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Re: HELP w/ New Doc!!!

Posted by bleauberry on June 23, 2012, at 13:37:04

In reply to HELP w/ New Doc!!!, posted by Bryn B on June 21, 2012, at 19:57:25

That is a sad story and that really sucks. What really sucks is that there are, tens of, hundreds of thousands....well,maybe millions....of people exactly like you who are getting no benefit from their doctors and are completely lost in figuring out where to go from here, how to find a new doctor, what med to try next, etc. I feel that way sometimes too and it really sucks.

The worst part is you are one of the few cash paying customers so it is easy to see your dollars wasted. Insurance patients don't feel and experience that side of frustration like you do.

I would think payiing cash is a good paperwork for them, no insurance red tape, no waiting, no fuss. They make more profit on a patient like you. It costs less to have patients like you. Expenses are lower, administrative stuff is lower. That said, they should be treating you better!

I'm kind of alone on this, but my opinion is screrw the diagnosis. It is not helpful to me. Ask 10 doctors and you'll get a variety of diagnosis. Which one was accurate? Did it matter? Did the best med come from the doctor who had the supposedly wrong diagnosis? Happens.

Look, 12 specialists over a 15 year period told me I had either depression, anxiety, or soft bipolar. They were all wrong it was none of those. It was Lyme disease. Depression just happens to go with the territory, but psychiatric treatments alone are not sufficient. So then they give you a different diagnosis to sort of explain their about maybe some schizoaffective traits mixed in there. Yeah that works. Ya know? If the first educated guess was wrong, well, make another one. In the end, did the diagnosis actually help by choosing the right meds? Maybe, maybe not. The odds are probably about the same as flipping a coin. There is no right or wrong diagnosis....they are merely opinions and they are only names created by humans to describe a particular bundle of symptoms, and those symptoms themselves may not fit perfectly into any model of a diagnosis, so the best guess has to be made. That's not science.

I think a better approach is to use clues from past experiences to help guide the future. For example let's say patient has had 3 ssris, none worked, abilify added, didn't work, lamictal added, didn't work. Ok. There are clues in there. We know serotonin by itself is the wrong target. We know doing a bunch of agonism and antagonism at a bunch of different receptors aint the answer. And whatever lamictal does, that's the wrong direction too. What things to similar stuff as abilify or lamictal? Whatever they are, you probably don't want to go there. Or if you did, you would only want to look at the cream of the crop in that group. Zyprexa in this example. Nothinig in the lamictal category. So what's missing in all this? Well, we see zero support for norepinephrine and very little support for dopamine. Bingo. There's something we haven't done yet. So that could logically bring up something like Zoloft+Nortriptyline, ssri+tca, ssri + stimulants. This whole paragraph is just an off the top of the head example, just trying to show you there are clues in your past and you can use them to guide the future and in my opinion that is much more helpful than someone's diagnosis that may or may not be true and may or may not choose the right meds because of it. As another short example, some doctors believe that if there is any bipolar suspicion, then antidepressants are out. Others believe that ssris themselves make good mood stabilizers.

Bottom line is it varies wildly from one patient to the next. Personal experimentation, and learning from those experiments, I think is the best prognosis.

I am assuming of course that the doctor is of average common skill. Once in a while someone lands a really good doctor who seems to have the magic touch and a lot of a passion for winning the game. That helps tremendously. Most of us are not there.

So, how to find a good MD in New York? Well sometimes people here references so that's a good start. I think basically if you think in terms of a salesman....expect many failures but the occasional big win....that's the right attitude. By failures I am referring to doctor searches. You might go through a list of 20 or 30 to find that one that somehow feels instinctually good to you.

Call hospitals. Ask them for MDs (don't limit yourself to just psychiatrists because some of the MDs are more skilled than the psychiatrists are) who have a reputation for being unusually good with depression patients. Nearby Universities, ask them the same thing. Look in the Yellow Pages. Anything that looks of interest, call them and ask them questions. It was a long time ago, but I sent out a mass letter to every psychiatrist in the book explaining briefly on one page my situation and asking if they felt confident of taking me as a new patient. Out of them all, I got only 3 replies. Ok fine, I weeded out a whole bunch of losers. Now, none of those 3 ended up being the right ones either after I asked a few questions on the phone with them, of them had another doctor's name to refer to me and that person ended up being fabulous! So the long journey and the hard work paid off. Within a year he retired (some of the old guys are really good so maybe look at their age) and then I was back to square one again. During your search there may be some unexpected twists and turns and that's ok, go with it and see where it goes, open mind, everything is game until you prove it otherwise. One of those unexpected twists or turns might be the crucial turning point you were hoping for.

Since you are literally the paying customer, do not be shy about asking a potential doctor questions that are important to you. You are basically looking to hire the best person you can find, so screen them well and expect to toss most of them in the trash if they don't measure up. Spend a few weeks in a good hunt, or spend many years suffering because you didn't. That's basically the way it is. imo

It aint easy but you are doing the right stuff. Hang in there! Even if you only have the strength to muster tiny steps every day, that's fine, any forward steps are better than none, any kind of forward effort is better than silence. You'll get there, and maybe quicker than you thought.

> hi all-
> I live in NYC and desperately need a new pdoc. I have mdd but don't even know if my diagnosis is correct anymore. (thinking I may have bipolar 2 or depression w bpd.) really at my bottom here--not functioning at all and my meds no longer work. my current doctor hasn't been helpful. any suggestions on where to go in manhattan for help (someone who is a great diagnostic person, med manager, etc) or a good clinic, program, etc?
> thanks in advance...
> I don't have insurance and have been paying a lot, and simply not getting any relief.
> thanks in advance.




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