I’ll tell you that the title of this turned me off but I forced myself to read it and then found it captivating…take a gander and see what you think. Thanks to Scott Wanless and the Business Intelligence Network. I’ve removed much of the business related info though. I think it’s interesting.

Increasing patient satisfaction is a critical goal for healthcare organizations of all types, especially in these times of increased competition, scrutiny and demand for services. Business intelligence based on satisfaction analytics can help you compete.

Our family doctor cements my loyalty as a patient every time I go to see him. He accomplishes this with one simple action combined with two sophisticated uses of patient intelligence. The simple action is to put notes into my care record that indicate what satisfies me. Currently, two of the notes in my record read: “Likes patient population statistics” and “Likes ideas that came from patients.” He has, for example, used both of these statements in a recent visit to diagnose and treat a sleep disorder I was experiencing. During our conversation, he asked one of the nurse practitioners to share statistics on the percentage of the clinic’s population who are experiencing the same type of sleep disorder, and then drill into the percentages for men vs. women and for men of my age group. This type of insight takes deep intelligence to be gathered, stored, processed and shared among the providers. This is business intelligence.

Taking this use of information one step further, our doctor then walked through a one-page sequence of events for my treatment. This included consult with a pulmonologist, an overnight study at a local hospital, education from a home health and medical equipment specialist, and finally follow-ups with both the pulmonologist and with him as my primary care physician. At each stage of this treatment, I was given information on what to expect and why, as well as homework I needed to do in preparation for the specific stage. He sealed the deal with me by telling me that this sequence of events originated with an idea from one patient, and has grown through refinements made in using it with a variety of patients over the past few years. This too is business intelligence.

What is Patient Satisfaction?
At first blush, patient satisfaction sounds like its cousin customer satisfaction. There are, however, significant differences between the two. Topping the list are the licensing and professional restrictions placed on healthcare providers, who must first consider what the patient needs before what the patient wants. In most businesses, trying to sell people what they need versus selling them what they want is an efficient way to go out of business because the competition will gladly reverse this order. I am free to buy just about anything I want in a grocery or hardware store without any regard to whether or not I need it. But I cannot just get an MRI scan or a prescription I saw advertised just because I want one.

In addition to these restrictions are the financial rules from payers, purchasers and the patients themselves. As a provider in a fee-for-service situation, another x-ray may be called for medically, and help the practice financially, but could very well be denied by the patient’s insurance plan. In a capitation situation, this additional x-ray comes out of the provider’s bottom line. Once again, need trumps want.

Patient satisfaction is the subject of numerous books, articles and studies. In Crossing the Quality Chasm, the Institute of Medicine identifies patient-centeredness as one of the six ingredients of quality healthcare. The book uses terms to describe this focus such as empathy, responsiveness to needs/preferences, involvement, respect, information, communication, education, emotional support, physical comfort, value, transparency and heeding expectations. Irwin Press (co-founder of Press-Ganey) discusses the importance of patient experiences and perceptions, and the need to go beyond technical quality to encompass service quality in his book Patient Satisfaction: Defining, Measuring and Improving the Experience of Care. Furthermore, the Gallup Organization has extended the concept of patient satisfaction to become patient engagement. In other words, involving the patient in their care and in the delivery of their care increases satisfaction, loyalty, cooperation and respect.

Common satisfaction measures were summed up in a recent study by DrScore and included:

• Accessibility – both physical access and financial access to care.
• Communication skills – of the doctors, nurses, PAs, NPs and others involved in direct patient care.
• Personality and demeanor – of the same group.
• Quality of medical-care processes – as provided directly to the patient.
• Care continuity – regarding the handoffs made provider-to-provider, as well as across time.
• Quality of healthcare facilities – in terms of having the appropriate equipment, supplies and peripheral resources available.
• Efficiency of office staff – in handling scheduling, billing, etc.

As you can see from these lists, the focus of patient satisfaction relies on providers going beyond the mechanical delivery of medical care to the delivery of a true health service.

Driving Forces for Increasing Patient Satisfaction
The list of benefits of paying attention to patient satisfaction is long and extends to virtually every corner of the healthcare organization whether hospital, physician practice, home health, long-term care and so forth. This makes sense, since the range of factors making up satisfaction is quite wide.

With greater patient satisfaction comes:

Clinical Benefits

• Greater patient trust and acceptance with treatment plans.
• Increasing buy-in for treatment plans more quickly, making best use of scarce physician time.
• Increasing trust, which allows physician to discover more factors that may affect the care needs of the patient.
• Enhancing patient involvement in their own care through preventative measures, corrective measures and so forth.

Operational Benefits

• Driving efficiency into the organization by focusing on what works well with patients, and eliminating what does not work well.
• Cross-over trust is enhanced. For instance, a good experience in scheduling appointments can cross over into a better experience with the care provider. In addition, a good experience with the patient’s PCP can cross over into a more positive experience with specialists that the PCP has referred.
• Increased internal support for other quality improvement efforts, such as timeliness improvement, care process improvement, etc.

References:
White B. Measuring Patient Satisfaction: How to Do It and Why to Bother. Family Practice Management; January 1999, Vol. 6, No. 1, pages 40-4.

 Another clip from Medical News Today about the number of pills and Daily Adherence to medication. Although it focuses on certain conditions, the issue is applicable to everyone and every condition. Compliance (adherence to instructions) is such a big factor in health success that we all (doctors and patients alike) must pay attention to what will improve a person’s ability to follow the advice/instructions:

New Study Suggests Number Of Pills Not A Factor When It Comes To Daily Adherence To Medication

There is no correlation between the daily number of pills a patient is prescribed to take and how well a patient will adhere to a dosing regimen, suggests a new study presented recently at the 19th Annual Meeting of the Academy of Managed Care Pharmacy (AMCP) held in San Diego (April 11-14). The large-scale study looked at patients taking a variety of high blood pressure medicines, specifically calcium channel blockers (CCBs), and provides more supportive evidence that adherence to prescribed medication is influenced by a multitude of factors. The study specifically examined dosing regimen to see if there was a relationship between that factor and adherence in patients with a co-payment of at least $20.

More on Do You Take Your Medicines As Prescribed?

This is a really good article that I found in Science Daily (and they took it from a press release from Indiana University)

Doctor-Patient Communication Has A Real Impact On Health

Science Daily — Good doctor-patient communication makes a difference not only in patient satisfaction but in patient outcomes including resolution of chronic headaches, changes in emotional states, lower blood sugar values in diabetics, improved blood pressure readings in hypertensives, and other important health indicators.

"In looking at these 36 studies we learned many things. For example, research on non-adherence to doctor’s instructions has focused on bad or poor behavior by patients rather than on the clarity of the physician’s instructions or whether the physician actually checked to see if his or her instructions were understood by the patient. The physician assumed that the patient understands and thus will comply.

But is this a logical assumption? We don’t assume that when a pilot and an air traffic controller converse that they have understood each until there is an affirmation of understanding. That acknowledgement is lacking in most patient-physician encounters," said Richard Frankel, Ph.D., IU School of Medicine professor of medicine and Regenstrief Institute research scientist, senior author of the study. Dr. Frankel is a sociologist who studies ways to improve the doctor-patient relationship. He is currently investigating how behavioral changes by both doctors and patients impact medical care.

"From previous work, including a well regarded 1999 study from the University of Washington, we know that doctors ask patients whether they understand what was discussed during a medical appointment only about 1.5 percent of the time," said Dr. Frankel. "It is extremely important that a patient be given the opportunity and probably even encouraged to ask questions. Doctors should be trained to routinely check for understanding to ensure that there is neither miscommunication nor mismatch between what the patient wants and what doctors assume the patient wants."

Co-authors of "Communication Interventions Make A Difference in Conversations Between Physicians and Patients: A Systematic Review of the Evidence" are Jaya K. Rao, M.D., M.H.S. of the Centers for Disease Control; Lynda A. Anderson, Ph.D. of Emory University; Thomas S. Inui, M.D. and Richard M. Frankel, Ph.D., both of the IU School of Medicine and the Regenstrief Institute.

Note: This story has been adapted from a news release issued by Indiana University.

I found an article the other day that discussed use of the ER for non-emergency conditions. I thought it would be a good discussion topic so here it is:

Overuse of Emergency Departments Among Insured Californians

October 2006

One of the key challenges facing emergency departments (EDs) nationwide is a marked increase in use, driven primarily by insured patients who do not have true emergencies. With the troubling trend in California of emergency room closures, it is important to examine the factors that lead to inappropriate emergency room use.

A recent Harris Interactive Inc. survey found that nearly half of recent ED patients felt their problems could have been handled by a physician’s office visit, had one been available, rather than using the ED.

CHCF commissioned Harris Interactive to conduct two sets of surveys, one of emergency room patients and one of primary care physicians and ED physicians. The patient survey found four key factors that drive increased ED use by insured patients who are not critically ill:

• Lack of access to medical care outside the ED (e.g., same-day appointments with a primary care physician, or evening and weekend appointments);
• Lack of advice on how to handle sudden medical problems;
• Lack of alternatives to the ED (e.g., nurse advice lines or urgent care clinics); and
• Positive attitudes about the ED as a site of care.

The lack of options for Medi-Cal patients, who have even more trouble with access to primary care than privately insured patients, is especially severe. The study also noted that patients with chronic conditions made more ED visits, suggesting that their primary care providers may need to improve their methods of chronic disease management.

This issue brief summarizes the key findings of the survey, recommends strategies to increase alternatives to ED use, and calls for streamlined ED processes, as well as improved communication between physicians and patients.
 
Overuse of Emergency Departments Among Insured Californians - CHCF.org  –  http://www.chcf.org/topics/hospitals/index.cfm?itemID=126089

The one good thing from this (remember, I’m an ER doc) is the last bullet - that people had positive attitudes about the ED as a site of care. They may complain about the wait they have to get the care and to complete the care, but it’s apparent that people do think that ED physicians and staff are on the cutting edge. That’s a very important point but not a good reason to use the ED.

Not only is it bad for you when the EDs are so crowded but it’s bad for everyone coming in. Fortunately the ED staff is used to getting the story quickly and barking off orders for this bed or that bed and they all get done. But this is NOT a good way to get personalized care. I hope that physicians look at this brief and say to themselves that they need to look at the services they offer. As I talk about in "Your Doctor Said What?", we have to get sick on the doctor’s schedule and I can tell you from expeirence on both sides of the fence (as a doctor and perhaps, more importantly, as a patient, that rarely occurs. The Urgent care clinics have been a great boost there but a greater review of the situation is needed.

Terrie

Here’s an interesting article that hinges around communication differences between men and women and the diagnosis of  complex pain conditions.

More Difficult For Doctors To Diagnose Complex Sources Of Pain In Women Than In Men

It is more difficult for doctors to diagnose complex sources of pain in women than in men and the reasons for this are rooted in language use. This finding, which is of major importance for both doctors and patients, is revealed by a now completed project by the FWF Austrian Science Fund. The results of this research into how the two genders typically describe pain are to be presented at the 2nd International Congress of Gender Medicine on 2nd and 3rd June in Vienna.

For quite some time, we have all known that men are from Mars and women from Venus, but scientific research has now proven that, when it comes to describing complex pain, men and women are worlds apart. This finding comes from studies that investigated patients suffering from complex headaches. While female patients give doctors brief and vague illustrations of their complaints, men describe their pain in an extremely concrete manner. This means that male patients are at an advantage when it comes to treatment as an accurate analysis of pain is essential for both diagnosis and therapy. 

{Terrie’s note - I do not necessarily agree with the statement that women give brief and vague illustrations of their complaints - or if they do, perhaps it’s for multiple, complex reasons - perhaps it’s perceptions of how the doctor is dealing with them or many other things…this statement is not well qualified to me and it gives women a bad "name" again}

LACK OF COMMUNICATION

A team headed by Prof. Florian Menz of the Department of Linguistics at the University of Vienna established that these different approaches to describing pain are caused by language barriers. Prof. Menz believes that "Women are rather vague and less detailed when portraying their pain, often focusing on the day-to-day situations in which the pain occurs. However, this does not constitute a description of pain in medical terms, as doctors develop a largely symptom-oriented language over the course of their careers. Men, on the other hand, describe their pain in very concrete terms focusing on their symptoms, which is very compatible with medical diagnostics and makes it easier for doctor and patient to understand one another."

{Terrie’s note - so maybe doctors need to be aware of this and change their approach to women?}

By investigating other patients suffering from chronic pain, the study showed that doctor-patient communication is also inadequate on other levels and leads to misunderstandings. While doctors are again primarily concerned with analysing pain when they speak to patients, the patients themselves ¬ who have lived with their pain for a number of years ¬ are more focused on treatment options for example. In such a scenario, doctor-patient discussions often fall short of patient expectations, as they are keen to be involved in the decision-making process.

The Institute of Medicine (IOM) published findings in 1999 on the quality of healthcare in America. That report, "To Err Is Human: Building a Safer Health System," concluded that as many as 7000 Americans die from medication errors each year.^[1] In July 2006, the IOM released a new report, "Preventing Medication Errors," stating that the frequency of medication errors and related injuries was still a serious concern.^[2]

A common question that arises is: "What drugs are most often involved in medication errors?" Matthew Grissinger, RPh, FASCP, is a medication safety analyst with ISMP, the nation’s oldest voluntary drug error reporting program, located in Huntingdon, Pennsylvania. His session on "The Top 10 Adverse Drug Reactions and Medication Errors" drew an audience that filled the meeting hall.^[3]

Grissinger first referred to a study that identified the 10 drugs most commonly implicated in adverse events requiring treatment in a hospital emergency department (ED).^[4] The study also documented the frequency with which each of the 10 drugs was involved:

1. Insulin (8%);
2. Anticoagulants (6.2%);
3. Amoxicillin (s) (4.3%);
4. Aspirin (2.5%);
5. Trimethoprim-sulfamethoxazole (2.2%);
6. Hydrocodone/acetaminophen (2.2%);
7. Ibuprofen (2.1%);
8. Acetaminophen (1.8%);
9. Cephalexin (1.6%); and
10. Penicillin (1.3%).

Unintentional overdoses made up 40% of these ED visits, representing the most prevalent mechanism of injury by far. Other mechanisms included side effects and allergic reactions. Some of the drugs on this list are especially common (eg, hydrocodone and amoxicillin), so the sheer volume of prescriptions written is a major factor.

The elderly also play a key role in this issue, as they account for 34% of all written prescriptions. The average number of prescriptions for an elderly person in the United States in 2000 was 28.5 per year. That number is estimated to reach 38.5 by the year 2010. Almost a quarter million seniors are hospitalized every year due to reactions between prescription and over-the-counter (OTC) medications.

Common misuses that lead to adverse drug events are taking incorrect doses, taking doses at the wrong times, forgetting to take doses, or stopping the medication too soon (all nonadherence issues). An example of commonly misused medications can be seen with arthritis therapies. Seventy million Americans suffer from arthritis and joint pain, which translates into 30 million people taking nonsteroidal anti-inflammatory drugs, either prescription or OTC. Misuse of these drugs leads to 103,000 hospitalizations and 16,000 deaths per year. Unnecessary use of nonsteroidal anti-inflammatory drugs also increases avoidable side effects, such as dyspepsia, peptic ulcer, and gastrointestinal bleeding.

Another high-volume prescription class is the antibiotics. This group represents significant inappropriate prescribing: Twenty-three million antibiotic prescriptions are written for colds, bronchitis, and upper respiratory infections each year, Grissinger said, despite the fact that antibiotics don’t kill viruses.

Top 10 Medications Involved in Drug Errors

A somewhat different top 10 list identifies medications that are most commonly misused or mishandled in some way by healthcare professionals. This list is based on information from the United States Pharmacopoeia (USP), which maintains a database of medication errors that are reported anonymously. The figures represent drug errors associated with acute hospital care^[5]:

1. Insulin (4% of all medication errors in 2005);
2. Morphine (2.3%);
3. Potassium chloride (2.2%);
4. Albuterol (1.8%);
5. Heparin (1.7%);
6. Vancomycin (1.6%);
7. Cefazolin (1.6%);
8. Acetaminophen (1.6%);
9. Warfarin (1.4%); and
10. Furosemide (1.4%).

Hospitals and healthcare systems use the USP database to track medication errors and identify trends. Drug errors are defined as unintentional acts committed by healthcare providers involving medications. Grissinger noted that comparable data are unavailable for outpatient care.

The number 1 error-prone medication is insulin. In fact, a 1998 ISMP study found that 11% of all serious medication errors involve insulin misadministration.^[6] Errors include mixing up products with similar packaging (look-alike products); confusing generic listings on computer databases; similarity in names (eg, Humalog and Humulin); and most importantly, confusing the abbreviation "u" for units with the number 0. ISMP reports that these errors have been occurring for over 30 years.

The second drug on this list is morphine, which can be extrapolated to include all opioids, Grissinger said. Similar names for some of these drugs often cause confusion, such as:

• Avinza and Evista;
• Morphine and hydromorphone;
• Oxycontin and MS Contin;
• Hydrocodone and oxycodone; and
• Oxycodone and codeine.

In the community pharmacy, these drugs often are stacked close together in a locked area, and many have similar packaging, making it easy to grab the wrong one when dispensing. Another common mistake is mixing up oxycodone with oxycodone ER (extended release), especially in handheld device order entry.

Morphine oral solutions cause many problems because of the multiple concentrations that are available, all stored close to each other. For example, it would be easy to confuse "mL" with "mg"; using 5 mL of morphine 20 mg/mL (100 mg) instead of the prescribed 5 mg (0.25 mL) would lead to overdosing the patient. Alternatively, an intended dose of 1 mL of morphine 20 mg/mL (20 mg) might be given as 1 mL of 10 mg/5 mL (2 mg), thus underdosing the patient. Grissinger also reported a case in which Avinza (morphine ER caps) 30 mg was misinterpreted and dispensed as "qid" (4 times daily) instead of "qd" (once daily), causing a near-fatal overdose.

Acetaminophen is another drug on the error list that causes many problems. It is available in many different strengths, and various measuring devices are available for dispensing it. In addition, it is found in many combination medications, both prescription and OTC. Prescription labels of combination products with acetaminophen can be very confusing for the patient. For example, hydrocodone 10/650 has 650 mg of acetaminophen, but many patients would not know how to interpret that.

Grissinger reminded the audience that acetaminophen can be toxic, even though it is sold OTC. A recent study showed that acetaminophen-induced liver toxicity accounts for more than 40% of US cases of acute liver failure.^[7]

Antibiotics are the next big group of drugs associated with medication errors. As with opioids, the liquid dose concentrations increase the risk for mistakes. Confusion over measurements in "mL" vs "tsp" (teaspoons) can cause a 5-fold overdose or underdose if undetected. In one case, for example, azithromycin suspension was dispensed with directions to take 2.5 tsp daily (equivalent to 12.5 mL) instead of the intended 2.5 mL daily, Grissinger reported. The entire contents of the bottle were administered according to the labeled instructions, and the child developed diarrhea.

Reconstituting antibiotics can also be problematic. Pharmacists have mistakenly reconstituted antibiotic suspensions with alcohol instead of distilled water.

System Errors May Interfere With Individual Efforts

Most healthcare professionals have learned the "5 rights" of safe medication use: the right patient, the right drug, the right time, the right dose, and the right route of administration.

However, in his book Medication Errors, Michael Cohen wrote that these "rights" focus on individual performance and can overlook system errors. Examples of system errors are poor lighting, inadequate staffing, handwritten orders, doses with trailing zeros, and ambiguous drug labels. All of these can prevent healthcare professionals from verifying the 5 rights.^[8]

Experts at ISMP have identified 10 key "system" elements that most influence medication use, reported Donna Horn, RPh, DPh, ISMP Director, Patient Safety - Community Pharmacy. Systems factors play a major role in increasing the likelihood that an individual will make an error. Deficiencies in any of these system elements can lead to medication errors^[9]:

1. Patient information (age, weight, allergies, diagnoses, and pregnancy status);
2. Drug information (up-to-date information readily available);
3. Communication (collaborative teamwork between all healthcare members and the patient);
4. Drug labeling, packaging, and nomenclature (limit look-alike and sound-alike drug names, confusing packaging);
5. Drug standardization, storage, and distribution (restricting access to high-alert drugs);
6. Medication delivery device acquisition, use, and monitoring;
7. Environmental factors (poor lighting, cluttered work spaces, noise, interruptions, nonstop activity, and deficient staffing);
8. Staff competency and education;
9. Patient education; and
10. Quality processes and risk management (systems are needed for identifying, reporting, analyzing, and reducing the risk for medication errors with a nonpunitive culture of safety).

When an error occurs, it is tempting to blame individuals, Horn said. A "systems approach," however, looks at the whole system rather than individual errors. For instance, failures in the design or implementation of systems can lead to excessive reliance on memory, lack of standardization, inadequate access to information, and poor work schedules. Thus, with a systems approach, accountability is expanded to include anyone who had any influence over the error, setting the stage for broader solutions.

How Can We Prevent Medication Errors?

Nearly half of all adverse drug events have some form of "preventability," and many do not represent errors of commission but, rather, errors of omission. This implies a failure on the part of someone (pharmacist, physician, patient, or the interactions between these groups) to detect certain factors that most likely led to the adverse event. These factors include:

1. Failure to detect a disease state contraindication to the drug therapy;
2. Failure to detect a significant drug interaction;
3. Failure to detect a significant drug allergy;
4. Failure to prescribe the correct dose for a specific patient;
5. Failure to monitor drugs with narrow therapeutic indexes; and
6. Patient knowledge deficits.

Many of these can be avoided by spending a few minutes counseling the prescriber and/or the patient. Communication is key, Horn said. Barriers to effective communication include illegible handwriting, abbreviations, verbal orders, ambiguous orders, and fax or ePrescribing problems.

When communicating with prescribers, pharmacists should identify the issues clearly and concisely, said Marialice Bennett, RPh, FAPhA, Professor and Pharmacy Director of the University Health Connection at Ohio State University in Columbus, Ohio.^[10] She offered these suggestions for such discussions:

• Outline the specifics of the problem;
• Keep focused on the patient;
• Provide possible solutions;
• Ask for prescriber feedback; and
• Document the final decision.

Conflict can lead to poor communication, which can hinder the discovery of medication errors, she said. Conflicting opinions about patient care should be handled objectively and professionally. The ISMP recommends that healthcare organizations create a code of conduct that encourages behaviors supportive of team cohesion, staff morale, and sense of self-worth and safety.

Boy is this a pertinent quip from Medical News Today .

In today’s world of very educated patients, most would be insulted if the physician even mentioned anything to do with depression. And yet, the universal presence of depression in the U.S. is phenomenal. Many people do not know that that is their diagnosis though. And therefore, they think that there "must be something wrong with me" - something that enough "tests", enough "diagnostic studies" - enough something - would show. The somatic symptoms of depression are multiple. And it should be considered in most scenarios. AND most patients should not be so resistant to the screening process. This resistance is what keeps physicians from even considering it as a diagnosis.

Providing a voice to an often silent disease, Epocrates, Inc. surveyed 500 clinicians to identify trends in depression diagnosis, prevalence and treatment. People dealing with stress, whether in the workplace or at home, should take note; nearly all clinicians identified stress as the leading contributor to depression.

The majority of clinicians reported seeing an increase in depression in the past five years, and believe this increase may be driven by greater disease awareness, and ultimately more patients seeking help. However, clinicians reported that many more patients may be experiencing symptoms that are going undiagnosed. More than half of survey respondents felt that physicians are hesitant to diagnose depression, primarily due to resistance from patients and lack of societal acceptance. Clinicians also reported uncertainty about diagnosing depression, as patients may present symptoms differently based on gender and ethnicity, or may be a product of another medical illness.

"In today’s digital age, the increasing pressure to get it done yesterday can lead to more stress and potentially depression. Early recognition and intervention are important to prevent the loss of jobs, damage to relationships or suicidal thoughts," said John Luo, MD, Assistant Clinical Professor of Psychiatry at UCLA Semel Institute for Neuroscience and Human Behavior.

The vast majority of clinicians reported recommending prescription therapies for their patients experiencing depression. Beyond pharmacotherapy and psychotherapy, 60 percent of respondents believe lifestyle changes such as diet, exercise and meditation may also be helpful in treating depression, depending on the patient’s individual situation.

Additional key survey findings include:

– Gender makes a difference when diagnosing depression

– Thirty percent of clinicians reported being less likely to discuss depression with men.

– Clinicians reported it is often more difficult to treat men because they are less "open" than women, and symptoms such as anger or addiction may not be immediately linked to depression.

– Clinicians may be more likely to experience depression

– More than 50 percent of clinicians reported experiencing depression at some point in their lives, which compared to the National Institutes of Health data, could make them more than twice as likely to experience depression as the general public.

– Additionally, 12 percent of clinicians reported missing work because they felt depressed. Clinicians are not alone-a national study revealed that depression is the leading cause of missed work days, and lost productivity due to depression is estimated at $83 billion a year.

For more about depression, including a podcast with UCLA psychiatrist Dr. Luo, clinicians’ comments and comprehensive survey results, please visit http://insights.epocrates.com/depression. Comprehensive dosing and drug interaction information for anti-depressants can also be found at http://www.epocrates.com.

Kristen Gerencher is a reporter for MarketWatch in San Francisco.