Communication is everything.
I have been thinking about all the potential areas where this aspect of patient care could be better. Let us start from the patient end of the story, go on to the carers, medical professionals and drug companies.
In mental illness, there is no obvious pain, rash, lump, raised temperature or blood tests or x-rays or any any other obvious signs. Just the way the patient behaves and the information he volunteers. My son did not mention the word ‘suicide’ once to me or his GP. However, there are short questionnaires (Patient Health Questionnaire 9 or PHQ 9) that the patient may be asked to fill out before or during a consultation so that various aspects of his mental status can be more accurately assessed. My son saw the GP 2 days before Day 0 and for some reason he was not asked to fill out the PHQ 9, despite the fact that his antidepressant medication was doubled, clearly because he was in the acute depressive phase of his illness. The doctor could also have requested me to leave the room and asked him some questions privately as my son might not have wanted to mention some things in my presence. But that did not happen either. So, in short we did not extract as much information from him as much as we could have done. Poor communication – verbal and written.
Despite the fact that I am a doctor, I did not know how much he was suffering. He was not the type of person who would complain too much about anything. I did not know about the warning signs which are : overwhelming feelings that seem impossible to deal with, a feeling of hopelessness as though things will never get better, a sense of worthlessness, shame or guilt, sudden changes in behaviour such as more sad, tired or angry and fear of loosing control. Now when I think about it, I remember that at some point or another during the couple of weeks leading up to Day 0, he had all of these signs. When his diagnosis was made and the decision was taken for his care to continue in the community (which means, at home), no one spoke to me or my husband about the nature of the illness, the implications for the family, the resources to seek help from – no leaflets, no reliable websites, no practical advise, nothing. We educated ourselves but obviously that was not enough. He was sent home with Olanzepine and first couple of weeks good monitoring took place and then…….nothing. Very poor communication!
The only side effect mentioned to us was ‘weight gain’. A few weeks later another drug for depression was added – Citalopram. Did anyone mention any side effects? No. Guess what – ”aggravated depression, suicide attempt, and confusion have been reported frequently”. As mentioned before, the dose of this drug was increased from 10 to 20 mg a couple of days before Day 0 without any mention of side effects. Did the doctor know this himself? If so, why were we not informed? Does the responsibility of the drug companies end with putting the side effects in small print? Unbelievably poor communication!
This is not acceptable. Is it?