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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by Wildflower on January 5, 2004, at 12:07:53
Any idea what the most common frequency for pdoc visits is? 1x/month? 4x/year?
I'm finding it odd that my pdoc keeps scheduling monthly visits (4 months in a row). Wouldn't you think that I would call if I had a problem with my meds?Is this common? It's becoming quite expensive...
Any advice?
Posted by Sebastian on January 5, 2004, at 12:15:02
In reply to Frequency of pdoc visits?, posted by Wildflower on January 5, 2004, at 12:07:53
cancel the appointment if you don't need it. that what they tell me.
Posted by dragonfly25 on January 5, 2004, at 13:22:11
In reply to Frequency of pdoc visits?, posted by Wildflower on January 5, 2004, at 12:07:53
they really are suposed to assess you each time they give out a prescription. so 1x/month doesn't sound excessive if you get your meds monthly . if you get a 2 month supply i would think every 2 months you would go. but i guess it also depends on the diagnosis. (ie. suicide risk)
dragonfly
Posted by stjames on January 5, 2004, at 14:42:38
In reply to Frequency of pdoc visits?, posted by Wildflower on January 5, 2004, at 12:07:53
It is specific to each patient, I see my doc every 3 months. This is a question you should bring up with your doc.
Posted by Bill LL on January 5, 2004, at 15:28:41
In reply to Frequency of pdoc visits?, posted by Wildflower on January 5, 2004, at 12:07:53
I get my meds from my internist. However, a few years a go I consulted a shrink. He also scheduled once a month. What I would do is make the appointment in his office. Then, after 2 weeks if I felt ok, I would leave a message that I felt ok so I am cancelling the next appointment.
That worked fine with him. But if our doc says that you must come in once a month or he will not refill your meds, I think you should either change pdocs, or ask your family doc to write the prescription.
Keep in mind that only about 30% of prescriptions for antidepressants are written by pdocs. The other 70% are written by internists, family practitioners, OBGYN's, pediatricians.
Posted by stjames on January 5, 2004, at 16:19:48
In reply to Re: Frequency of pdoc visits?, posted by Bill LL on January 5, 2004, at 15:28:41
> Keep in mind that only about 30% of prescriptions for antidepressants are written by pdocs. The other 70% are written by internists, family practitioners, OBGYN's, pediatricians.I find that very hard to believe. What is the source for this statement ?
Posted by socialdeviantjeff on January 5, 2004, at 17:39:40
In reply to Re: Frequency of pdoc visits?, posted by stjames on January 5, 2004, at 14:42:38
I see mine once a month. It seems that I'm on the phone almost weekly with him. Keep in mind that I'm a tough nut to crack. The majority of his patients see him once every 3 months.
Posted by AnneL on January 5, 2004, at 23:14:47
In reply to Re: Frequency of pdoc visits?, posted by stjames on January 5, 2004, at 16:19:48
Most AD's are initially prescribed by the patient's primary medical doctor, whether that M.D. happens to be an internist, GYN, etc. This is not as difficult to believe given the fact that many Americans are uninsured or underinsured
(no mental health benefits). The prevalence of advertising AD's on television and in magazines is another factor. It is very common to hear, "If you think you may have depression, talk to your doctor about . . . (fill in the AD).As a healthcare provider in a Cardiology clinic, we prescribe AD's and anti-anxiety medications on a daily basis. We will refer to a Pdoc if the patient cannot tolerate 1 or 2 SSRI trials and the patient has access to mental health benefits. Given the state of health care in the US, patients are fortunate to get *someone* to address their mental health care needs. Too bad we don't live in Perfect as the Walmart ad goes.
Posted by utopizen on January 6, 2004, at 11:33:37
In reply to Re: Frequency of pdoc visits? » stjames, posted by AnneL on January 5, 2004, at 23:14:47
1x/every 3 months? Wow. I use to see a p-doc who would see me every 3 weeks, but would return my calls the same day if I had any problems. Problem was, he was benzophobic, so it was a waste of time.
Then I saw a p-doc who would schedule 1x/month, which would be adequate, except that he would never return calls in-between.
So now I'm about to see a doc that's $125/appt. (bear in mind I've always seen p-docs under my PPO, which allows for unlimited and pre-authorized visits to as many docs as I want). So I think I'll see him 1x/month, because I figure he'll be more likely to return calls in-between if I have problems.
Posted by sarita0001 on January 6, 2004, at 12:03:07
In reply to Frequency of pdoc visits?, posted by Wildflower on January 5, 2004, at 12:07:53
Hi,
I went to a psychiatrist 1x a month because I wasn't going to talk therapy. I also thought that it was too much but found out that's usually the routine. If you go to counseling, usually the therapist makes sure you're ok so it's not necessary to go the psychiatrist often- maybe 2x year. My diagnosis was bipolar so I don't know if it had anything to do with that.
Sara
Posted by stjames on January 6, 2004, at 12:16:49
In reply to Re: Frequency of pdoc visits? » stjames, posted by AnneL on January 5, 2004, at 23:14:47
Sorry, I do no think 70% of all psyco meds
are written my non pdocs. Also, # of prescriptions written does not really mean much
in terms of a doc's quality.AS I asked in my post, do you also have some studies showing this rate, or were you just chiming in ?
Posted by Karen_kay on January 6, 2004, at 16:20:45
In reply to Re: Frequency of pdoc visits?, posted by stjames on January 6, 2004, at 12:16:49
I see my Pdoc once a month. Now that my moods are stabilized, I have the option to see him once every 6-8 weeks. I'm dx Bipolar Disorder, if that matters. The appointments are usually 20 minutes in length and it is basically just a med check. I've never talked to him on the phone personally, I have talked to nurses and staff on the phone and they return phone calls within the hour.
I'd say if you feel the appointment is not necessary, call and cancel. Also, when your Pdoc tries to reschedule, just say that you feel it is unnecessary to see him/her that often. And say when you think a better appointment schedule will be. If you are doing fine, I'm sure s/he will agree.
Posted by AnneL on January 6, 2004, at 16:26:34
In reply to Re: Frequency of pdoc visits?, posted by stjames on January 6, 2004, at 12:16:49
I respect your belief that 70% of psychiatric meds are not written by non-psychiatrists. Medline has some excellent journal articles dealing with the issue of GP's, Family Practitioners,Gynecologists, Cardiologists, etc., taking on the majority of the burden of diagnosis and treatment of various mental health issues due to the state of neglect of our healthcare system. Using the term "chiming in" is condescending and not conducive to inviting others to share their points of view and experience.
Posted by stjames on January 6, 2004, at 17:39:09
In reply to Re: Frequency of pdoc visits? » stjames, posted by AnneL on January 6, 2004, at 16:26:34
The issue was % of prescriptions written, not patients seen. Since you provided no details
and I don't find these facts evident, I discount
the claim of 70% prescriptions written by general practice docs as beening an opinion not based on fact.
Posted by gardenergirl on January 6, 2004, at 18:11:25
In reply to Re: Frequency of pdoc visits?, posted by stjames on January 6, 2004, at 17:39:09
Just to chime in...I have been on antidepressants on and off for about 10 years. I am currently on Nardil. ALL of my AD's have been prescribed by my primary care physician, including the MAOI. I have never seen a pdoc.
Although I do not have a reference to support AnneL's statement, I find it very credible. AD'a are prescribed for more than just depression. They can be effective for chronic pain, migraines, and chronic fatigue. All of these are treated by primary care MD's, not pdocs. If you add to this use the fact that:
"For most older adults, the primary care physician typically provides the majority of mental health services..." [Anderson, B.T. & Haley, W. E. (1997). Clinical geropsychology: Implications for practice in medical settings. Journal of Clinical Psychology in Medical Settings, 4(2), 193-211.]
then it does not seem so hard to believe.
Posted by stjames on January 6, 2004, at 18:58:59
In reply to anecdotal evidence, posted by gardenergirl on January 6, 2004, at 18:11:25
My primary would not begin to prescribe the sched.
II meds I take. In general specialists are better in treating their areas of training.I have always suspected it is denial that makes people so happy to go to a generalist for what is a quite serious condition, mental illness.
Posted by stjames on January 6, 2004, at 19:12:49
In reply to Re: anecdotal evidence, posted by stjames on January 6, 2004, at 18:58:59
http://www.mcmanweb.com/article-121.htm
Do you rely on a family physician to diagnose and treat your depression? Perhaps you should reconsider. In January 2001, three studies came to light that strongly suggest primary care physicians are better off poking and prodding our bodies than getting inside our heads.
The first, an Indiana Community Cancer Care-Aetna US Healthcare-Pfizer study of the records of 100 patients who were prescribed antidepressants in primary care, found that 90 charts contained documentation of just three or fewer symptoms of major depression, sixty revealed one or more criteria, and 40 contained no documentation of any criteria. The required five or more symptoms were to be found in only seven charts. Use of screening tools was documented in only four charts. Only 57 of the charts revealed a depression-focused follow-up visit, while just five charts indicated an educational intervention.
In other words, these doctors were indiscriminately handing out meds.
Not surprisingly, only 37 percent of the patients improved. Sixteen percent were referred to specialists. There were two suicide attempts. The article cited other studies suggesting that primary care physicians misdiagnose depression in as many as two out of three cases, and when the correct diagnoses is made, patients are often treated with subtherapeutic doses prescribed over periods of time too short to produce a benefit. The article also noted that 50 percent of patients quit their antidepressants after less than 30 days, but if a follow-up visit was scheduled, 86 percent of patients complied.
According to the authors of the study: "These survey results may add credibility to concerns ... that antidepressants are being used too frequently and without proper consideration and justification."
This is not a minor problem. In 1998, more than 130 million prescriptions for antidepressants were written in the US, the vast majority by primary care physicians, very few who refer their patients to more specialized treatment or counseling.
In the second study, UCLA-Rand researchers found that only 19 percent of a sample of depressed or anxious people they surveyed received appropriate treatment from their primary care physician.
By contrast, 90 percent of those who saw a psychiatrist got proper care.
The study surveyed 1,635 people, more than 80 percent who had seen a health care provider in the past year. On average, only 30 percent received proper treatment.
Those least likely to have benefited were African Americans, men, people with less than a high school education, and those younger than 30 or older than 59.
According to James Underberg MD, who operates a general internal practice in New York City, in an article in WebMD: "In a busy general internal medicine office, physicians often don't have the time to fully explore those kinds of problems. Most of the time, we're limited to ten or 15 minutes."
Enough time to spot a tumor or a heart beat irregularity, perhaps, but nowhere near enough to unearth the silent enemy that is depression and intelligently work with the patient in finding the right treatment. The final study bears this out, a survey of 1,001 patients and 900 primary care physicians commissioned by the National Depressive and Manic-Depressive Association which found that more than than three-quarters of those being treated for major depression felt their illness is not under complete control.
Other key findings include:
While 69 percent of physicians said they usually mention sexual problems as a possible side effect of medications and 47 percent usually mentioned weight gain, only 16 percent of patients reported either problem was ever brought up.
Forty percent of patients believe they have to tolerate avoidable medications side effects compared to just nine percent of physicians who believe side effects can't be avoided. While 90 percent of the patients who had side effects said they told their primary care doctor about them, close to 20 percent also reported that their doctor did not do anything in response.
Almost half of all patients surveyed reported having had side effects, which caused 55 percent to stop taking their antidepressant and 17 percent to skip doses
Seventy-one percent of the physicians said treatment decisions were made jointly with the patients, but only 54 percent of patients concurred. Only 36 percent of patients reported that their doctor asked about their preferences or willingness to tolerate certain side effects before making a decision about which antidepressant to prescribe.
"This data reveals a serious disconnect in the patient/physician relationship," commented Drew Pinsky MD, a participant in the survey. "The most important tool we have to monitor progress during the treatment process is open and effective communication."
Ultimately, responsibility for proper care is in your hands. Try to think of your brain as being every bit as important as your heart and act accordingly.
Posted by gardenergirl on January 6, 2004, at 19:39:30
In reply to Re: anecdotal evidence, posted by stjames on January 6, 2004, at 18:58:59
> In general specialists are better in treating their areas of training.
One would hope, otherwise, why special training? But specialists are not always necessary. I would not feel the need to go to an ear/nose/throat doctor for a sinus infection that my primary doc can treat with antibiotics. As my depression is not severe, and I have a good working relationship with my doc (despite his VERY annoying habit of always running an hour behind), I see no need to see a specialist. But that is me. Everyone has to do what's best for them.
> I have always suspected it is denial that makes people so happy to go to a generalist for what is a quite serious condition, mental illness.I think "serious" does not necessarily go hand in hand with "mental illness". Certainly there are serious mental illnesses, as there are serious physical illnesses. Rather, I think mental and physical illness exist on a continuum from mild to severe.
Posted by gardenergirl on January 6, 2004, at 19:42:30
In reply to Warning - Family Physician, posted by stjames on January 6, 2004, at 19:12:49
I absolutely agree, there are MANY MANY people with mental illness who do not receive adequate treatment, for a variety of reasons. And that is a real shame. Perhaps the drug reps who market psych meds to GP's can provide more education to help with this problem.
Posted by Karen_kay on January 6, 2004, at 19:49:19
In reply to Warning - Family Physician, posted by stjames on January 6, 2004, at 19:12:49
Just my personal story....
It was actually my family physician who dx me with Bipolar Disorder, after suffering for years and refered me to my Pdoc. So, a Family Physician is a good place to start. Although my previous one had me on numerous AD's which caused me to become manic several times over the course of several years, the latter Family Physician diagnosed me on my first visit and started me on Lithium. When I began having problems with the medication and he realized that my problems were "out of his realm of knowledge" he then refered me to a knowledgable Pdoc. I have a very good Family Physician!
Posted by stjames on January 6, 2004, at 20:22:06
In reply to Re: Warning - Family Physician » stjames, posted by gardenergirl on January 6, 2004, at 19:42:30
> I absolutely agree, there are MANY MANY people with mental illness who do not receive adequate treatment, for a variety of reasons.
Lack of insurance or restrictive HMO policy
means many do not see a pdoc. Clearly, most who
do not have ins. cannot afford to see multiple
docs. I've taken psyco meds most of my life (40's)
and for myself it is clear who gives the best treatment.I would be happy if the primary would just refer out for Dx and starting meds, then hand the med management back to the primary. This could solve the 2 common problems, incorrect dose & Dx. A Primary does not have the time or training to
Dx mental illness, that is a whole 2 years in residency training.
Posted by AnneL on January 6, 2004, at 21:42:53
In reply to Re: Warning - Family Physician, posted by stjames on January 6, 2004, at 20:22:06
Interesting question. . . There are many arguments that would support this idea. St. James brings up many good points that support the theory that psychiatrists have the extra training and time that is necessary in order to diagnose and treat mental illness. My concern is for those patients whose access to any type of care is limited. Healthcare practitioners of all types and specialties are practicing outside of their training and specialty due to declining resources. In many communities and locales it is simply not economically feasible to refer a patient to a psychiatrist for initial diagnosis and Rx. What does the family practitioner do then? My family practitioner was far more brilliant than the 3 HMO pdocs I saw. Training and education are essential and so is intelligence, compassion and a willingness to go the extra mile - no matter what the specialty is.
This is really about healthcare reform and for the sake of maintaining protocol, we can take this issue to another board. :) Anne
Posted by cybercafe on January 7, 2004, at 9:32:50
In reply to Frequency of pdoc visits?, posted by Wildflower on January 5, 2004, at 12:07:53
> Any idea what the most common frequency for pdoc visits is? 1x/month? 4x/year?
>
> I'm finding it odd that my pdoc keeps scheduling monthly visits (4 months in a row). Wouldn't you think that I would call if I had a problem with my meds?
>
> Is this common? It's becoming quite expensive...
> Any advice?
i used to go once a week ... for maybe 1.5 years? and i wasn't suicidal or manic ... but it turned out i had bipolar + anxiety + ADD so it's a good thing i got a little more attention (or the ADD never would have been diagnosed and treated)... my depression was also a little resistanti'm in canada btw
Posted by jbs on January 7, 2004, at 22:06:06
In reply to Frequency of pdoc visits?, posted by Wildflower on January 5, 2004, at 12:07:53
As stated by someone else, I would discuss it with your doctor. I think cost, time, effort, your diagnosis and symptoms, his comfort in knowing you, all factor into the decision. Once a month for a stable patient is too much and for an unstable patient too little....
Posted by Bill LL on January 8, 2004, at 10:23:09
In reply to Re: Frequency of pdoc visits?, posted by stjames on January 6, 2004, at 17:39:09
I just did a quick search on google. It said that non-psychiatrists prescribed 57% of antidepressants in the first quarter of 1997. In my last post I said that the number was 70%. I don't remember where I saw the 70%. It's possible that if the correct figure was 57% in 1997, it could be higher now. I believe that this trend has been increasing due to the growing pressures of HMO's and other managed care plans.
I personally feel very comfortable with having my internist prescribe my AD's. He is very knowledgable and experienced with AD's. Also, I only pay $15 per visit as opposed to $100 or so when I went to a pdoc.
Where I live, the big majority of internists participate in Blue Cross/Blue Shield. Most pdocs do not participate (hardly any do). That means that I have to pay the difference between the full charge and the BCBS payment. But for an internist who participates (most internists) I only pay $15.
I do feel however that pdocs are generally more qualified than internists to treat difficult cases. Also, I think that in many cases, although a primary care doc is treating the patient, the doc may from time to time have the patient consult with a pdoc about a change in treatment strategy.
> The issue was % of prescriptions written, not patients seen. Since you provided no details
> and I don't find these facts evident, I discount
> the claim of 70% prescriptions written by general practice docs as beening an opinion not based on fact.
>
>
This is the end of the thread.
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