Posted by novelagent on June 15, 2012, at 11:14:10
It seems the only docs that will treat me after you've had one little tiny day of psychosis are either hospital residents who won't treat me and sit on any big decisions and wait to talk to their supervising docs before changing any meds, if they bother to change meds when it's needed at all--- or, you get docs who basically want to exploit the fact other docs won't see you by, in one case, quoting you $500 for the first appointment ($300 or up for each appointment thereafter, I would imagine, as is the going rate these days for that tier of pricing).
I got the $500 quote after finding a doc who advertising, among other conditions, treating schizophrenia. It's virtually unheard of that a doc adverrtises treating psychosis, even if they do treat psychosis. It's unfortuantely the thing that makes you black sheep in psychiatry-- docs assume you're a complicated case, and don't think it's worth it to treat you.
It doesn't help the odds of you being poor are high when you've got it, altough for me, that has more to do with cognitive impairment that cost me a job right after my episode, but I've since grown out of the cognitive impairment. I suppose it's possible to get a referral from docs, but I once asked a GP for a referral, and saw on my medical record later that "Patient called for a referral to a psychiatrist. Do you know of one? He asked for one that accepts insurance, but most don't accept insurance now, so I'm not sure what to tell him."
And that was before I had psychosis, so you can imagine how alone I feel when it comes to finding a doc now. And having residents means they don't even know the area-famous docs I once had when my family paid for expensive docs that cost $300 an appointment that any doc who's anyone in the area has heard the name of. So they don't know of any docs to refer me to, especially since referrals are basically favors the receiving doc is doing for the referring doc when the patient has psychosis in his history.
The thing is, I'm not a complicated patient. I have no positive symptoms, and I don't even think I have negative symptoms-- I have anhedonia when I don't have Vyvanse, but it's the same anhedonia I had years before my psychotic episode (which lasted a day-- I walked myself into a hospital and ever since have been on a long-acting injection). Thing is, I use to take high doses of amphetamine, as prescribed, because I thought I had a sleeping disorder (and my doc prescribed it thinking so, too). It turned out to be depression, combined with sedating meds. But it burnt my receptors, so now I need a stimulant to function (I have AD/HD, so I'd need it anyhow).
So that's it, I'm not complicated. I'd like to have some Aricept to help me in school, and hope to get that, but besides that, I jsut want to go back on klonopin, and up my Vyvanse to 140mg, so it's equal to 20mg 3x/day of Adderall, which I use to take and do well on. Right now, I'm just on 70mg, and my resident of a doc is only going by the PDR, because she's a resident and lame. Any private doc would be fine with the rationale to going to 140mg.
I use to see a private doctor that accepted my Medicare, and a modest $75 per visit extra payment in cash, but I happened to not tell him I had a psychotic episode. Instead, I saw him for what I use to see docs for-- AD/HD and social anxiety. He treated me with Dexedrine and Klonopin, and my resident doc focused on refilling my Risperdal Consta. At some point, the two found out I was seeing both docs, and I couldn't see that private doctor anymore.
Sad thing is, it sounded like he would have seen me had I told him everything up-front. But I called so many docs on my Medicare list of docs that wouldn't even see me just because I had Medicare that I didn't dare tell them yet another reason not to see me.
So I guess what I'm asking is, how do I find a doc who accepts Medicare, yet isn't a resident, and willing to see me even though I had a single psychotic episode (they call it "first contact psychosis" because these days, it's unclear what it would have evolved into had it not been treated so agressively and early).
How did you guys find your doc? Referral from a GP? Another psychiatrist's referral? Do you have a history of psychosis, and are you stuck with a resident doc?
I'm finding the difference between private psychiatry and public psychiatry (or psychiatry that accepts medicare/medicaid in general) is that private psychiatrists have higher treatment expectations, and prescribe to meet those expectations. Public psychiatry is risk-adverse, because they only get in trouble (or have to explain themselves through medical documentation) when a patient is re-hospitalized.
poster:novelagent
thread:1019769
URL: http://www.dr-bob.org/babble/20120608/msgs/1019769.html