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Dalkey Medical Centre, Co Dublin
O'Connell Street Medical Centre, Dublin 1
August 30, 2009
VOL 26 NO 35
A Pill For Every Ill
'Sunday Tribune' journalist Ali Bracken went undercover as a patient presenting with symptoms of mild depression and found that most GPs she visited were happy to prescribe her with antidepressant pills
Aungier Street Clinic, Dublin 2
Bray Medical Centre, Co Wicklow
Slievemore Clinic, Stillorgan, Co. Dublin
The Sunday Tribune visited five GPs in Dublin and Wicklow last week and reported feeling depressed. I provided my correct name, address, date of birth and medical history but the symptoms I described of feeling depressed because of the break-up of a long-term relationship four months earlier and of losing my job one month ago were incorrect. The doctors were told that because of the break-up of this relationship, I was now living alone. I also incorrectly told one of the doctors I had been bereaved five months earlier when an uncle died in a road traffic accident.
The purpose of this investigation was to establish how easy it would be to obtain a prescription for antidepressants under false pretences. In four of the cases, GPs who had never met me before prescribed antidepressants. One refused on the basis that she did not know anything about my past medical history and she added that "pills are not a cure-all".
All of the doctors except one recommended some form of counselling to deal with the issues I was experiencing and some provided me with names and contact numbers for psychiatric assistance. All of the doctors asked me several questions about how I was feeling, including whether I felt suicidal (to which I replied no) and about family medical history of depression (to which I replied there was none of this in my immediate family) and whether I was sleeping and eating well (to which I replied no in both cases). All of the doctors told me that it would take about two weeks before the antidepressants started working. I asked three of the doctors about the waiting time to see a counsellor/psychiatrist in the public health service and all reported there would be a wait of at least several weeks, possibly several months.
Dr Matthew McConville O'Connell Street Medical Centre, Dublin 1
This was the first surgery I visited and reported feeling depressed because of a recent bereavement, the break-up of a long-term relationship and the loss of my job.
Dr Matthew McConville listened at length to the problems I reported having and asked me a series of questions about how I was feeling. He told me that antidepressants were "not a magic cure" and said I could get the name and number of a trained professional at reception for me to speak to – which he recommended. I did not ask for antidepressants, the doctor suggested them and prescribed a three-month prescription of Fluoxetine (trade name Prozac) and non-addictive sleeping tablets. He asked me to come back to the surgery after the three months or earlier if I wished. McConville said the reason I was depressed was because I was reacting "to external shocks to the system". I appeared by far the most depressed and upset during this visit. The consultation lasted about 20 minutes.
When contacted later and informed that the depression reported was false and I was a journalist, McConville said: "It was a lengthy consultation and I informed you about counselling. I'm reasonably happy with the consultation."
Dr Hossein Tabesh Aungier Street Clinic, Dublin 2
I reported feeling depressed because of the break-up of a long-term relationship and the loss of my job.
Dr Hossein Tabesh produced a 'depression checklist' and asked me a series of questions including whether I was feeling hopeless, worthless, tearful and anxious, to which I replied yes on all counts. I did not ask for antidepressants, the doctor suggested them and prescribed a three-week prescription of the antidepressant Lexapro. He asked that I come back and see him after that, free of charge, to discuss how I was feeling. He recommended counselling but said that unless I had the money to pay for it privately, I would "have to wait a long, long time". He said if I could not afford private counselling, Dublin Business School provided it but a student counsellor would be sitting in on consultations.
Tabesh also said he was seeing a lot more people "because of the recession". He told me it was very important to "stay positive" and take regular exercise. The consultation lasted about 15 minutes.
When contacted later and informed that the depression reported was false and the patient was a journalist, Dr Tabesh said he had followed all the guidelines when dealing with depression and had recommended counselling. "I went through the checklist. I put you on a low dosage, which I thought was appropriate with your symptoms."
Dr Ray Hawkins Bray Medical Centre, Co Wicklow
I reported feeling depressed because of the break-up of a long-term relationship and the loss of my job as a mortgage broker.
Dr Ray Hawkins asked me a few questions about how I was feeling, including whether I was sleeping properly (no), had lost my appetite (yes) or was feeling suicidal (no). I did not ask for antidepressants; the doctor suggested them and gave me a four-week prescription for the antidepressant Lexapro and nine Xanax tablets, used for the treatment of anxiety, and asked that I come back to see him in a month. He said the medication "will have you feeling better in a month".
Hawkins said "people don't always need counselling" and recommended I talk to my family and friends about how I was feeling. He also suggested I look into retraining and contact Fás as it could be difficult to get anther job working as a mortgage broker because of a lack of jobs.
Hawkins also recommended I "don't do anything too challenging" for a while but to get some exercise and he enquired if I'd applied for social welfare yet as I claimed to be out of work.
He asked me to come back to the surgery after a month. This consultation was the shortest, lasting about five minutes.
Hawkins was uncontactable for comment later in the week as he was away on annual leave. He was sent a fax informing him of the true nature of my visit.
Dr Jane MacDonagh Slievemore Clinic, Stillorgan, Co Dublin
I reported feeling depressed because of the break-up of a long-term relationship and the loss of my job.
Dr Jane MacDonagh produced a 'depression checklist', provided by the pharmaceutical company behind antidepressant Lexapro, and asked me a series of questions including whether I had feelings of worthlessness or hopelessness, or was anxious or often tearful. The doctor then spoke to me at length about how I was feeling. She recommended that I go and speak to a trained professional about the problems I described and provided me with contact details and literature. The doctor said the psychotherapist she recommended did not believe in antidepressants as she believed talking through problems was the answer.
MacDonagh asked what I thought I needed, and I replied that a friend had been on antidepressants following a bereavement and it had helped him considerably.
The doctor then explained some reasons why people get depressed, because of a drop in serotonin, and that the symptoms I described were a reaction to unfortunate events. She said I did not fit into the category of physically suffering from depression but that I had enough symptoms to show I was depressed. She explained that antidepressants were expensive, as was counselling, and there would be a wait of several weeks in the public service.
She prescribed a one-month prescription of the antidepressant Lexapro. She recommended I take the antidepressant for six months and said I could renew my prescription with the Slievemore Clinic by contacting the reception. MacDonagh said because she was putting me on a low dosage, it should not be a problem for me when I stopped taking the pills but I should do so slowly and with consultation.
The consultation lasted about 35 minutes.
When contacted later and informed that the depression reported was false and the patient was a journalist, MacDonagh said: "Prescribing antidepressants is not something that I undertake lightly but in this instance both the patient and myself agreed that medication was appropriate and she also agreed to consider counselling as I advised."
Dr Nuala Tierney Dalkey Medical Centre
I reported feeling depressed because of the break-up of a long-term relationship and the loss of my job.
Dr Nuala Tierney asked why I had not gone to my regular GP to report these problems and whether I had discussed how I was feeling with my family and friends. I told her I was uncomfortable in doing so in both cases. I requested anti-depressants but was told by the doctor: "Pills are not always the answer... There can be side-effects and not everyone reacts well to them."
She added that because I was a first-time patient, she would not feel comfortable prescribing antidepressants.
After establishing that I was not suicidal, she encouraged me to talk to family and friends over the weekend and to call back on Tuesday to discuss how I was feeling and she would pass on the name of a counsellor and discuss the possibility of prescribing the herbal antidepressant St John's wort but added she would probably not be comfortable doing so.
Tierney declined to comment but was sent a fax informing her of the true nature of my visit.
August 30, 2009
Comments
#2 Vandala commented, on August 31, 2009 at 10:27 a.m.:
Contrast this with the much-maligned NHS across the water. When I moved to the UK a few years ago, I was already on medication – a depression I attribute solely to the Celtic Tiger. When I registered with a doctor, I was immediately offered counselling…it began a week later and went on for eight weeks, with an option to extend. Both visits to the GP and the counselling were free, the medication incurred only a nominal charge (£6 if I remember rightly).
Within three weeks, I was off the tablets and getting on with my life.
#3 Patrick Hunt commented, on August 31, 2009 at 11:40 a.m.:
Depressing article by a journalist prepared to weave a yarn to get a 'good' story. Communication in a doctor's surgery is not solely verbal: facial, body and tone of voice also influence a diagnosis. How good an actress is this lady? Doctors act on good faith; none of them claims to be omniscient.
#4 orla cahill commented, on August 31, 2009 at 12:44 p.m.:
St John's Wort was indeed banned in the 26 counties, but only as an over the counter purchase. It is now only available on prescription
#5 Jim commented, on August 31, 2009 at 5:43 p.m.:
Does the author not feel a bit guilty at faking an illness like that: How should the GP respond if a patient presents with symptoms diagnostic of clincal depression- perhaps ask if she is a journalist? Besides, antidepressants are neither drugs of abuse nor of addiction.
#6 Neil commented, on August 31, 2009 at 9:25 p.m.:
I'm not sure your article has a point ? Are you implying the herbal doctor gave the best advice ? Sure they probably thought you were as odd as hell and that the story was contrived. Did it ever occur to you the Doctors might actually know what they are doing and your performance as a patient puzzled them ? Its a well known fact that most people have 2 doctors- their steady GP they use all the time and the totally new guy they go to when they are having mental health issues. Its not unheard for a doctor to have to deal with a completely unknown patient. Such a silly article
#7 seamus commented, on August 31, 2009 at 11:07 p.m.:
The author does not state what she was trying to achieve by this exercise; expose poor service? criticise medical care? The implication is that prescribing / being prescribed antidepressant medications is wrong. Is there a criticism of doctors for treating the patient?
#8 Clare commented, on September 1, 2009 at 5:50 p.m.:
What a revelation! If you are prepared to lie through your teeth in the spurious name of investigative journalism, you can persuade a decent, work-overloaded GP to prescribe antidepressants for you. And you have the gall to name them as if they'd committed some kind of crime? The way I see it, the only ones to come out of this with a black mark are the Sunday Tribune and their reporter.
#9 Mary Maddock commented, on September 1, 2009 at 7:40 p.m.:
I congratulate Ali Bracken for breaking the silence in Ireland. Millions of people worldwide are disabled by psychiatric drugs. The medical profession are bribed by the pharmaceutical companies whose only interest is profit. We need to wake up and see what is happening to us. Unfortunately life is much more demanding because there is no pill for every ill.
http://kurtdanysh.com/
#10 Misskend commented, on September 2, 2009 at 11:55 a.m.:
Irish doctors prescribe too much medication its a fact. I think this is an excellent story, people who have depression need support and to prescribe someone with depression medication without ensuring that they have family support or the back up of a therapist is I believe is very very wrong, how can a prescription of pills help you get over a relationship, is it any wonder the whole country is in the grip of a recreational drug epidemic when even the doctors turn to a drug to solve every problem. wake up people and smell the coffee drugs are not the solution to all our ills.
#11 Gordon Cantwell commented, on September 2, 2009 at 2:48 p.m.:
By pretending to have a mental illness and seeking to demonise those who tried to help her the journalist only succeeded in trivialising the suffering of those who suffer from a mental illness and demoralising those of us who deal with it on a daily basis. If she wanted to know the prescribing rate of antidepressants in primary care she could have "googled" it. I have already had a consultation with a teenager who took an overdose and an elderly lady with cancer who wants to die.... neither of them are pretending.
So less of the conspiracy theories about bribes and the cheap shots at GPs. We have to deal with this on a daily basis, it makes up over a quarter of our workload and we try to manage with limited resources and limited time and that "is a fact".
#12 J. commented, on September 5, 2009 at 1:31 a.m.:
We live in challenging times.If ever the time were out of joint for an article such as this one, it is now. Having seen many ups and downs in life and with a history of a related but separate nervous illness, I have found myself in need of a leg-up from time to time.
In the present economic climate, many things unravel. Difficult marriages become unbearable, tricky financials become impossible, stretched nerves become overwrought.
For a journalist to take up the time of five separate doctors is the equivalent to a good part of a morning surgery. A more useful issue to pursue in this area would have been the fees charged by doctors per visit.
As for the prescriptions for anti-depressants, if ever there were a time to err on the side of believing the patient, now is that time.
Timing is everything...
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I thought that both St John's wort and Gingko Biloba had been banned in the 26 counties several years ago.
How then can a doctor prescribe them? (They are readily available in the North, the UK and most of mainland Europe - which has a long history of the use of natural remedies, e.g. in Germany, St. John's wort is prescribed 10 times as often as Prozac for the treatment of depression).