Tuesday, March 8, 2016

For depression, primary care doctors could be a barrier to treatment.

Featured on PBS, For depression, primary care doctors could be a barrier to treatment has a few important points I'm going to pull-out.
Often referred to as the “common cold of mental health,” depression causes about 8 million doctors’ appointments a year. More than half are with primary care physicians. A new study suggests those doctors may not be the best to treat the condition due to insurance issues, time constraints and other factors.
That’s important. Most people with depression seek help from their primary care doctors, the study notes. Why? Patients often face “shortages and limitations of access to psychiatrists,” the authors write. For example, patients sometimes have difficulty locating psychiatrists nearby or those who are covered by their insurance plans.
I can attest to this, but my experience is isolated.  For me, I'm lucky to have access to basic insurance plan through work, which would cover up to 800$ of session through a co-pay structure. I think it covers 80% of the cost. And I'm reimbursed after several days. To me, this isn't ideal. I'm sure it's fine when you don't live pay-check to pay-check, but when you do, shelling out 60-160$ for a session upfront is brutal. It's not always even possible!
The approach to depression should be like that of other chronic diseases. By and large, primary care practices don’t have the infrastructure or haven’t chosen to implement those practices for depression.” 
My experience with Dr. Rishi, and the countless folks I interacted with before, leads me to think this is very generational. Younger doctors seem to have a more inclusive view of wellness. I often think this has to do with their inclusion in that generation themselves. They know. They're part of a generation or two that has high anxiety, and for which mental health is a part of the vernacular.
“When we treat high blood pressure, the blood pressure may start at 150 over 95, and then it’s monitored over time until it gets to a level that’s being aimed for. If somebody has depression, their symptoms need to be monitored until it gets to a level that the depression is lifted.”
If we actually treat depression as a chronic illness and use the level of tools we’re using for diabetes, then we’ll be able to better treat patients — and help them live healthier lives and more productive lives."
Well... yes. It is a chronic illness. I need to be checked-in on. I need to be able to say when things are going better or worse. We need to be aware of my treatments. I need to be followed. If I stop taking my medication, I become disabled by the withdrawal. I lose my mind! When winter comes around - I have to prepare myself for a few months of an additional bout of seasonal affective disorder, and my doctor needs to play a role in that as well. 

The ultimate goal is to have a witness to my health. To be able to map out if there are cycles and methods of coping with those cyclical ups and downs that work for me. I feel that Dr. Rishi could be a partner in that, and everybody deserves that support. 

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