<p>I still don’t see why the student did not consult his own physician, just 20 minutes’ drive away.</p>
<p>Shrinkrap–I fear you are right.</p>
<p>The “efficiency” that impending budget cutbacks will bring next year, in particular, will definitely be a cause for concern. Health services will be for band-aids and tylenols and that’s about it.</p>
<p>Could you imagine going to your doctor’s office and being told the nurse will see you instead and will relay the info to the doctor and then the receptionist will email you with what the doctor says? If this is the future, maybe all of our kids should just go to med school. Then, they can just treat themselves–that would be highly efficient.</p>
<p>
</p>
<p>You’re right, Marite - Cambridge and Wellesley are no more than 15 miles apart. I feel great sympathy for the student and his family, but I can’t understand why it’s “gross negligence” for an NP who saw the young man briefly and intermittently to not pick up on alleged warning signs that apparently also escaped his family, who could have seen him at great length as frequently as they wished.</p>
<p>“The “efficiency” that impending budget cutbacks will bring next year, in particular, will definitely be a cause for concern”</p>
<p>Good point, but I wasn’t thinking of schools…</p>
<p>“Could you imagine going to your doctor’s office and being told the nurse will see you instead”</p>
<p>This is not that uncommon.</p>
<p>“…and will relay the info to the doctor and then the receptionist will email you with what the doctor says?”</p>
<p>IF they include the doctor at all.</p>
<p>“why it’s “gross negligence” for an NP who saw the young man briefly and intermittently to not pick up on alleged warning signs that apparently also escaped his family,”'</p>
<p>I don’t know about “gross negligence”, but I DO feel anyone who is prescribing medication for Major Depressive Disorder ( not just one, but two medication trials? What does the protocol m abort when to refer) and AD/HD ( what does the protocol say about managing co-morbidity?) should be doing a complete evaluation and appropriate follow up for each. This should require extensive training and regular experience. ( to be fair, I can’t tell if that happened, but it took ME twelve years of training and takes ME several hours for evaluations not to mention follow-up.) I don’t think a family has exactly the same expectations. Their “job” is a little different.</p>
<p>I don’t really “blame” the NP. I am just worried about present and future mental health treatment. Some seem to think all you need is a forum on the internet.</p>
<p>I’m pretty shocked to see these kinds of drugs prescribed by someone that doesn’t know the student at all. I would expect a psychiatrist to prescribe some of these medications after getting to know the student and expect regular visits with a therapist for a while. This seems like handing out drugs like popcorn.</p>
<p>This students parents were less than an hour away from Cambridge (or even a T-ride away). I’d think that dad would have preferred the family physician over university services.</p>
<p>I like the NPs at our pediatrician offices, I would much rather see them than the doctors.</p>
<p>My thoughts on the Accutane - my D used it, it is only a short term drug (6 months at most) so if he was on it in June, probably not still on it in November. It is only prescribed for 30 days at a time, so he would have had to visit the doctor every month to get a check up and a new prescription. He would have been asked about his feelings of depression every monthly visit.</p>
<p>Many doctors’ offices, including our own, use NP’s and we rarely see the doctor.</p>
<p>Many family doctors or NP’s diagnose ADD or ADHD. </p>
<p>Many families, perhaps including this one, do not want to shell out thousands of dollars for a full neuro-psych. evaluation, and it sounds like this kid did not give his parents signs of needing one.</p>
<p>Psychiatrists who take insurance are given 45 minutes, in one appointment, to come up with a diagnosis, and after that, they are limited to 15 minute appointments to discuss meds.</p>
<p>It is quite common to prescribe drug cocktails for kids who have both ADHD and depression or other mental health problem.</p>
<p>It sounds like the Dad spent time with his son before the suicide. It is surprising that nothing was noticed by the parents. The health services and NP there are prohibited from communicating with the parents, so direct communication with their son would have been their only avenue to know what was going on. I wonder if the son ever told his parents that he was on meds.</p>
<p>Suits like this discourage campuses from allowing depressed kids to stay on campus. Students with depression will be urged to leave and then come back in a year, after they have spent awhile working full-time to prove they are okay.</p>
<p>There are a LOT of kids at elite colleges who are on anti-depressants. The fallout from a suit like this will be interesting.</p>
<p>Maybe I read the article too hastily, but my impression is that the family was aware of his condition and what was being prescribed. It is not knowledge gathered after the fact. Which is why I am so puzzled.</p>
<p>“Psychiatrists who take insurance are given 45 minutes, in one appointment, to come up with a diagnosis, and after that, they are limited to 15 minute appointments to discuss meds.”</p>
<p>That is not true, at least for me. I make less money, but I think it’s the right thing to do. </p>
<p>“Many family doctors or NP’s diagnose ADD or ADHD”</p>
<p>Perhaps they “diagnose” (meaning labeling a group of symptoms), but the problem is, this is a reflection of trying to do something “efficiently” rather than effectively.</p>
<p>Right now, we can all vote with our dollars.</p>
<p>The HIPPA laws make it impossible to get any information about your adult child’s medical treatment or condition from student health unless you get your child to sign a waiver. I think services hide behind HIPPA…</p>
<p>Then there is the way some colleges will kick a kid out of their dorm if they complain of depression symptoms, like GWU did a couple of years ago.</p>
<br>
<br>
<p>I have eye insurance, dental insurance and health insurance. When something costs more than the insurance will cover, I just pay it out of pocket. Wellesley’s median income is $125,000, considerably more than the town where I live.</p>
<br>
<br>
<p>I had a root canal on Monday. My dentist referred me to an endodentist - he only does the easy stuff. The endodentist had specialized equipment, probably has more experienced staff to do the procedure and is the guy that my dentist goes to for work on his teeth. One person can’t know it all which is why we have specialists.</p>
<br>
<br>
<p>You don’t need to spend thousands for a neuropsych workup though if one wanted one, I would think that someone from Wellesley wouldn’t have any trouble ponying up a few thousand for one.</p>
<p>
</p>
<p>Good thing: This would force the kid/allow the school to communicate with the parents about what is going on.</p>
<p>Bad thing: The number of kids with depression complaining of depression symptoms will go down to zero.</p>
<p>wow - I’m very surprised that they prescribed the psychiatric drugs over the Accutane. When DS was prescribed Accutane, (after a long series of trying everything else and a seriously bad disfiguring case of acne,) he had to go off of his ADD meds (Concerta) which he had started four years prior, this had to be confirmed with his primary care doctor before he received the Federal ID packet necessary to start Accutane. He also had required monthly blood work and an exam. There was no room for leeway in any of this and if we had not agreed he would go off any other meds then he would not have been able to get the Accutane. I think the parents have a solid case here, it’s spelled out pretty clearly in the Federal Accutane ID binder.</p>
<p>Do any of you have a HIPAA agreement with your child and student health services? How about if they need ER care? Should student carry around a blanket HIPAA with them? I never figured out how to do this.</p>
<p>I looked into the HIPPA waiver question last year. I think it is best to have one in place (that means, in front of their chart) with any providers your student may visit if you are their emergency contact person or handle their bills and insurance. A generic one that your kid carries with insurance ID and your emergency contact info isn’t a bad idea either. Otherwise, you may get an alarming but vague phone call from providers or the college in the event of an crisis, and a refusal to answer specific questions. Or a refusal to discuss invoices/claims/reimbursements (been dealing with this lately). HIPPA really complicates caring for relatives. My impression is that practices vary regionally as to how strictly waivers are worded and interpreted (for example, in CA, because of what has happened with medical records of the rich and famous, you might need a more intricately worded HIPPA). You also need some kind of waiver or authorization to disclose filed with your child’s insurance provider to get them to discuss claims. I think insurers hide behind HIPPA to delay, delay, delay payment…Still trying to figure this out myself for kids, so anyone who has uses or knows of a generic waiver, please post and thanks!</p>
<p>The article stated that:</p>
<p>This student was an adult who chose to go to the health care center. He was given adderral to help him study. After having side effects of anxiety and depression he was prescribed prozac and wellbutrin. He was also taking acutane at the time. He chose to seek treatment at school and not the family Dr. if there was one at the time. His father saw him over thanksgiving and thought he was fine. His father was surprised to hear fron his son he was prescribed adderral.</p>
<p>Four mood changing drugs at one time. Criminal. Manslaughter.</p>
<p>Who knows what our own kids are taking at college. Don’t be so sure your kids are telling you everything,</p>
<p>
</p>
<p>That is unfortunate for you, because some of the best NP’s I know are better than some of the doctors I work with.
There is a lot of misconception on this thread about NP’s. First, they are advanced practice RN’s who have Masters degrees and extensive training and college work in medicine. They are not hired by a Nursing department but rather through the medical staff department and are credentialled the same way the MD’s are. They have precription authority and able to see patients independently.
With that said, there are good doctors and there are bad ones just like there are good NP’s and bad. So please don’t make a generalization about a profession that does a lot of good to many people.
However, this NP at the Student Services at Harvard, should have had the patient seen by a mental health professional prior to prescribing any medications based on his accutane use. Also, Adderall is a widely abused drug among college students because it is like legal cocaine. It increases concentration, makes you have energy and you absorb material like a sponge. A red flag should always go up if a person presents with the symptoms he has. It is hard to conceptualize a student at Harvard, no less medical school, who has thus far managed to get his work done without any of the drugs or diagnosis before. I think she overstepped her boundary. He should have been referred to a psychologist/psychiatrist to get cleared or evaluated for the medications which they wanted to prescribe.</p>
<br>
<br>
<p>This is purely anecdotal evidence and says nothing about what the general case is and doesn’t take into account the poster’s personal situation. My perspective on preferred care is continuity of care where the practitioner knows the patient over a long period of time.</p>
<p>Clearly this student’s case isn’t where the NP would have been the best choice.</p>
<p>If you read my post, my sentiment is the same.
I stand but what I say about NP’s. My perspective is as relevant as it is of the poster.</p>
<br>
<br>
<p>Which still says that it is irrelevant.</p>
<p>I’ve solved medical problems for others with with a lot of research that their doctors missed. It’s like trading with OPM - you’re not necessarily as effective if you don’t have some skin in the game. First and foremost, I think that anyone should do a moderate amount of research on any kind of treatment programs that involve risk. Perhaps that’s something to pass on to our students.</p>