationship between doctors and patients is a crucial touchstone to the service user’s perception of healing and betterment. Unfortunately, however, previous research indicates that prescribers rarely share the risks of taking and discontinuing psychiatric medication with their patients: what the adverse effects are, when is the right time to discontinue, and what withdrawal feels and looks like. These risks may be especially pronounced for antipsychotics.
One explanation is that the prescribers, too, are unaware of adverse effects, how to distinguish between withdrawal and relapse, and how psychiatric medications work. However, another explanation is that prescribers may feel that sharing psychiatric medication risks may deter patients from taking it or negatively affect outcomes.
An online questionnaire titled, The Experiences of Antidepressant and Antipsychotic Medication Survey, was disseminated via an online research company and social media. The inclusion criteria were: ‘I have been taking or have previously taken antipsychotic medication continuously for at least one month’; ‘I am aged 18 or older’; and ‘I am not currently compulsorily detained in a psychiatric hospital.’ Of the 2,346 individuals who responded to the survey, 757 were included in Read’s analysis.
Of those included, the majority of respondents were women (69.0%), with most hailing from the United States (71.5%), while the rest of the respondents were from 29 other predominantly white countries, e.g., Australia, the United Kingdom, New Zealand, Ireland, Denmark, Norway, and Spain. Six-hundred sixty-three (663) respondents provided their primary diagnosis. About 30% of respondents received a diagnosis of Schizophrenia Spectrum and Other Psychotic Disorders whereas about 28% were diagnosed with bipolar disorder and 25% a ‘Depressive Disorder.’ The remaining respondents received diagnoses of trauma, stress-related, or personality disorder (8.4%).
The participants were asked the following questions:
- “Did the prescribing doctor tell you how the antipsychotic medication works?”
- “Did the doctor inform you of any possible side effects?”
- “Were you offered any other treatment options to consider as alternatives or additions to antipsychotics?”
- “When you were first prescribed antipsychotic medication, how long were you told you could expect to take it for?”
- “How would you describe your relationship with the doctor?”
- “Overall, how satisfactory was the initial prescribing process for you?”
Each question produced notable results: in particular, 75.7% of respondents replied ‘no’ to the question, “did the prescribing doctor tell you how the antipsychotic medication works?” and those that responded “yes” articulated that they were told it alters or fixes a chemical imbalance in the brain.
In response to the question, “did the doctor inform you of any side effects” participants were most likely talked about weight gain and drowsiness/sedation/tiredness. But 70.5% were not told about any side effects, even though many are life-altering, such as diabetes and reduced brain size.
Meanwhile, about two-thirds of respondents (roughly 65%) were not given other treatment options. Those that were offered alternatives cited other psychiatric drugs, with women far more likely to be offered another prescription. Others remembered being offered a form of therapy or counseling; 29 participants mentioned electroconvulsive therapy (ECT) as another treatment option.
Over 70% of respondents were not told how long they would be on the medication or were told they would be on it indefinitely, and this was especially true for those with a psychiatric diagnosis.
Overall, Read found that the satisfaction with the doctor-patient relationship and initial prescribing process was low, especially if the participant had a psychosis diagnosis.
Notably, of those who were in the minority, that is, they were included in the prescribing process and given information about the side effects of their respective medication and given an understanding of how the medication works and for how long they ought to take it actually reported that the medication was more efficacious.
“Prescribers may fear that informing people about the adverse effects of APs would decrease the chances of their taking medication, thereby negatively influencing outcomes. This is a reasonable explanation given that few people would take something if told it might cause diabetes, reduced brain size, and shortened life span; but it is not an excuse for unethical practice. Psychiatrists may be reassured to hear those participants who were informed of adverse effects reported better outcomes.”
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Read, J. (2022). How important are informed consent, informed choice, and patient-doctor relationships when prescribing antipsychotic medication? Journal of Mental Health. (Link)
With such high-risk drugs, it seems unconscionable that so few doctors provide information about neuroleptics. Another angle on this issue is the fact that they are often prescribed off-label and I wonder how many folks so prescribed for issues such as insomnia are told that the drug is, in fact, an “antipsychotic” and has all of these risks…
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making people brain injured is profitable
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….and constitutes genocide….
PhRMA & Psychiatry are literally genocide-for-profit….
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“One explanation is that the prescribers, too, are unaware of adverse effects, how to distinguish between withdrawal and relapse, and how psychiatric medications work.”
Every doctor – including the psychiatrists – is taught in med school that the antidepressants and antipsychotics can create psychosis, via anticholinergic toxidrome. So we know the psychiatrists are NOT ignorant of this fact.
But I do agree there does seem to be a staggering amount of ignorance and/or denial – on the part of the psychiatrists – as to the adverse effects of their drugs, how to distinguish between withdrawal and relapse, and how psychiatric medications work.”
An example of this ignorance is the fact that none of the “mental health” workers I worked with knew that “brain zaps” was a common symptom of antidepressant discontinuation syndrome until 2005.
https://www.cambridge.org/core/journals/psychiatric-bulletin/article/brain-shivers-from-chat-room-to-clinic/642FBBAE131EAB792E474F02A4B2CCC0
Many thanks to John Read for his truthful research.
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“Prescribers may fear that informing people about the adverse effects of APs would decrease the chances of their taking medication, thereby negatively influencing outcomes”.
Yeah. As if wanting to prevent someone from avoiding losing 1/10th of brain weight, one quarter of life, developing obesity, sexual dysfunction, emotional and intellectual suppression, as well as tardive akathisia and dyskinenisa is totally sensible and benevolent.
Scrap that.
Psychiatrists may not be evil, granted, but they are (the vast majority) bloated infatuated self-interested and delusional ignorami blithely addicted to their (enormously destructive) power.
They certainly dont do it out of benevolence.
This sentence is nothing but damage (and criminality) control.
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“Negatively influencing outcomes?” Don’t they mean “Negatively influencing profit margins?” As far as I can tell, outcomes for most any “mental illness” you define either remain the same or get worse with long-term “medication” (aka drugging). Stimulants, antidepressants, antipsychotics, all are associated with either no change or deterioration over time when used long term. Not to mention killing people off 20-25 years younger with the antipsychotics, hardly an “improved outcome!” How do the doctors get away with this nonsense?
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Because they have far too much power in the western world. Not only that but they are the incarnation of the good guy for the layman so they can get away with a lot of things. They basically have a concentration of impunity factors.
I really think this is a hefty problem that is a bit overlooked.
The million dollar question is of course how could an other system curb this “accountability void”? I really think society should dwell on that, but a lot of people are attached to the good guy doctor can’t do wrong image, not the least of course being the drug cartel.
Wearing the garment of good is the most comfortable way to dabble in evil.
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I hate this mentality that doctors and nurses are heroes and can do no wrong. It is what enables them to do great harm to so many people.
Let’s face it. They are not a hero. They are far more likely to push me in front of a train than jump in front of a train to save my life.
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Unfortunately, failing to tell patients about the side effects of any drug is probably common. Physicians also often fail to discuss basic information, like how likely the drug is to help the patient. When doctors prescribe exceptionally toxic drugs like antipsychotics this failure to inform should be considered malpractice. But of course it isn’t.
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I agree. Even when you ask they down play the side effects. I asked about one drug’s side effects and was told it didn’t have any bad side effects. I was told most patients just have pins and needles. 1) I thought clearly my doctor has never experienced paresthesia because if he had he would have considered it a bad side effect 2)if it cause paresthesia (pins and needles) what other side effects does this drug cause…I looked it up and common side effects (meaning occurring in more than 10% of patients) included liver necrosis (liver death) and death. I never took the medication. My doctor wanted to use it off label for Sjogren’s.
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psychiatrists…tend to view little things, such as “democracy,” “human rights,” and “quality of life” as rather….inconvenient. 🙁
I really don’t understand it, at all. Most shrinks do med checks, now. What’s the incentive to push people to pop major tranquilizers, especially since now many of the “atypicals” are generic or not far from going off patent? hmmm…
worth noting that -most- psych drugs dampen emotions, reduce cognitive abilities, and overall…impair the aspects of our being that we need the most when suffering. the neuroleptics are on the extreme end.
maybe its because to be psychiatrized is to no longer matter (socially), if one ever mattered, at all? label-drug-done. I think the social function of the psych guild is more about the labeling and invalidating. the drugs, talk, what have you…not the real “point” of society permitting psychiatry free reign, from my perspective.
ugh. “informed consent” hard enough with those practicing in valid branches of medicine. psychiatry? pshaw. 🙁
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The basic approach of psychiatry is to suppress the brain’s abilities and to impair normal functioning. Kind of like, if your hand hurts, numb your hand. If that doesn’t work, remove it. There is no effort to actually determine WHY your hand hurts or what else might be done. If “depression” is the problem, then the “answer” is to make the person less depressed. So “antidepressants” are the way to go. The idea that a person may have a good REASON to be depressed, or that some other physiological problem is causing it, doesn’t appear to be a relevant concern of theirs.
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Nowhere in the 1000 page DSM 5 does it obligate the psychiatrist to ask the person if they were sexually abused in childhood. Or emotionally neglected, or the other 8 ACE questions. As you say, there is no effort to understand what psychological injuries caused your severe emotional pain.
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One could almost say there is an effort NOT to understand the cause of severe emotional pain. My experience as a provider was that it was rare that most “clinicians” asked such questions, or if they did, they’d simply “catalog” them along with other “symptoms” in order to claim a “diagnosis.” Very few seemed to understand the significance of such events, and of those who did, most didn’t really know what to do about it. I used to say there’s a one in five chance of getting a competent therapist. Nowadays, I think that would be a gross overestimate!
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Both the pill (and shock…and tms…and occasionally, operations…) pushing branch of “mental health” and the “talking” sections (counselors, psychologists) seem to be focused on sort of “care” that Szasz terms “cruel compassion.”
One needs the pills because of the labels the “experts” have decided upon. The lower one’s status, the more “severe” the label/”diagnosis,” the more damaging the pills, especially over the long haul. That is not only acceptable to the “experts.” it is…
to be accepted by the psychiatrized, too, as part of his/her slow-motion march towards destruction, destitution, and (based on data…) early death. Clozapine, for instance, is ridiculously toxic, but even now is heralded as something of a modern day “miracle med.” Clozapine patients are lauded for “adhering to treatment,” with the implication that these suffering souls endure all sorts of toxic ill effects to control their “severe illness,” blah blah blah. This is an extreme example of telling the (often, understandably miserable) “depressed” patient to “wait it out” on the latest wave of “antidepressants.” Apparently, “treatment is effective…,” but also often (quite) unpleasant. Beating back the evil monster of “depression” is worth the often dangerous adverse effects, especially in the first 1-4+/- weeks, because…”they” say so. 🙁
but yeah, shutting up the “sick” and dehumanizing and often destroying the “sick” is what (often never ending) “treatment” is all about, even with the branches of the industry that claim to focus on psychotherapy, counseling, all that.
Honestly, I think the talking parts of the guild are sometimes -more dangerous- , because their labels are then used by the psychiatrists, psych hospitals to create a never ending cycle of labels, stigma, fraud, and destruction. And then…
-social class- many of the counselors and psychologists I’ve encountered seem to be in somewhat less than secure positions. The counselors are often at the fringes of what’s left of the respectable middle-class, and that seems to be a -huge- problem, at times. Psychologists tend to have more advanced degrees, more resources…
which often makes them even more dangerous (upper class, not as solidly upper class as psychiatrists), as their toxic labels and pseudoscientific “wisdom” is regarded as especially “insightful,” etc. blah. 🙁
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There is no such thing as informed consent. I went to the Emergency Department last November for a GI bleed and abdominal pain. They decided to give me a drug to help with my “anxiety and nausea.” I told them calmly that I wasn’t experiencing anxiety or nausea. I asked what the intravenous medication was called. They refused to tell me. I found out from Medicare I was given a neuroleptic. Shortly after injecting me with this neuroleptic, I immediately started having breathing issues and I felt extremely hot. Those were listed on the drug monograph as tell your doctor immediately if you are experiencing these symptoms. This neuroleptic also has a black box warning for prolonging the QT interval. I never should have been given this drug because some of my previous EKGs had showed I had a prolonged QTc interval. My mother could tell I was in distress and asked the doctor what I had been given and he blew her off. So informed consent…I think not. It is not informed consent when patients are not told what they are being given, even when the patient directly asks.
Doctors and nurses are reckless and it is time society holds them accountable. Throw them in Psych Wards and give them the same negligent care they give patients. Forget to feed them for days. Give them neuroleptics. Gaslight them. Tell them they are not experiencing hunger or any symptoms they complain about. See how they like that type of treatment. On a side note: that would make for an interesting experiment.
I can honestly attest that it is horrible when they gaslight you and make you doubt whether you have an infection. Then the infection spreads and requires surgery and intravenous antibiotics. Then you have to explain how so many doctors failed to give you care. It is so uncomfortable because the underlying message is that I somehow failed as a patient.
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(#1)-“One explanation is that the prescribers, too, are unaware of adverse effects, how to distinguish between withdrawal and relapse, and how psychiatric medications work. However, another explanation (#2)-is that prescribers may feel that sharing psychiatric medication risks may deter patients from taking it or negatively affect outcomes.”
Gosh, those well-meaning, befuddled prescribers….
This article is the apex of cynicism regarding the industry’s possible ‘reasons’ why they don’t practice fundamental informed consent when drenching clients in dangerous drugs, knowingly placing clients in harm’s way & chemically co-ercing compliance.
This topic has been exposed, examined, & condemned by ETHICAL medical professionals for decades…as CLIENTS (stripped of credibility by diagnoses) have shouted it from the rooftops.
Here’s the ‘answer’ to the disingenuous “Gee, how could this be occurring…?”
Full Moral Status is canceled by ANY mental health diagnoses. FULL STOP.
It creates an unobstructed ‘lifetime’ revenue stream with a reduction of cost & liability…(“we know what’s best for u”) from clients who have had credibility nullified by the culture & the with the court’s (!) blessings…an All-Access pass for psychiatry, no apologies necessary.
All this wide-eyed ‘questioning’ is easily answered by the AMA’s UN-willingness to clean it’s own house….and the APA will NEVER bite the ‘hand’-Pharma’s-that feeds them.
I thought we learned how this kind of cultural & financial power works with the Catholic church, enabling sexual predators…rarely charged or punished by the legal system…and continues.
Our culture sweeps the “mentally ill” off the table, into a white noise bin while sanctimoniously parroting pharma’s mkting…”No stigma, get help” The “help” is drugs, of course. It turns internet, PRESCRIBING ‘therapists’ into friends with ‘likes’.
Pharma’s business model is brilliant and playing the long game. Only downside is not killing the ‘host’, as all effective parasites instinctively know. It’s a tricky balance as we saw with Oxycontin. And barely moved the population’s awareness meter. But the TV series was good!
Psychiatry won’t protect the ‘marks’….the powerful, overarching medical paradigm won’t censor their own.
And states continue to block public access to complaints & charges regarding malpractice & ‘mistakes’…the latter #3 in U.S. cause-of-death.
Nothing new here. Just more suffering & damage & death.
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“Unaware of adverse effects” is absolutely no excuse – if they don’t know the adverse effects, they have no business prescribing them! And the truth is, most know enough about the adverse effects to know they’re not being honest when they prescribe. I believe point #2 is the main reason – they don’t want the truth to get out because many of their clients would then refuse to take what they prescribe, and that will cost them in some way or another. It’s quite intentionally dishonest.
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About those negatively shifting outcomes, well what is expected anyway? No one claims that any of these drugs actually cures an illness. Is a good outcome a quiet patient who is now a lifetime source of income?
It’s been pointed out before: An effect of Seroquel is diabetes, and the manufacturer of Seroquel also manufactures treatments for diabetes. Add to this the fact that most prescriptions for Seroquel are not for psychosis but for off-label sales, and we have the perfect business model.
Here is what a psychiatrist said to me: “There is a new drug for insomnia; it’s very mild. it just makes you sleepy”. The same guy said: “The most that will happen when stopping Xanax is three nights of trouble sleeping”. He said that while looking at a person visibly quaking in withdrawal.
We may want to give the benefit of the doubt and say that that guy just didn’t know. The problem: he knew or should have known because he is a licensed prescribing-psychiatrist who does see the results of his work. And who is “in denial”?
This same doc, who claimed no problem with withdrawal from Xanax, then immediately wrote a prescription for an effect of withdrawal from Xanax. Yes, he really did that.
It often is claimed that a physician is better informed of treatment consequences than are we. I think not. We go to the source and Look it up. Was this doc absent on the day when drug monographs were taught?
There is informed consent, and then there is misinformed consent.
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Hi Bananas,
I’m writing an investigative story on antipsychotics and diabetes. I’m looking for folks who took Abilify, Zyprexa, or another med for any reason (including depression, sleep, ASD, dementia) and then developed diabetes or other serious metabolic issues. I wonder, do you or someone you know have experiences with this issue?
This is happening more and more but rarely discussed. I’m hoping to find a range of sources from pediatric to elderly to show the scope of the problem.
I have experience working with sources on sensitive mental health topics. I’m happy to protect your identity if needed. I’d love to know if you’d like to connect.
All my best,
Sunny
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You are CORRECT, Mr. McCrea! I see your bet, and raise you 1. The title of this article contains a glaring error. It SHOULD READ:
“Anti-psychotics Are NEVER Prescribed With Full Informed Consent.”….
If I knew then, what I KNOW NOW, then I would NEVER have been taken to that quack shrink in 10th grade by my parents. NEVER got the bogus, imaginary “diagnosis”. NEVER got the Rx for potent neuro-toxins. NOIT WASTED the next 20 – 25 years of my life…. Psych drugs actually CAUSED MOST of my so-called “symptoms”…. The longer I saw psychiatrists, the more psych drugs I took, – AS PRESCRIBED, – the crazier & more dysfunctional I became…. The booze I drank on my own was bad enough. The few illegal “street drugs” I experimented with were not so bad, and easy to recover from. But it was the legal, prescribed neuroleptics that damn near killed me at least 3 times, once on a toxic withdrawal, and once when I went toxic due to accumulation, because the local CMHC never checked my blood levels, as they should have done…. Psychiatry & psych drugs, have done, and continue to do, FAR MORE HARM than good….
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I know this article addresses psychiatrists and their failure to tell the patient the truth about the adverse effects of the antipsychotic drug or drugs or even if there might be what the medical community calls “Contraindications.” But sadly, this also happens in traditional medicine. My mother was prescribed a different thyroid drug that interacted with the blood pressure drugs she was taking. The thyroid drug and the blood pressure interacted so adversely that she began to have trouble seeing and this occurred while she was driving. Was the doctor unaware? Could the pharmacist not see it? I don’t know. But the lack of ethical sensibility in prescribing drugs and explaining the side effects or considering the interaction between/amongst other prescribed prescription drugs is dangerous and tragically is no longer confined to just psychiatry. It is obvious that the influence on psychiatry is far beyond psychiatry and its influence has become very dangerous. Thank you.
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A doctor almost killed my father when I was 8, as he was taking blood thinners (which he reported to the doctor) and was prescribed something that created uncontrollable bleeding when combined with blood thinners! His arm bruised if he just set it on the table. If he’d fallen off a ladder or been in a minor car accident, he’d have bled to death in minutes. I learned at that young age never to take ANYTHING I hadn’t personally looked up for adverse effects, no matter what the doctor told me.
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(#1)-“One explanation is that the prescribers, too, are unaware of adverse effects, how to distinguish between withdrawal and relapse, and how psychiatric medications work.”
This statement is insulting and obscene.
How did they qualify for a prescription pad? All they have to do is read the side of the box.
That’s like saying a radiologist isn’t aware of the dangers of radiation exposure….
I sat in waiting rooms and ‘group’ for 10 years and ‘adverse effects’ were the main event…nobody was spared. By year 9, I was a staggering, drooling, head lolling, air gulping, glassy-eyed, balding wreck dragging 85 extra pounds around and trailing my hand along hallways to stay upright. At my 10 minute med-checks, Stevie Wonder would have noticed.
If Pharma told/paid them to prescribing cat urine, they wouldn’t think twice.
#2-Justifying oneself to a ‘mentally ill’ patient is NOT what psychiatry does. They don’t have to. I was NEVER more stigmatized than in those offices. My cat’s vet had more compassion & concern.
But technically speaking……
Not knowing how psych meds ‘work’ or concern about thei client’s welfare speaks to the continuing, decades long, official, evidence-based, APA policy of….
‘So f*cking what?’
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Ignorance or malfeasance or a combination of both, it doesn’t matter much to the client/patient/victim, they’re still harmed just the same. If they don’t actually know the adverse effects, they should not be prescribing it. It’s like saying, “I didn’t know guns shot bullets.” PUH-LEASE, take a little responsibility, medical folks!!!
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thank you, Krista Hartmann. 🙂
I’m fairly certain all doctors who play their hand at acts of psychiatry know what they’re doing, just as Krista Hartmann pointed out.
Notice: the “antidepressants” are “safe, effective treatment” for “depression…” and also “help” with: “ODD,” “anger management,” vexing “patients” labeled with some flavor “personality disorder…”
on and on and on. Its hard to argue that MD/DO providers (and the vast majority of the underlings, too) are unaware of all this when they openly talk about giving people antidepressants for “head pressure” and something like 2/3 of antidepressant prescriptions from the general practitioner/family doctor realms are handed out -without even bothering to establish a dsm-label- to justify ongoing treatment.
Szasz writes of a Pharmacracy, in which we the “patients” get the pills “we deserve.” The pills one “deserves” depends upon a number of variables that themselves change based on location, the providers’ demographics, on and on….but…
it -does- appear that the lower status one is, the more noxious and downright poisonous the “treatment” becomes. And that’s just the pills. That doesn’t include the non-stop lies and labels from the talking sections of the guild, the periodic confinement in “hospitals” and then often in jails, even prison (Szasz–yes, again– writes of prisons as the place to best truly see what psychiatry is really all about…), and…
rambling, sorry. The mental health industry is itself so damaging and wicked that it should simply be abolished. “Antipsychotics” — the best selling “medications” that are so toxic and unpleasant that the industry is now putting them in LAI (long acting injections), just like the old Haldol and Prolixin drug-induced Parkinsonism depot shots — are not even “antipsychotics,” as many articles on MIA and various posters here have pointed out, already. They are neuroleptics, tranquilizers with such unpleasant effects on mood, outlook, and behavior that they are routinely used as -punishment- by all those “experts” who engage in acts of psychiatry, both “voluntary” (really? is there such a thing?) and (truly, openly, obviously) “involuntary.”
the whole thing is truly ridiculous and infuriating. Today’s “mental health treatment” — drugs into people, talk is optional — is the sort of “treatment” that poor and/or low(er) status people/”patients” have -always- received. My growing, personal concern — and I’ve heard this from other people, at different strata of society — is that the label-drug-out the door approach to “mental health…”
is also the standard approach to -most- healthcare in these united states. and Pharmacracy is bad enough dealing with real pills for fake diseases…
what is happening when the “pills one deserves” means that only “good patients” can get quality, truly helpful, healthcare for -valid- health conditions? -shudder-
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My thoughts are along the lines of they are the ones living in a world of delusion, perhaps even the label psychotic could not be discounted. The choices that a psychiatrist faces daily is surely to cover up or not? More often than not it’s cover up what they know. They begin by learning as doctors, and so understand the basics of ailments. Next, when the training process is to branch into psychiatry, they learn (almost all) to forget the basics and to simply label and prescribe. For instance I had a cholesterol outside the normal range, twice, for the first time in my life while on psych drugs. I was told both times that result is nothing unusual, do nothing about it. Yet atherosclerosis has a direct connection with high LDL cholesterol, is responsible for being killer ( a sudden, no advance warning killer) number one, (heart attack) costs per person for surgery medical
treatment add up to $1 million in a lifetime. It must surely be the first thing they learn, and should be the last thing they forget!!
Somehow there is a wagon unhitched to the Healthcare train alright. I thought that would be an obviously unhealthy outlook for a nurse, doctor etc. to ignore the potential symptoms of the number one killer of people. Are they alright? To expect informed consent you have to make them uncomfortable. That what they don’t do is illegal, they can and do ignore their obligation to the patient, that is the “norm” in their world.
If they really cared there would be a lot more apology, a lot more patient freedom, a lot more admission of what they don’t know. In my view also a lot more recovery.
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