Pill pushers?

I have often heard myself and other doctors referred to as pill pushers. In my experience this is usually from someone who disagrees with treatment recommendations that involve medication and the term is always used pejoratively.

Many patients will not accept the use of psychiatric medication under any circumstance even if they do not hold the same beliefs when it comes to other areas of medicine. If they were to have a heart attack, they would be right at the head of the line for medication.

I actually started my career as a behavior therapist and for many years did not use medication at all. In the practice I had at the time, at a behavior therapy center, most of the patients I saw could be treated solely with behavioral therapy or what is now referred to as cognitive-behavioral therapy. After moving into a general psychiatric practice, however, I soon had to broaden my tool kit. There are many problems in psychiatry for which the optimum treatment is not behavioral. That is not to say that education, discussion and even cognitive behavioral techniques have no place, but without medication they will be weakly beneficial at best.

Sometimes patients refuse medication on philosophical grounds. In a situation where medication is clearly the best choice and failure to use it will be unsuccessful or greatly prolong the process, others and I may elect not to participate. It is certainly an individual's right to refuse medication but there is likewise no obligation on a physician to proceed with treatment that they don't believe is appropriate. This is especially true in a publicly funded health system. When patients choose less effective or more costly options over the recommendations of their caregivers, this affects the community at large and may reduce services to others. I see this sometimes with those who are off work on disability but who refuse recommended treatment. Should the insurer be responsible for ongoing disability payments when available recommended treatment is being refused? People have a right to their choices but also some responsibility for the consequences of those choices.

If you asked a cabinetmaker to build you a piece of furniture and then made it a condition that he not use his specialized finishing tools, he would likely refuse. You would be free to find someone else to agree to your terms.

With respect to treatment options there is certainly room for informed people to disagree but there are also professional standards and guidelines that help to establish the best choices. Only when these have failed would most professionals move on to less well-established or more costly alternatives.


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