- Another scientifically inaccurate
and potentially harmful statement
made by another celebrity about health.
It's no surprise, but we're talking
about it on this week's Wednesday checkup.
(upbeat music)
I found out last week
that Lady Gaga sat down to have an open and honest
conversation with Oprah about her mental health.
This conversation talked about her own journey,
breaking the mental health stigma that exists
and addressing disparities.
Now all of those things are incredibly important
and I'm actually really passionate
about addressing those issues.
In fact, many of my patients who are uninsured
or only have catastrophic insurance,
they face a really tough task
in finding a mental health counselor,
therapist, psychiatrist,
and it's my job as a family medicine doctor
to not only fill that void
but also help them navigate this really tricky system
that we have here in the United States.
When it comes to mental health stigma
this absolutely needs to be broken.
But, in order to break the mental health stigma
we need honest and accurate information.
When we talk about someone having
a mental health issue, that's not to say
that they're weak, it's not to say
that there's something wrong with them.
But diagnosing ourselves is not the solution.
Reading a book and saying,
"Oh, I must have x, y, and z,
"and now I need to self-treat myself,"
also is not ideal.
The most ideal way
to go about getting proper mental health treatment
is, A, to see a licensed therapist,
psychiatrist, or primary care physician.
And I say primary care physician
because there was a specific
segment within Lady Gaga's speech
that is harmfully inaccurate.
"By the way, if your primary care doctor
"is prescribing you an antidepressant,
"this should not be happening.
"Primary care doctors should be introducing
"you to a psychiatrist, an expert in brain medication."
Now as a primary care doctor,
a board certified family medicine physician,
my problem with this statement is not personal offense.
Lady Gaga did not offend me by saying this statement.
But what she is saying is scientifically inaccurate
and it's wrong, factually.
Let's start off on a practical note.
Let's talk about the numbers.
The National Institute of Health
estimates that one in five adults
will have a mental health issue.
When I say issue, a classifiable mental health disorder.
That equates to about 40 to 66 million
individuals with a condition.
Now there's only
about 20,000 practicing psychiatrists in the U.S.
How are all those people gonna get care?
And on top of that,
there's certain geographic limitations
where there are no practicing psychiatrists in a given area.
Then there is people who have lower socioeconomic standing
who are uninsured and have higher
rates of mental illness.
What are they supposed to do, Lady Gaga?
Second, we don't wanna put even more stress
on our overburdened mental healthcare system.
Think about this,
psychiatrists are specialists in what they do
and they should be seeing more complex cases.
If every single time any patient
that needed an antidepressant needed
to be referred to them,
think about the incredible wait times
that that would create for patients who are truly complex
and can't be treated by family medicine doctors.
This will completely break
our already nearly broken system.
In fact, psychiatrists and other specialists
that I've worked with in the past
have sometimes laid the complaint at my feet
that some family medicine providers are too quick to refer
instead of trying first line treatments like antidepressants
and I completely agree with that
which goes completely against
what Lady Gaga was trying to say in this speech.
Three, board certified family medicine doctors
receive extensive education and training
in mental health conditions and brain medications
with the ability to refer or triage as needed.
In reality, it's the actual job
of the family medicine doctor
to be able to administer first line
and even second line treatments
before sending the patient to a specialist.
If you try the first line treatment, and it fails,
maybe you try the second line treatment, and it fails,
then you need a specialist.
If you need to perform
a procedure that you're not trained in
or you don't have the equipment to perform,
you need to send them to a specialist.
If you've come across a complex case
with a patient having more than one illness
or taking more than one medication
that could be high enough complexity to warrant a referral.
Perhaps you're not comfortable
with a specific illness that the patient has
and you don't have enough experience with it.
That warrants a referral
but these are the minority of cases.
The huge majority of patients with anxiety and depression
who warrant antidepressants
can and should be treated by primary care doctors.
Also, as a side note, not every patient with anxiety
and depression needs antidepressants.
And, in fact, that's the beauty of family medicine.
We understand that cognitive behavioral therapy, DBT,
all these options work very well for our patients
and because we have existing relationships
with these patients,
because we're their primary care providers
we treat them for years, we know what works.
We know what medications they do well with.
They have direct access to us
and it only makes sense that we continue
this line of treatment until it passes
that complexity line where we do need
to get a specialist like a psychiatrist involved.
Four, I think there's a faulty mentality
at the heart of this statement
where more money spent always yields better care or outcomes
and that's just not the case.
In reality, I have many celebrity
or wealthy patients that come
in to see me that request every single test
or every single treatment.
And I have to explain to them
that tests come with possible risks.
Treatments come with possible risks.
Even though some of them may
seem completely benign like a blood test
and we need to have those conversations.
Now you may be wondering to yourself,
how is seeing a specialist putting me at risk?
Well, it's not directly putting you at risk
because specialists are very confident
they know what they're doing
but, from my experience,
what I've seen is, if a patient
who does not have a primary care doctor
gets sent to a specialist too early,
they sometimes get treatments or even tests
for things that they don't need yet.
This is not because the specialists
don't know what they're doing
or because they're trying to push things onto the patient.
It's because they're used to seeing more complex cases.
So they have a lower threshold
of when to order certain tests or certain treatments.
And they don't have existing relationships
with these patients like we do as primary care providers.
For example, I have some patients,
and when they come in, they say that
their pain level is a four or a five,
I get really worried
because I already know that
they have a very high pain threshold.
But if they go see a cardiologist
and they say, "Oh, my pain is a four."
Maybe it's not taken as seriously.
If you jump onto any review site
you'll see patients complaining
that they didn't get tests or treatments from their doctor
and they think that's a bad thing.
But I recently came across a tweet
from a doctor, Christina Johnson,
that I think works very well in this case.
It reads, "Just because no tests
"were performed or medicines prescribed
"it doesn't mean that you didn't get care."
I completely agree with this statement
because it takes careful evaluation
to know what a patient has.
To weight the risks and benefits of each procedure
and each treatment, and figure out
what's right for the individual sitting in front of you.
That's why generalizations don't work well in medicine.
And that's why Lady Gaga's statement here
does more harm than good at the end of the day.
It puts patients at risk
who would otherwise go get care
from a family medicine doctor.
It hurts existing doctor-patient relationships
that are potentially going very well.
I guess the final thing
that really makes this statement
inaccurate is that pretty much every medical organization
agrees that family medicine doctors
are more than capable and are trained
to prescribe antidepressants, to know
when to refer patients if a complexity arises.
And to make a universal statement like that
that this agrees with all of medicine.
It just doesn't make a lot of sense.
Just four days ago,
the active president of the AFP, Dr. Leroy,
made a great statement.
"Family medicine physicians
"are on the front lines of mental health care in America."
And I completely agree with that statement.
Do you know why?
I would actually go as far as to say
80% of my visits, there is a mental healthcare component.
So when a patient comes in for back pain,
acid reflux, diabetes, chronic care management,
those usually have a mental health component in them.
Whether we see it or not,
whether we diagnose it or not,
and if we're gonna go ahead and make a universal statement
and say, "Family medicine doctors
"should prescribe antidepressants
"or they're incapable to take care of mental health."
It's just flat out wrong.
I'm dropping some great resources down below,
including a response
from the American Academy of Family Physicians
and a fantastic open letter
by Dr. Megan Babb on the subject.
I encourage you to read it.
A lot of the same points I brought up
in this video where addressed in her letter as well.
And we really send a message to Lady Gaga
and really all influential celebrities out there.
Your message is gonna be heard by millions of people.
They're gonna trust you because of your familiar face.
They have respect for you.
So if you're gonna be making
universal recommendations about healthcare,
please, please, please, partner with a medical organization,
partner with a medical professional
before more harm than good is done with those statements.
If you're interested to watch
some of my other videos about mental health
which I'm very passionate about
as an osteopathic and holistic physician, click here.
As always, stay happy and healthy.
(upbeat music)