Simply wrong

I want to discuss the wrongness of what my pdoc (psychiatrist) did.

There is absolutely no question that the "standard of care", the accepted protocol for prescribing Lithium, requires testing the blood level of Lithium in order to determine when a therapeutic dose has been reached. Further, there is absolutely no question that the blood test used to make that determination is a "trough level" test -- that is, a test taken 12 hours after the evening dose, but before the morning dose. There is *no* value in evaluating a so-called "random level" or (certainly not) a "peak level" -- the result one would get one or two hours after the morning (or evening) dose.

There are *no* criteria for therapeutic drug monitoring of anything other than trough level Lithium blood tests. Somebody who says otherwise is simply spewing bullshit.

What my pdoc did was order a Lithium level blood test in the usual way, on a lib slip he sent in the US mail. It is important to note that this was my *first* Lithium test. I had no prior knowledge the timeframe during the day when the test should have been administered. He and I had exchanged emails, in which he said I needed to get the test and I requested he send the lab slip.

---------

Let me take some time from my narrative to say one thing. It shouldn't have been my job to request the lab slip. He should have known *exactly* how many days following my beginning to take Lithium that I should have gotten the test. He should have sent the slip either at the same time he sent the prescription for me to fill at the pharmacy or had his staff send it *automatically* a few days thereafter. The date I should take the test should have been written on it. As it turned out, he didn't even send the lab slip for more than twice as long as any accepted standard of care specifies. The entire point of "therapeutic drug monitoring" is to get the patient to the right dose as soon as possible.

As I will discuss in other posts, he clearly stated in his "Progress Notes" (the records he kept during and following each session) that the specific reason he was prescribing Lithium was because I was suicidal. He described prescribing Lithium as a "prophylactic against impulsive suicide." So I ask you, gentle reader, what reason, if any, was there for him to *delay* taking the necessary steps to put me on an effective dose? Every day he delayed was a day I suffered in a depression s profound that I thought of killing myself (literally) every waking moment.

I will provide the date in question later. I would encourage any pdocs out there to tell me if my pdoc acted with adequate care for my well-being. Now I understand that doctors don't like to say, "That other doctor did the wrong thing" -- or, in this case, committed gross malpractice -- so when I state my understanding of the accepted method to establish the correct Lithium dose, all I'll ask you to do is say something like, "Yes, that's how I do it, too." You don't have to say anything like, "Thay fellow was am idiot. His negligence could have killed you." I know that already. I'll keep explaining it until even a lay audience can see it.

---------

Sorry for the distraction. Where were we?

Ah, yes. The lab slip and the emails. I have copies and will produce them if you like. The significant thing about them is this: *NOWHERE* does it state to get a trough level test. *NOWHERE* does it state is simple English what I stated before, "12 hours after the evening dose, in the morning but before the morning dose." I was taking "300mg BID" -- that means one 300mg capsule twice a day. It would have been the simplest thing for the pdoc to write the instructions for when to have the test done. Literally a few seconds. But he did not.

I will probably write considerably more about this in another post, but let me cover this point here very briefly. Is it possible that, even if he absolutely should have written down the instructions somewhere so that I couldn't miss them, he told me verbally and I simply forgot? I suppose he could claim to have done so, but then he would have no honor. Let me assure you, when a doctor prescribes a medication intending it to save your life and has explained that the drug's intended purpose is to do so, the patient listens carefully to any and all instructions about how to take it.

I want to make this absolutely clear. He *NEVER* told me how to get the blood test. Whatever result he saw was completely random. I feel like I should be making a list of the instances of his negligence. Not telling me when to take the test would be at or near the top of the list. An error so egregious that, had I killed myself, I hope my wife would have specified it prominently in a wrongful death legal action.

What he *did* with those meaningless results is the topic of the next posr.