stupid doctor, my soap box

stupid doctor. really.  consider this: a patient (my brother) is hospitalized for attempted suicide.  He is given haldol decanoate 50mg IM, once a month.  Two days after the medication adminstration, he is discharged home.  Two days after discharge (which is a total of four days since the injection), he went to see his psychiatrist. The psychiatrist gave him a prescription for the pill, Invega, 6mg by mouth daily.  Did not explain to my brother that there's still medication in his system and that this old medication would not clear until three more weeks.  So my brother picked up the prescription at the pharmacy, then went home and took the daily pill as prescribed.  Of course, he is overdosed.  Throwing up everything he eats and drinks, even water, extremely lethargic, flat affects, slowed speech, hypotension.  And there's no fucking doctor to call.  All we have is his goddamn office number, which is not open on the weekend and has no answering service.  I thought about taking him to the emergency room, but he didn't complain of lightheadedness, no protectile vomitting, his speech while slow is not slurred, hypotension alleviated when he lays down and rests, and he could answer me with a certain degree of clarity, so I decided to call the pharmacist instead (avoid the emergency room if possible, it's not a nice place to be in unless you're really sick and dying) to double check medication side effects and signs and symptoms of drug overdose.  Luckily, the pharmacist was a nice lady.  She told us that unless we see signs of altered mental state, we could just keep an eye on him at home.  While double dosing of Invega and Haldol does duplicate the drug effects, it is generally not life threatening, and since it was only one pill that he took.  That was good to know, a relief.  Mom was worried as hell, and so was I.  A while ago I read somewhere someone's letter to his dad regarding his psych meds.  He wrote something to the effect of, "Dear dad, the drugs are not for my good, it is for your good."  It is a difficult realization, but I think it's true.  Patients are put on meds supposedly for their own good, but I have to wonder if it's truly for their good or for ours (us being family, healthcare professionals, society at large).  Ever since my brother got home from the hospital, he has been very agreeable and much easier to deal with, no attitude and irritating remarks and off-the-planet ideas, which makes it so much easier to care for him, but in truth, I cannot deny that I feel guilty, because while the medication makes him docile, it also makes him lifeless.  He's either on the bed or on the couch most of the time from the meds, but while the meds make him tired, it also gives him insomnia, so he's inactive and tired, but he can't sleep.  What the hell, right?  I tried to arrange for some kind of group support for him, so I called the hospital and set up an interview for him to attend this outpatient support group for people diagnosed with schizophrenia, but after the interview, he told me he doesn't want to go because the group consists of people that are in their 50s or 60s, nobody his age.  I'm going to call in the city to see if they have something for the younger age group there.  The healhtcare system in this country is so damn screwed up.  On good days, it can mess up your mind.  On bad days, it can fuck you sideways.  Everybody knows, allegedly, that the most effective treatment for patients with mental illness is a combination of therapy modalities that includes psychotherapy, behavioral therapy, art/music therapy, and pharmacotherapy.  Of these treatment modalities, pharmacotherapy should be the last consideration and used with maximum considerations, but because it is the cheapest and quickest fix, it is the most frequently used method of treatment.  (Read about it Here from the New York Times).  This means even worse news (or not so news) for those who have publicaid insurance, because for every dollar that the mental healthcare provider is owed, publicaid only reimburses about 60 cents.  So, if your dollar is already dwindling with private insurance patients, why would you want to give any more attention to those on publicaid?  Add to that the inability of the social structure to absorb or absolve the strains of a mental illness (ie., lack of understanding and empathy for those with mental illness, even fear and animosity towards these individuals), what is left? 

I can't keep riding my soap box.  I have to go and try to call that doctor again.  Stupid doctor.