Dear Dr. Roach: I just read your column about anxiety and sleep disturbance. I take issue with your advice to go back to the primary doctor. If a patient had cancer, would you send them to a general practitioner or an oncologist? Anyone needing help with medication for anxiety should be directed to a psychiatrist or a certified nurse practitioner with expertise in psychotropic drugs. They are the clinicians who have the experience needed to help patients take the correct medications at the correct dosage. B.C.
I both agree and disagree with you. A听specialist is not always the best clinician for medical and psychiatric illnesses. There are many conditions for which specialists provide superior care, and indeed I听refer every patient with cancer to a cancer specialist. However, there are many conditions for which the primary-care physician is the best clinician, and studies have shown that for some conditions, specialist care adds cost but does not improve outcome.
In the case of psychiatric care, the data are clear that psychiatrists and mental health professionals in general (including psychologists, clinical social workers, clinical mental-health counsellors and advance-practice nurses) are more likely to correctly diagnose the condition. Further, most patients prefer counselling to medication as their initial therapy, and most primary-care doctors lack training in听effective counselling. On听the other hand, many patients prefer their own doctor to treat their psychiatric condition.
Based on the information and my experience, I feel that the primary doctor is the right person to start with, but that the doctor should collaborate with mental health professionals if the results of treatment are inadequate.
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Dear Dr. Roach: I recently had lab work done for my thyroid, and the thyroid peroxidase antibodies showed a high of 65. Should I be concerned? M.M.S.
Thyroid peroxidase antibodies are almost always high in a person with autoimmune thyroid disease, especially Hashimoto鈥檚 thyroiditis. It represents part of an autoimmune attack on the body鈥檚 own thyroid gland. Although you have not had any problems before, the fact that you have these antibodies makes it more likely that you could develop the disease.
Hashimoto鈥檚 usually starts off with a temporary period of having too much thyroid hormone (hyperthyroidism), followed by a prolonged period of having not enough (hypothyroidism). Many people come back to normal, but we often keep people on thyroid doses for life.
Since you have a higher-than-average risk, I would recommend that you pay careful attention to the signs of thyroid disease, especially hypothyroidism.
