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Q: BP Partner Had Steroid Injections...
I live in Spain with my partner who was diagnosed with manic depression 18
months ago(he is 37 years old). He was successfully treated with
Tegretol until January when he went to his General Practitioner with back
problems. She prescribed a course of what I have since found out were
corticosteroids. (a 6 day course of injections). The back pain persisted and he
was given another 6 day course. The back pain continued and unbelievably another
6 day course was prescribed. From the beginning she was aware that he was taking
Tegretol and that he was taking it for Bipolar. His sleeping patterns were
only slightly disturbed during January and quite unexpectedly a week after
finishing the last course of injections he had a manic epsode,was hosptalised
for a month and is still on medication to reduce the mania. My question is
am I justified in feeling anger at the doctor's negligence in prescribing
corticosteroids (over a month) to someone that suffers from bipolar?
Dear Helen --
Being angry, being frustrated, and wanting to do something about this are all
very understandable and "justified".
Now, for the next statement, this is going to sound
like a doctor defending doctors. That may be part of the basis of my
response, in that I haven't been sued yet but I know what it would do to
me. I'd sure want someone to think that I was doing what I thought was
best, and out of a genuine wish to help, and that doctors are mortals too who
can't be expected to know everything -- especially general practitioners,
who are expected to know an absolutely incredible range of things that I'd be
quite overwhelmed to take on (I did that for a year and it was
petrifying).
Ok, next statement: actually, there is nothing in
the standard of care that says "hey doc, you're supposed to know that
steroids can cause bipolar disorder to get worse, and to screen for bipolar
disorder before you give them". That would be good --although the
oncologists I work with, who use steroids quite a bit in some patients with
cancer, estimate that they see bad reactions about 1 in 100 times. They
now know from working with me that I'm wanting to be watchful every time someone
with known bipolar disorder is given a steroid, and that I'd rather avoid it if
at all possible, but I have had several patients with clear bipolar conditions
get steroid injections like your partner and do okay. In other words, we
haven't really reached the point where we can even say unequivocally "don't
give steroids to someone with bipolar disorder", let alone expect doctors,
especially general practitioners, to know or practice this.
Nevertheless, I would expect all that verbiage of mine
there to make you feel any less frustrated. It doesn't matter what the
intent was when something really bad happens from a treatment -- it's still
something really bad. I think all we can really ask is that the doctor
listen up when given feedback (preferably in a way that makes it easier not to
get defensive) and incorporate that feedback in future practice, at least in a
situation like this. Sorry to hear the story.
Dr. Phelps
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