The short version of the story

As I edit the reference list of words I'll use, I find myself eager to tell my story, so I'll tell you a highly abbreviated version. It will be accurate, but missing lots of details. I will omit, for now, the part before the "I almost died" event and the interactions with the pdocs afterward.

Simply put, I was suicidally depressed and my pdoc knew it. He decided to put me on the prescription medication Lithium. Lithium is what I call a "Goldilocks and the 3 Bears" drug (NOT a medical term). Take just a little less than the therapeutic dose and nothing happens. Take just a little too much and there can be serious complications, including death. The therapeutic dose is "just right."

Where the potential exists to provide no benefit to the patient, when the dose is too low, or cause harm (and possibly kill the patient), when the dose is too high, you can be sure there is a way pdocs establish that their patients are taking the right dose of the drug. The way they do it is with blood tests.

The method of testing is well established. I can point you, for instance, to hundreds, perhaps thousands of web pages that explain it. Many of those web pages are from psychiatric journals. There is no question, I repeat, no question how the pdoc should order the test be conducted and, while there is some art and some science to interpreting the results, there are guidelines for doing so.

As you will see, the way my pdoc interpreted the results of my test is not a matter of his experience or expertise. It CANNOT be described as anything other than gross incompetence and negligence. I'm lucky to be alive. I like the guy and think he should be allowed to practice medicine, but I *don't* think he should be prescribing Lithium, except under supervision.

It is critical that the blood test be conducted at a specific time during the day, a time when the level of Lithium is at its lowest. EVERY explanation of how to interpret blood levels clearly state that fact.

My pdoc didn't tell me when to get the test done, so I just happened to do it when my level was at its *highest* (a "peak level" reading). He interpreted the results as though they were from a test conducted at the right time of day (a "trough level" reading) and sent me an email saying essentially, "No need to increase your dose. Everything's fine."

Now, as you may remember, a dose just slightly too low does nothing at all. Had he ordered the test correctly, he would have seen the dose I was taking was completely insufficient to do me any good. It was like taking a placebo. Subsequent testing, at a higher dose, showed this fact.

So the situation in a nutshell is this: I was very suicidal and my pdoc knew it. He prescribed a drug to help, but botched the process of getting enough of it into my system to do any good. After weeks of complete, abject misery, spending every waking moment thinking about killing myself, I had a telephone appointment with him. He became so alarmed at my state of mind that after the call he called the cops, who came to my door and took me away for a 72-hour involuntary psychiatric hold.

That I was suicidal is not my pdoc's fault. That he intervened and prescribed medication in the first place was a good thing. That he was completely incompetent and negligent in getting the dose right was a crime -- at least it would have been, negligent homicide, if I gad killed myself. I am remarkably lucky I didn't kill myself. No thanks to him.

Not following the "standard of care" in "therapeutic drug monitoring" of Lithium is negligence. the very definition of stunning medical malpractice.

If I can find an attorney willing to take my case, I'll sue.

-------------------------------

This is from the Lithium pharmacology page on Wikipedia at
http://en.wikipedia.org/wiki/Lithium_pharmacology

Now wouldn't you expect your DOCTOR to know this?

"Lithium salts have a narrow therapeutic/toxic ratio and should therefore not be prescribed unless facilities for monitoring plasma concentrations are available. Patients should be carefully selected. Doses are adjusted to achieve plasma concentrations of 0.6 to 1.2 mmol Li+/litre (lower end of the range for maintenance therapy and elderly patients, higher end for pediatric patients) on samples taken 12 hours after the preceding dose."

The "12 hours after the preceding dose" part is the critical one. Next time I will talk about "trough levels" and "peak levels."