Shirah Vollmer MD

The Musings of Dr. Vollmer

Should Psychiatrists Weigh Their Patients?

Posted by Dr. Vollmer on August 8, 2016

We prescribe antipsychotic medications which cause weight gain and serious metabolic side effects. Why don’t we weigh patients at every appointment to monitor the impact of our medications? It seems obvious that we should, but changing the model of care is slow and out of step with our shift towards a more medical model of treatment, and away from the more psychological, or history-driven emphasis of care. Psychiatrists were quick to embrace becoming “pill-mills” which meant shortening appointment times, lengthening the time between visits, and relying on non-MDs for the patient’s history, and yet, we, as a group, are slow to embrace the “data” available to us, which in this case means weight. Although it is a simple point, I think it speaks volumes about the inconsistencies in my profession. If we are to align ourselves with our internal medicine colleagues, then we should follow their lead in collecting as much patient data as we can. At the same time, we can maintain the strong principle of listening, allowing ourselves time to understand, as a means of healing. As I have posted previously, I take issue with our new model of care in which the psychiatrist prescribes in the dark, without understanding the meaning of the patient’s symptoms in the larger context of his history and his associations to his struggles. I now also go on record as objecting to the lack of data mining to monitor the impact of our prescribed medication. It is time to weigh our patients.

2 Responses to “Should Psychiatrists Weigh Their Patients?”

  1. Shelly said

    Why stop at weighing the patient? Prescribing antipsychotic medications may cause a host of other side-effects. Increased obesity can increase blood pressure. Why don’t you measure your patients’ blood pressure. If you prescribe these meds for children, it can stop growth…why don’t you measure their height at each visit? Why not do blood tests for cholesterol and lipids? My point being weight measurement isn’t the only thing you need to measure. I think measuring weight, for some, is a highly sensitive issue. And that might bring up a whole set of discussions not associated at all with the reason the patient came to you in the first place.

    • You are right. Most psychiatrists do laboratory monitoring when a patient is on antipsychotic drugs, so that is standardized. Yes, the associations to weight, as you say, is very complicated for most people, and as such, weighing patients would require a great deal of sensitivity to the matter, but that does not mean it should not be done. Thanks, as always.

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