Disagreeing with MD Treatments

[nicholaa2]

I have become so frustrated lately because it seems like many of my patients are not being appropriately diagnosed or treated.

I know I'm not a psychiatrist and of course do not have the ability to diagnose, but when I have long-term patients (100+ days) and repeated frequent fliers in an "acute care" treatment facility, I can't help but begin to think these patients are being played for monetary purposes and insurance billing.

I work on an ECT floor, and I always thought that ECT was typically left as the last resort measure for treatment, but I see people being admitted for their first psych breakdown, and the doctors are often in a huge a rush to get them to agree to ECT without even attempting medication stabilization and therapy.

I see patients getting ECT that suffer from dementia/Alzheimers/are 85+ years old, and I am told they get ECT only to control their level of violence/agitation.

I see people who clearly are borderline or another personality II disorder and they too are getting ECT with NO IMPROVEMENT after weeks and weeks of treatment because they aren't getting the in-depth behavior therapies that are so needed.

I see patients who clearly do NOT have mental capacity and the ECT staff rushes in and gets consent to treat and off those people go to get zap zapped and I can't help but think that they have no idea what they just consented to do.

How on earth do I not go crazy myself?

I literally cry when I get home out of the frustrations of feeling like I can't do anything and these people keep returning time and time again - wanting (and getting) their narcotics, their benzos, their sense of entitlement and demands being met - all because they've got insurance and can pay.

(Okay - thanks for letting me vent - please, any suggestions would be greatly appreciated)

[poppycat, ADN, BSN]

As a person who has had several courses of ECT in the past 25 years, I have done a lot of research on the subject. There's a lot of information on the Mayo Clinic website concerning why it is done for patients such as the ones you're describing.

For myself, I have been on antidepressants for a long time but have had "breakthroughs" of worsening depression during which I was seriously suicidal. Had the "quick fix" of ECT not been available to me to get me through those times, I probably would not be alive.

[vegnurse21]

Oh honey, I am right there with you and it is a helpless, awful feeling. We are not quite as gung ho on the ECT treatments as your facility seems to be, but I see people being diagnosed with disorders just after minutes spent with the psychiatrists and it makes me cringe. For the most part, our ECT candidates are properly screened and have the capacity to give consent. Seeing people who really can't give consent being rushed in to have it done would make me sick.

Like you, my frustrations lie with patients who are demanding, entitled, rude, med seeking, etc. who are welcomed to stay as long as they want due to insurance and monetary purposes. It's crap! I am tired of being someone's verbal punching bag/slave. Granted, I am getting paid for it, but this is NOT why I became a psych nurse. Plus, one of our psychiatrists just likes to mess with us and it's getting very old.

We really can't do anything about the psychiatrists treatment choices or diagnosis. We can only advocate to our patients to choose what they would like to take or how they are treated. I just give as much education as possible and encourage the patient to make their own decision.

KarenfRN - I am glad ECT worked out for you. But there's a difference between patients who are willing and able to consent to ECT and someone who isn't. I will have to do more research into doing ECT as a first line therapy instead of last resort. Maybe things are changing and we are just old school lol. Glad it worked for you though. Don't get me wrong - I am in full support of ECT if it works, for sure! I think it's a great treatment for some.