Previous Page  122 / 171 Next Page
Information
Show Menu
Previous Page 122 / 171 Next Page
Page Background

122

IV. Quality of Care

High √ Meets

Significant Improvements

Standard Standard

Required

Comments/Specific Incidents:

Dr. Good provides his patients with good quality of care.

Most of the consultation reports describe the presenting

problems, the main psychosocial stressors, mental

status examination, psychiatric and medial history,

family history or mental illnesses, habits and substance

abuse, and DSM-IV diagnosis. In addition he provides

his patients with proper psychiatric treatments including

psychotherapy, the use of psychotropic medications,

and psychiatric follow up. Dr. Good takes part in the

call schedule with the other psychiatrists in Small

Town. While he is away one of the other psychiatrists

in the clinic provides coverage for his practice. Five

files of patients with anxiety disorders were reviewed.

Dr. Good has done a good job identifying the chief

complaints, and the DSM-IV criteria of anxiety

disorders. He diligently explores the social situation

and describes any contributing factors such as history

of childhood abuse, family and employment stressors,

and alcohol and drug abuse. Dr. Good’s management

of patients with anxiety disorders is generally good

and consistent with current standards of care. He is

skillful in using SSRI’s, arranging for psychiatric follow

up and referral to psychologists for cognitive behavioral

therapy. A file of post-traumatic stress disorder patient

was reviewed. There was a good description of DSM-IV

criteria of this disorder, including the traumatic event

that produced the condition. Four files of adjustment

disorder patients were reviewed. In all cases

precipitating psychosocial stressors were documented.

Dr. Good has primarily utilized psychotherapy to treat

these patients which is the current recommended

management strategy. Five files of patients with

psychotic disorders (schizophrenia and schizo-affective

disorder) were reviewed. Dr. Good has provided

good DSM-IV criteria of these disorders. In addition,

he has described important relevant issues such as

substance abuse and poor insight. He utilizes up to

date treatment strategies including hospitalization,

the use of modern atypical anti-psychotic medications

and referral to community services. He has done an

excellent job of providing follow up for both acute

and chronic psychotic patients. Five files of patients

with mood disorders (depression and bipolar effective

disorders) were reviewed. The initial consultation

reports, in the majority of cases, are detailed and

comprehensive. In these reports he describes DSM-

IV criteria of depression, the psychosocial situation,

childhood information, medical and psychiatric history

and a treatment plan.

Concerns:

In a number of files, it

appears that Dr. Good

tends to over prescribe

Benzodiazapines.

He also prescribes

combinations of

Benzodiazapines and

higher dosages of these

medications.

In a few cases

Benzodiazapines were

prescribed for patients

with known history

of substance abuse

disorders.

Some consultation

reports (especially the

psychiatric updates)

did not contain a full

description of the

presenting features and

DSM-IV criteria of the

psychiatric condition.

It also appears that

Dr. Good seldom

makes the diagnosis

of personality traits or

personality disorders

on Axis II of the DSM-

IV diagnostic system.