Re: LONG: my personal notes for psych eval

[Guest guest]

At 00:200 -0400 4/28/01, Steve Goldstein wrote:

> " Bariatric surgery should not be attempted in patients who have a

>history of noncompliance or have psychotic illnesses, including

>schizophrenia and personality disorders, suicidal behavior, substance

>abuse, and uncontrolled depression.

I wonder if a PCP could make a case for 'noncompliance' by citing

previously failed physician-supervised diets?

--stella

[Guest guest]

Failed diets aren't what non compliance generally means. It is almost

always used to mean not taking prescribed medications or essential-to-life

treatment. It is a term that reveals the arrogance of the healthcare

profession in that it assumes that not following the provider's " orders " is

non compliance. When in fact it may be better described at times as

substituting ones own judgment for that of the professional. And at times

it looks like very very bad thinking on the part of the patient.

Non compliance is a major issue in the mental health field. Many of the

medications have unwanted direct or side effects that lead people to stop

taking them. Lots of rethinking the notion that the " prescriber knows all "

is going on. However, there are some folks who decide not to take their

medications and end up rehospitalized for chronic illnesses including

psychiatric problems, diabetes, respiratory disease, etc. These folks are

thought to be at high risk for not taking medications in the future. And

with the DS and the necessity for maintaining protein, vitamin and mineral

intake, many providers are unwilling to risk having them as patients.

in Seattle

----- Original Message -----

> At 00:200 -0400 4/28/01, Steve Goldstein wrote:

> > " Bariatric surgery should not be attempted in patients who have a

> >history of noncompliance or have psychotic illnesses, including

> >schizophrenia and personality disorders, suicidal behavior, substance

> >abuse, and uncontrolled depression.

>

> I wonder if a PCP could make a case for 'noncompliance' by citing

> previously failed physician-supervised diets?

>

> --stella

>

> ----------------------------------------------------------------------

>

[Guest guest]

Failed diets aren't what non compliance generally means. It is almost

always used to mean not taking prescribed medications or essential-to-life

treatment. It is a term that reveals the arrogance of the healthcare

profession in that it assumes that not following the provider's " orders " is

non compliance. When in fact it may be better described at times as

substituting ones own judgment for that of the professional. And at times

it looks like very very bad thinking on the part of the patient.

Non compliance is a major issue in the mental health field. Many of the

medications have unwanted direct or side effects that lead people to stop

taking them. Lots of rethinking the notion that the " prescriber knows all "

is going on. However, there are some folks who decide not to take their

medications and end up rehospitalized for chronic illnesses including

psychiatric problems, diabetes, respiratory disease, etc. These folks are

thought to be at high risk for not taking medications in the future. And

with the DS and the necessity for maintaining protein, vitamin and mineral

intake, many providers are unwilling to risk having them as patients.

in Seattle

----- Original Message -----

> At 00:200 -0400 4/28/01, Steve Goldstein wrote:

> > " Bariatric surgery should not be attempted in patients who have a

> >history of noncompliance or have psychotic illnesses, including

> >schizophrenia and personality disorders, suicidal behavior, substance

> >abuse, and uncontrolled depression.

>

> I wonder if a PCP could make a case for 'noncompliance' by citing

> previously failed physician-supervised diets?

>

> --stella

>

> ----------------------------------------------------------------------

>

[Guest guest]

Failed diets aren't what non compliance generally means. It is almost

always used to mean not taking prescribed medications or essential-to-life

treatment. It is a term that reveals the arrogance of the healthcare

profession in that it assumes that not following the provider's " orders " is

non compliance. When in fact it may be better described at times as

substituting ones own judgment for that of the professional. And at times

it looks like very very bad thinking on the part of the patient.

Non compliance is a major issue in the mental health field. Many of the

medications have unwanted direct or side effects that lead people to stop

taking them. Lots of rethinking the notion that the " prescriber knows all "

is going on. However, there are some folks who decide not to take their

medications and end up rehospitalized for chronic illnesses including

psychiatric problems, diabetes, respiratory disease, etc. These folks are

thought to be at high risk for not taking medications in the future. And

with the DS and the necessity for maintaining protein, vitamin and mineral

intake, many providers are unwilling to risk having them as patients.

in Seattle

----- Original Message -----

> At 00:200 -0400 4/28/01, Steve Goldstein wrote:

> > " Bariatric surgery should not be attempted in patients who have a

> >history of noncompliance or have psychotic illnesses, including

> >schizophrenia and personality disorders, suicidal behavior, substance

> >abuse, and uncontrolled depression.

>

> I wonder if a PCP could make a case for 'noncompliance' by citing

> previously failed physician-supervised diets?

>

> --stella

>

> ----------------------------------------------------------------------

>

[Guest guest]

> I wonder if a PCP could make a case for 'noncompliance' by citing

> previously failed physician-supervised diets?

they could make a case for being a candidate for surgery:

The following text is from Gastrointestinal Surgery for Severe

Obesity. NIH Consensus Statement 1991 Mar 25-27;9(1):1-20.

PATIENT SELECTION

" Those patients judged by experienced clinicians to have a low

probability of success with nonsurgical measures, as demonstrated for

example by failures in established weight control programs or

reluctance by the patient to enter such a program, may be considered

for surgery. "

mary bmi 68

corona, ca

surgery sch. 6/27/01 Dr Rabkin

cigna ppo

[Guest guest]

> I wonder if a PCP could make a case for 'noncompliance' by citing

> previously failed physician-supervised diets?

they could make a case for being a candidate for surgery:

The following text is from Gastrointestinal Surgery for Severe

Obesity. NIH Consensus Statement 1991 Mar 25-27;9(1):1-20.

PATIENT SELECTION

" Those patients judged by experienced clinicians to have a low

probability of success with nonsurgical measures, as demonstrated for

example by failures in established weight control programs or

reluctance by the patient to enter such a program, may be considered

for surgery. "

mary bmi 68

corona, ca

surgery sch. 6/27/01 Dr Rabkin

cigna ppo

[Guest guest]

> I wonder if a PCP could make a case for 'noncompliance' by citing

> previously failed physician-supervised diets?

they could make a case for being a candidate for surgery:

The following text is from Gastrointestinal Surgery for Severe

Obesity. NIH Consensus Statement 1991 Mar 25-27;9(1):1-20.

PATIENT SELECTION

" Those patients judged by experienced clinicians to have a low

probability of success with nonsurgical measures, as demonstrated for

example by failures in established weight control programs or

reluctance by the patient to enter such a program, may be considered

for surgery. "

mary bmi 68

corona, ca

surgery sch. 6/27/01 Dr Rabkin

cigna ppo

[Guest guest]

excellent point, from Corona

from Seattle

----- Original Message -----

>

> > I wonder if a PCP could make a case for 'noncompliance' by citing

> > previously failed physician-supervised diets?

>

> they could make a case for being a candidate for surgery:

>

> The following text is from Gastrointestinal Surgery for Severe

> Obesity. NIH Consensus Statement 1991 Mar 25-27;9(1):1-20.

>

> PATIENT SELECTION

>

> " Those patients judged by experienced clinicians to have a low

> probability of success with nonsurgical measures, as demonstrated for

> example by failures in established weight control programs or

> reluctance by the patient to enter such a program, may be considered

> for surgery. "

>

>

> mary bmi 68

> corona, ca

> surgery sch. 6/27/01 Dr Rabkin

> cigna ppo

>

[Guest guest]

excellent point, from Corona

from Seattle

----- Original Message -----

>

> > I wonder if a PCP could make a case for 'noncompliance' by citing

> > previously failed physician-supervised diets?

>

> they could make a case for being a candidate for surgery:

>

> The following text is from Gastrointestinal Surgery for Severe

> Obesity. NIH Consensus Statement 1991 Mar 25-27;9(1):1-20.

>

> PATIENT SELECTION

>

> " Those patients judged by experienced clinicians to have a low

> probability of success with nonsurgical measures, as demonstrated for

> example by failures in established weight control programs or

> reluctance by the patient to enter such a program, may be considered

> for surgery. "

>

>

> mary bmi 68

> corona, ca

> surgery sch. 6/27/01 Dr Rabkin

> cigna ppo

>

[Guest guest]

excellent point, from Corona

from Seattle

----- Original Message -----

>

> > I wonder if a PCP could make a case for 'noncompliance' by citing

> > previously failed physician-supervised diets?

>

> they could make a case for being a candidate for surgery:

>

> The following text is from Gastrointestinal Surgery for Severe

> Obesity. NIH Consensus Statement 1991 Mar 25-27;9(1):1-20.

>

> PATIENT SELECTION

>

> " Those patients judged by experienced clinicians to have a low

> probability of success with nonsurgical measures, as demonstrated for

> example by failures in established weight control programs or

> reluctance by the patient to enter such a program, may be considered

> for surgery. "

>

>

> mary bmi 68

> corona, ca

> surgery sch. 6/27/01 Dr Rabkin

> cigna ppo

>