A 47 year old man walks into a psychiatrist's office and complains of low energy, poor sleep, apathy, lack of appetite, disinterest, and a general sense of malaise. The psychiatrist thinks, "Depression." and prescribes a suitable medication. Good call. But what if it's not?
Had this same gentleman come into my office, I would have thought the same thing. I certainly would have handed him the name and number of one of the (very few) meds managers whom I trust - but I also would have suggested that, before he called, he go to his PCP and get a stress test. Depression in a middle-aged man with no history of said just screams cardio-pulmonary distress.
The other day a friend of mine mentioned in passing that anemia mimics depression. Interesting - I pride myself on being something of an interdisciplinary polymath, especially when it comes to diagnostic profiling, but that was a new one on me.
Later that day I saw one of my clients who has a whole host of medical conditions on board. Lately, she been struggling with a surge in her depression and both her neurologist and her psychiatrist have been tweaking her meds, with little success. Recalling that previous conversation, I suggested that she go to her PCP and get some blood work done. The verdict: morbid anemia. What do you know?
Last month one of my more profoundly disturbed patients was complaining of a marked increase in depressive symptoms, which is not good because her down cycles tend to exacerbate her schizoaffective symptoms and paranoia. Her meds manager, a brilliant APRN with whom I would trust my own children, told her, after unsuccessfully messing around with her meds for a few weeks, to go get some blood work. The verdict: mono. What do you know?
The point here is that just because it looks like a duck, sounds like a duck and walks like a duck doesn't necessarily mean that it's a duck. Not getting hung up in own agendas - or, worse yet, someone else's - or trapped by our own expectations is important for all of us, every day, true, but it is of special importance for those of us on the receiving end of diagnostic and intervening medical services. You know yourself better than anyone else. Not taking things on faith, or as an FBI agent friend of mine likes to say, "Trust - with verification." could literally save your life.
© 2009 Michael J. Formica, All Rights Reserved
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