If All the Docs are Doing it is it not Malpractice

Part of the legal definition of malpractice includes the idea that the treatment provided falls below the accepted standard of practice in the medical community.  In other words, it must be shown that the practitioner was acting in a manner which was contrary to the generally accepted standard operating procedures that are currently being widely used by other physicians in the city in which the doctor practices.

For a malpractice case to be successfully pursued in court, the treatment must also be shown to be negligent and of course result in some quantifiable harm to the patient. But what happens if certain harmful procedures were being widely performed by almost all of the other doctors in the community? Even if the harms are predictable and significant, is a doctor protected from liability just because "everybody's doing it?"

Many mothers back in my day used to answer their kids' protestations that "other kids get to do it!" with, "If everyone jumped off a bridge, would you do it too?" I can't speak for others, but mindlessly following the herd was not something that was encouraged in my family system.

I do not know off hand what the answer is to the question above. Perhaps some malpractice attorney who happens to read this might write in with the answer. The reason I thought of this question was something I recently read in the psychopharmacology (psych drug) newsletter Biological Therapies in Psychiatry (July 2014) about how often kids are monitored for side effects when they are prescribed psychiatric medications.

Regular readers of this blog know that I think that the diagnosis of pediatric bipolar disorder is in the vast majority of cases a scam, and that prescribing antipsychotic drugs to children to control their behavior is a reprehensible activity. Kids should not be sedated into being less affected by family dysfunction.   

That would be bad enough, but what is worse is that antipsychotic drugs have potentially dangerous side effects. Particularly with the newer, "atypical" antipsychotics, there is a significant risk of causing weight gain, type II diabetes, and high cholesterol. These risks may be higher in children and adolescents than they are in adults.

If a patient is psychotic, the benefits of these medications generally outweigh the risks, especially if the patient is monitored for the emergence of these side effects. And there are few other options. (Sometimes one drug in a class will do it in a given patient, but not another drug in the same class). If patients are not psychotic, and very few kids are, the benefits decidedly do not outweigh the risks.

At the very least, the doctor should take blood tests periodically to see if these side effects are developing. You would think that doing that would be the standard community practice.

Well, if you thought that you would be wrong. 

In a retrospective study by Delate and others (JAMA Pediatrics, 2014 May 5) of pediatric patients started on an atypical antipsychotic within the Kaiser Permanente system HMO in Colorado, the authors found that only 1 patient out of 1023 received the full recommended panel of baseline and follow-up blood monitoring!

That's right; you read correctly. 1 out of over 1000, or one tenth of one percent. Of course we don't know if kids in other health plans are being treated this negligently, but I would not be surprised.

So if almost all of the doctors in a community are making little kids jump off bridges, does this mean that they are not going to be held liable if they are sued for malpractice?

Depression Suicide is NOT the answer Christians Depression and Suicide

The extract below is from my diary, written while stuck in the miry pit of severe depression. I had virtually no hope, could see no future, and feared depression would never end.

29th April 1990 -
How many other people are out there like me?
I wish I could help them, comfort them,
But I wouldn’t know how.
I don’t even know how to survive myself.
What was it that stopped me from ending it all?
Why did I persist?
Jesus was some of the reason, sure,
But even my spiritual life was in a complete shambles.

The one main thing that stopped me from ending it was my mother.
I had to keep going for her,
And for the others who cared for me.
How could they cope if I had killed myself?
I saw the devastating effects a suicide could have on a family,
And there’s no way I could put others through such an ordeal.

A common reaction if experiencing unbearable suffering such as depression, is to want to die or kill ourselves. Unable to see an end to the suffering, and not knowing how to be free from it, suicide or wanting to die may seem like the only escape route available.

This is a lie from Satan. Capitalising upon our fears and feelings of hopelessness, Satan tries to convince suffering people that death is the only way out. He tries to hide the truth from us because he wants to destroy us. We must not give into Satan; we must not give him the victory.

John 8:44 “the devil…was a murderer from the beginning, not holding to the truth, for there is no truth in him. When he lies, he speaks his native language, for he is a liar and the father of lies.”

Another extract from my diary, 14th June 1990 –
I keep asking myself, why am I still here?
Why am I still even trying?
Why don’t I just give up and end it?
I mean, is this all there is to human life?
Suffering?
Is this it?

But regardless of how hard it gets,
I can’t end it, for my mother could not handle it.
I’ve seen the effects suicide can have on a family,
And I would not willingly do that to anyone.
I feel so like Job. “Curse God and die!” my thoughts yell at me.
“Look at this suffering!
How can He be faithful,
When He’s apparently done nothing for six whole months now –
Curse Him and die!”
But God is faithful, and I know that -
It is His name – Faithful and True.

The main thing that stopped me from ending it was that I had witnessed the effects suicide has upon a person’s family, and I loved my family too much to destroy their lives by ending my own. They loved me, cared for me, and were supporting me the best they could, as were my friends. If I had taken my own life, it would have destroyed their lives by causing them to enter a depression worse than what I was experiencing. I refused to put them through that.

And as to the fear that depression would never end – that was a lie as well. I did recover. The fact is, if I had succumbed to Satan’s lies that death was the only way out of depression, I would have been robbed of all the wonderful blessings that God was yet to give me.

1 Corinthians 2:9
However, as it is written:
"No eye has seen,
no ear has heard,
no mind has conceived
what God has prepared for those who love him."

Once I came to understand how depression worked and how to recover, hope re-entered my life. During the next four years, while I slowly healed, I learnt to live with it and got on with my life. I made a lot of new friends, took up new hobbies such as writing and computer games, and joined a new church where I played the piano and taught Sunday school.

And then, when I recovered from depression, God continued to pour His blessings upon me. I bought a house, married a wonderful lady and had two beautiful (busy!) children.

Quality of life after depression was also much better than it had been before depression. Why? Because it was through depression that had I finally learnt how to deal with anxiety and panic attacks – I was finally free of them for the first time in my life! And best of all, I came to receive a much deeper understanding of God’s love for me, I learnt how to trust Him during difficult times, and I came so much closer to Jesus.

Another thing that helped me to press on, where the memories of my relationship with Jesus before I became depressed. I often reflected upon the times He had comforted me, the times I had felt His wonderful presence, and upon Bible passages that offered encouragement. Most of all, I remembered when Jesus so clearly revealed His love for me - a love so deep and touching that I had wept for joy afterwards. I focused on the fact that God is faithful and true, irrespective of my circumstances.

Ephesians 3:17-19 ‘And I pray that you, being rooted and established in love, may have power, together with all the saints, to grasp how wide and long and high and deep is the love of Christ, and to know this love that surpasses knowledge—that you may be filled to the measure of all the fullness of God.’

One thought that helped me persevere was the joy of reaching heaven and hearing Jesus say, “Well done, good and faithful servant! You have been faithful with a few things; I will put you in charge of many things. Come and share your master's happiness!” Matthew 25:23. How could Jesus say that if I had taken my own life? That is not being a good and faithful servant, making the most of the life and gifts He had given me – that is giving up!

I also kept in mind that God rewards the overcomers, those who persevere in times of trouble. The book of Revelation lists several wonderful rewards that Christ gives to the overcomers. If you have a moment, please check them out. Revelation 2:7, 2:11, 2:17, 3:5, 3:12

In conclusion, if plagued by thoughts that suicide is the only way out of depression, remember that this is a lie - there is a way out, we can recover, and we can enjoy the richness of life again.

And some advice - we need to talk to those who are supporting and caring for us, and tell them if we are having suicidal thoughts. When I confided to my mother that I felt like ending it all, she immediately arranged for me to see her doctor. The anti-depressants the doctor gave me were very effective in reducing the severity of depression’s symptoms, which made life much more bearable. So if having such thoughts, please see a good doctor and follow his or her advice.

As well as seeing a doctor, we need to get help from a professional therapist or counsellor and deal with the underlying issues that are causing the depression. I also recommend reading “Self Help for Your Nerves” by Dr Claire Weekes. It was after reading this book that hope returned to my life.

And most of all, we need to cling to, rely upon, and trust in Jesus. He will not abandon us if we turn to Him.

If no one is available and you need to talk about suicidal thoughts, please talk to someone at a suicide helpline. Here is a helpful listing of such helplines available in a number of different countries.

All verses from the NIV.

The picture is worth

First, I just need to mention this, because it's pretty cool:

My work is going to be translated into German! Woohoo! Kathleen is amazing with the foreign rights stuff. She's off in Italy now, in advance of the Bologna Children's Book Fair. I am jealous--but only because she's in Italy. Not because she has, and I do not exaggerate, 72 meetings she will be attending during the fair.

NOW, last week I posted my Sarah Fine author pic. I say it like that because I also have an S.E. Fine author pic which has yet to be unveiled. Kathleen told me I needed two different photos. SCAN is a thriller, whereas SANCTUM is an urban fantasy. Two genres, two author names, two pictures. Both photos were taken by Rebecca Skinner, who is now my favorite photographer ever.

But SCAN comes out in fall of 2013, and SANCTUM comes out in the fall OF THIS YEAR OMG OMG, so bemusedly-standing-amidst-the-rubble is my persona of the moment. It's ideal for the story, because the bulk of SANCTUM takes place in a vast, desolate city, full of dark alleyways and abandoned buildings, a bunch of hollowed-out, unhappy people, a crew of mischievous and seriously evil creatures, and a cadre of indentured Guards charged with keeping things under control. At one point a character actually does huddle against a large pile of rubble. Yay, rubble!

*ahem*

So! I asked you to caption my photo, and you folks did not disappoint. I had so much fun last week, with all these enormously witty comments popping into my inbox. As promised, I entered all commenters into the random number generator, and the winner of the $25 Amazon gift card is:

Michael Di Gesu!

Michael's entry was also quite fitting, and captured the way I think about a lot of these abandoned buildings and lonely, desolate locations, places that snag and hold my attention more often than not. His caption also happens to be perfect for SANCTUM itself, in which the main character finds herself falling for a guy while trapped in that terrible city I just described.

Michael's caption: "There's beauty in the least likely of places ..."

Thank you, Michael, and thanks to all of you who played along, and for all of your generous compliments!

Now, because it's Monday, please go visit Lydia to read her Medical Monday post, and Laura for her Mental Health Monday post!

Addict Cleans Up THEN is Shunned by Family

An interesting letter appeared in the advice column Dear Abby on 11/30/14:

DEAR ABBY: I am a former drama queen and addict now enjoying long-term sobriety, or trying to. What's missing in my life is my family. Since returning from rehab, I have been "going it alone" -- and I'm not sure why. My kids are the only grandchildren in the family. I work and go to school. I am pleasant. There have been some rough spots I have had to deal with, and when I have needed to, I have called my mom or sister, but they don't call me or visit. They have expressed no love for me through all of this. When I call, I feel like I'm intruding. Aren't I entitled to their love and caring? I feel abandoned. It's hard doing things on my own. My family lives close by, so distance isn't the issue. What am I missing? I want my kids and me to have a family, but when I try to reach out, I end up hurt by their lack of interest. Should I just get on with my life? I have been going through this for years. -- MOVING ON IN FLORIDA

DEAR MOVING ON: It's possible that the "drama" and turmoil you put your family through while in the throes of your addiction is the reason your mother and sister avoid you. They may be reluctant to take a chance again. Because they have made it plain that they aren't interested in a closer relationship with you and your children, you should absolutely get on with your life.

Abby's response was predictable. There were also several comments on the website from the public about the letter, and the commenters were more or less unanimous: the letter writer had probably "burned her bridges," the family probably got sick of giving her one chance after another and were burned out, etc. etc. 

After all, as another commenter opined, "Addicts hurt a lot of people and cause a lot of problems." The family's response is due to their need for "self preservation." The writer probably used to call them "only when she needed something."

These responses were in fact so predictable that the letter writer herself undoubtedly knew what she was going to get. She was setting herself up, and making herself look bad while all the while criticizing her poor family. The criticisms of the family did not go over well at all with Abby's readers. With her criticism the writer was in fact garnering sympathy for her family, rather than making them look bad. She had to know that would happen.

The burning bridges thing probably contains an element of truth. But more likely a half truth.

How did this former drama queen/addict turn out the way she did in the first place? Wasn't she in fact raised by the very family that is now shunning her? How many chances did they give her before giving up on her? When she was actively using did they get involved with her over and over again?  Enable her? Try to "rescue" her?

Notice that she identifies herself as a former drama queen. Where did that label come from? Is that what everyone in her family would call her over and over again until it became a role she would play in order to confirm their opinion of her? 

Was she in fact the only one in the family who had been expressing feelings that everyone else was stuffing? Was she the identified patient, as  family systems therapists call such folks, who gets all the blame for a problem shared by the entire family?

And most importantly, did they abandon her only after she cleaned up?

Inquiring minds want to know the answers to these questions before passing judgment.

This is a counter intuitive way to look at this. I understand that. But when the whole story comes out from patients in therapy, the answers to my questions are often yeses. Respected interpersonal theorist Lorna Smith Benjamin describes an analogous dynamic in which she lists two of the four characteristics she has observed in families that produce offspring with borderline personality disorder (BPD) - who often share many characteristics with both drama queens and addicts:

1. Parental love and concern is elicited only by misery, sickness and debilitation

2. Family chaos - The borderline individual is subtly blamed for problems or expected to exert control over them.

(The other two characteristics:  3. Episodes of traumatic abandonment are interspersed with periods of traumatic over-involvement, and 4. Efforts by the person with borderline disorder to establish autonomy are interpreted by the family as indicated disloyalty).

What may be happening in the case of the letter writer is that her family needs a black sheep, and she was elected to play the part. Because she finally stopped playing the part, they then shun her. In this situation, they would be in effect be punishing her for not being who they need her to be. However, they would also be helping her out in a strange way - by protecting her from their own pernicious presence. As Dr. Benjamin has also said, pathological behavior can be a gift of love.

This could be the real answer to the letter writer's question.

3 Diseases More Terrifying Than Ebola Trigeminal Neuralgia is Listed!!

This video is a must watch. Trigeminal Neuralgia is listed as number 3!!