Antidepressant

Once upon a time, patients were less informed about the different kinds of medical conditions, much less the treatment advised for certain medical conditions. Nowadays, medical information is so ubiquitous with the internet accessible to anyone all within a pocket’s reach.

I don’t mind patients learning about their medical conditions through the internet, and coming up with questions to ask me in regards to some medical conditions. In fact, I welcome patients reading and learning about their medical conditions. What I do mind however, is the patient who relies solely on the internet, and believe this information is a substitute to the doctor. Dr Google in essence can help treat the patient’s medical condition, and all they need to see the doctor for is so that they can stamp a prescription that Dr Google has advised them they may need for their (potentially misdiagnosed) medical condition.

I have had one argument with a patient in regards to this very same issue.

One patient stands out, just in the fact of how ridiculous his demand was. He was in his 40’s, and had been on sertraline for his depression, having been started on this by another GP at my practice about 3 months ago.

“Doctor, I’ve come here for some more antidepressants. But that last one I had been given is really causing issues with erectile dysfunction. I looked up information about antidepressants, and I want to get some bupropion since it has less side effects of erectile dysfunction. Actually, the last GP that saw me even advised that I could get some bupropion in the next visit.”

I look through the past notes of his last visit, and note no mention at all about use of bupropion. I am confused in fact. Surely, bupropion is only used for smoking cessation from memory? The fact that the patient has brought this up makes me feel like I may have not learnt about the “antidepressant” properties of bupropion.

“I am fairly certain that bupropion is not recommended as a suitable antidepressant as per the guidelines, but I will double check to make sure. ”

I google bupropion, and confirm that it is definitely used for smoking cessation, and it is not used as an antidepressant.

“Having looked up the information and guidelines, bupropion is only used for smoking cessation and not used as an antidepressant. Unfortunately, I am unable to prescribe bupropion for you to use as an antidepressant.”

The patient glares at me. “I don’t understand, the previous GP said he would give it to me. Why don’t you just prescribe it to me?”

“I cannot prescribe it because it is not used as an antidepressant. I have no record in the past notes ever documenting that the previous GP recommended use of bupropion as an antidepressant either. ”

“Are you for real!!!?? You had to look up this information on Google. All you have to do is just write me the script! It’s that easy!”

“As I told you, the medication is not suitable for use as an antidepressant. I am happy to prescribe your previous antidepressant sertraline however.”

“I’m going to report you!!!!!” And with that, the patient left the consult room.

What I learned from that experience was to never let a patient pressure you into doing things just for the sake of keeping them happy.

I think at my current practice, there is going to be a whole lot of such patients who think that a 10 minute Dr Google search┬ácan replace the extensive medical training and clinical experience that I have acquired over the last 8 years. I don’t mind patients looking up information to get a better understanding of a certain condition, but I just hate it when they use that information as a substitute for proper professional medical advice.

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When You Don’t Know, Just Say “I Don’t Know”

In the practice of medicine, there are a lot of things one doesn’t know. Even though medicine in the 21st century has come a long way from the practice of medicine in ye olde 14th Century, there are still lots of things that in general, medicine does not know or does not have an answer for.

The thing with dealing with your seniors as a junior doctor, is that they will press you on knowledge. You’ll be quizzed about things eg “what interleukins are responsible for fevers?” and the such. The senior doctors will naturally have the answers, since that’s why they asked you the question right? For me, I’ve gone through several embarassing moments of trying to “fudge up” the answers. I guess a part of my nature, is that I’m competitive, and don’t wont to be seen as ignorant, but that competitive nature makes me look foolish when I’m called out on my “fudged up” answers.

Saying “I don’t know” in medicine is perfectly acceptable, especially since medicine is full of uncertainties. Saying “I don’t know” means that you are recognizing your own limits of knowledge, and just because you don’t know now, doesn’t mean that you won’t know forever.

I was told that the only certain thing in life, is death. So too in medicine, the only certain thing is death as well. But the point of medicine, is to try and prevent this certainty occurring to the best of our abilities.

So, it’s perfectly ok to not know something, provided you are taking steps to know it later on, and to retain that information in your database. What you don’t know now, you’ll soon get to know. It’s about growth of oneself, and the ability to recognize our limits in medicine.