One important part of the clinical interview is to check if the patient has other somatic disorders that might explain or influence the psychiatric complaints. I always ask about thyroid function, diabetes or cardiovascular problems. The patient in front of me says she’s okay. But I nevertheless insist and I ask her about any medication she might take.
– Well… yes… I’m actually taking some pills… It’s Diazepam.
– Interesting… Who gave it to you? You just said that I’m the first psychiatrist you see.
– Oh… I have some back pains and my family doctor sent me to a neurosurgeon. He gave me the pills.
I look a bit suspicious at the patient; is she making fun of me? What is she talking about? Diazepam (Valium) is a drug that is usually given by psychiatrists or by neurologists in case of epileptic seizures. Neurosurgeons are unlikely to prescribe it in ambulatory and there are definitely other anti-inflammatory drugs out there for pain management… Diazepam is a sedative drug and a well-known sleeping pill; I never heard it has anti-inflammatory effects and I’m rather shocked although I keep this for myself.
– And how do you take Diazepam?
– The doctor prescribed it twice a day. One pill in the morning and one pill in the evening.
– Are you sure?
– Two tablets of Diazepam? That is… 20 mg daily?
– For back pain.
Something isn’t right. Diazepam is a powerful drug. One tablet can make you sleep continuously for more than 12 hours. Two tablets make you sleep all day long. In normal circumstances, a non-psychiatric patient would have trouble waking up so as to go to the bathroom…
– Did the neurosurgeon tell you that Diazepam is highly addictive?
– No. But I searched on the Internet with the help of my daughter. And I refused to take it as prescribed. I take one half of tablet once or twice per month when I have trouble sleeping. Nothing more.
My patient is clever. But I increasingly begin to doubt my clinical judgment. Maybe Diazepam has peculiar effects I wasn’t aware of, effects that are used by other medical specialties, but some occasional back pains can’t justify, in my opinion, the daily prescription of two pills. I wait for the patient to leave and I go online; after more than a year spent in Romania, and after seeing all sorts of weird treatments, I began to doubt myself. The Internet confirms however what I already knew: no use for Diazepam as anti-inflammatory medication.
At the end of the day, at home, I take extra time to do some online searching. And I find a recent article about promising results when using Diazepam as an anti-inflammatory drug… on rats. Diazepam is not approved for human use as an anti-inflammatory drug. At least, not yet.
There are certain aspects I’d like to highlight.
First, this is among the most shocking medical errors I have encountered so far. Using a sedative as anti-inflammatory and inducing addiction is not ok. Diazepam is one of the most commons drugs in any hospital and everybody knows it, both physicians and patients. Transforming a patient into a drug-addict is unacceptable for me.
Second, you don’t look intelligent if you read research articles and then you apply the results of that research without checking if that particular medication is approved for human use. You risk the lives and the health of your patients because you want to show off and be perceived as a doctor familiar with the latest trends in medicine. You might be perceived as a famous well-trained doctor by unknowing patients, but you will actually do a lot of harm.
Third, the work environment does not have a negligible impact. If you don’t keep yourself fit to practice and up to date, nobody will. Medicine – as I said several times already – is first a science and afterwards an art. Know the basics before being (or dreaming that you are) an artist! I see a lot of psychiatrists and other physicians sharing news on their social media accounts and marketing themselves as being truly wonder-docs. But when I encounter their patients and their prescriptions… I often have to disagree with them and even reverse their diagnosis or fundamentally alter their treatments. Even if I don’t advertise myself as a psychiatrist and I might seem to be some sort of mix between a hippie photographer and mystical writer, I do know my craft fairly well.
And lastly… Oh, man! My country is really in a pitiful situation… This blog is a place where I write about the most terrible situations, those situations that are deeply scandalous. It’s a way to vent the frustration I accumulate. But there are so many other things that I encounter and decide not to write about. There is so much incompetence and injustice here… and so many people who are so needlessly arrogant… and so many patients who pay the price…