![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by football on March 20, 2007, at 12:12:41
I've noticed from reading through a lot of the messages here, that many of you have docs who won't prescribe the medicine you want. The medicine I'm sure you've researched and believe will be the best for you.
So, what the hell are you doing with that doctor? Get a new one! A doctor's not like an in-law, you can get a new one whenever you feel like it!
There's too little time in life too be stuck with one who won't give you the meds that you believe would be most beneficial to you.
Posted by Phillipa on March 20, 2007, at 12:45:48
In reply to Something I don't understand..., posted by football on March 20, 2007, at 12:12:41
Is it possible the doc doesn't believe it would be in your best interests? Love Phillipa
Posted by lymom3 on March 20, 2007, at 13:26:40
In reply to Re: Something I don't understand... » football, posted by Phillipa on March 20, 2007, at 12:45:48
Just because we think we know best doesn't mean that we do. I agree though that a good pdoc should be open to suggestions other that his/her own.
Posted by Ines on March 20, 2007, at 13:36:26
In reply to Re: Something I don't understand..., posted by lymom3 on March 20, 2007, at 13:26:40
I live in the UK, and over here it's not so simple. If you are using the National Health Service you don't have much choice- you have to use a surgery that's closest to to your house. You can see a different GP within the same practice, but in some places there aren't that many. And a lot of them will say the same (e.g. I can't get any of them to prescribe me MAOI's for atypical depression). If you get referred to a psychiatrist you have no choice at all over who you get to see.
Posted by football on March 20, 2007, at 14:09:25
In reply to Re: Something I don't understand..., posted by lymom3 on March 20, 2007, at 13:26:40
If you do enough research, you will absolutely know more about a drug then your doc.
Plus, only you know your body.
Posted by Quintal on March 20, 2007, at 15:24:59
In reply to Re: Something I don't understand... UK situation, posted by Ines on March 20, 2007, at 13:36:26
>If you get referred to a psychiatrist you have no choice at all over who you get to see.
And what a battle it is to get to see one at all. Even then you'll be waiting the best part of a year (and that's an emergency referral), and even then they'll just give you another SSRI or whatever they've been bribed to by the drug companies.
It's only by talking with fellow brits you get a pictre of how grim the mental health care really is.
Q
Posted by Racer on March 20, 2007, at 16:17:16
In reply to Re: Something I don't understand..., posted by football on March 20, 2007, at 14:09:25
> If you do enough research, you will absolutely know more about a drug then your doc.
One can certainly learn a great deal about individual drugs, but most of us don't have enough context to prescribe for ourselves. There's so much more than just knowing that Drug A is serotinergic, and should therefore treat symptoms X, Y, and Z. Medical school teaches doctors the context in which they're working. Many may not research individual drugs, necessarily -- consider how many drugs are out there, for how many sorts of conditions, after all -- but they do know more about the interconnections between different systems within the human body.
And anyway, the fact that many doctors don't know about every drug on the market is why one does better seeing a psychopharmacologist for psychotropic medications, rather than a GP. A pdoc may not know everything about every drug, but he/she should know enough to make some educated choices in treating mental illness.
>
> Plus, only you know your body.I may think I know my body, but that doesn't mean that my perceptions are accurate. I could tell you a dozen stories from my own history, when I thought something which I later learned wasn't true. And my depression often colors the way I see the rest of the world, as well. I've come to the conclusion that my doctors really do know my body better than I do in many ways. I can safely say that i trust my current pdoc to be able to extrapolate my reactions to various drugs, based on my reactions to similar drugs, better than I can. That's why I pay him to make those educated choices.
This is a topic that comes up from time to time. Frankly, I think everyone here probably has an opinion about it, and I doubt that many of us will be swayed much by any arguments, for or against.
Maybe it's best for me to say that I've offered my own experience and opinion, for whatever they're worth.
And to remind everyone to keep it civil, even if you disagree with another poster.
Posted by Quintal on March 20, 2007, at 17:47:53
In reply to Re: Something I don't understand... » football, posted by Racer on March 20, 2007, at 16:17:16
Yes, I do disagree with you on some points Racer. A lot depends on the skill of the individual pdoc and, I would say even more, on their empathy. Much healing comes from that in my experience. I know being stuck with a pdoc who lacks these qualities can do a great deal of harm.
I would say Anorexia Nervosa is a disorder where the perceptions of your own body are notoriously distorted, and outside opinion is very likely to be more accurate than your own. This is not necessarily true for other psychiatric problems where a great deal of thought and insight is needed to get a clear picture of what is going on with a person's inner emotional life. We see our pdocs usually only once every six months here, and then only for twenty minutes. Nobody, and I mean nobody, no matter how experienced and keen of perception can get a reliable, clear picture of a person in that short space of time.
Many of my pdoc's comments suggest he has no idea at all of how my mind works, or how much I suffer. In addition he often used to refuse to make suggestions for me saying "I don't know how to help you any more Mr. Quintal" as well as making mistakes in prescribing MAOIs, when he should really have double checked. I'd be a fool to trust his perceptions more than my own.
Q
Posted by Ines on March 20, 2007, at 18:12:37
In reply to Re: Something I don't understand... » Racer, posted by Quintal on March 20, 2007, at 17:47:53
I think it all depends so much on the knowledge, dedication and insight of the doctor you see... When I need to see a specialist for whatever reason I always spend the first appointment assessing the doctor just as much as he is assessing me. I look for clues like how much attention he/ she is paying, do they look like they are really taking it in, are they giving you the time to explain what you need to explain or are they rushing you, do their comments suggest they've understood the issue etc. I also try to find out about their reputation, experience and all that. If I trust a doctor to be knowledgeable, experienced and genuinely interested in the welfare of his patients I will introduce suggestions about treatment if I have any, but I will ultimately leave it to them to make the decision. If I don't get a good feeling about them I will be much more careful and do a lot of research myself. I've found this works well for me; after all medicine is like any other profession- some are more skilled than others...
I have a friend who suffers from bad migranes and was going through a depression; her GP prescribed her an AD that could not be taken with her migrane medication; when researching the drug she realised this and went back. The GP then prescribed her something else, and after she'd bought that she read the enclosed literature and found out that one was also dangerous if combined with her migrane meds! I myself was prescribed Paroxetine by my GP after I had taken Escitalopram and had no effect from it + SERIOUS trouble coming off it. As far as I'm concerned these things just goes to show you need to use your own judgement until you know your doctor is to be trusted. Sad, but there it is.
Posted by Racer on March 20, 2007, at 18:27:12
In reply to Re: Something I don't understand... » Racer, posted by Quintal on March 20, 2007, at 17:47:53
>
> I would say Anorexia Nervosa is a disorder where the perceptions of your own body are notoriously distorted, and outside opinion is very likely to be more accurate than your own. This is not necessarily true for other psychiatric problemsAnorexia is not my only diagnosis, Quintal. And, for the record, being anorexic does not mean that I am incapable of undistorted thought in other areas of my life.
I'm going to bow out of this discussion now, having had my say, because I'm a bit offended by that comment.
Posted by Quintal on March 20, 2007, at 18:47:49
In reply to Re: Something I don't understand... » Quintal, posted by Racer on March 20, 2007, at 18:27:12
I apologise if I've offended you Racer, but that does confuse me given that you said the same thing yourself. Anorexia is one disorder in particular where the perception of your body is often badly distorted, but I've read many times that depressives often have a more realistic (if scathing) perception of themselves and the world than their 'euthymic' counterparts.
Q
Posted by stargazer on March 20, 2007, at 21:45:30
In reply to Something I don't understand..., posted by football on March 20, 2007, at 12:12:41
Easier said than done. Try finding another pdoc who takes insurance. That is the latest trend here in CT where many people pay out of pocket with no trouble whatsoever. And no one can deny them care, their psych problems stay private and the docs get the money they ask for. Two names I was given had this arrangement. I had to find someone that took insurance, at least while I still have it, that will be changing
I put out a call for psychopharmacologists in CT several times and got no specific names, just suggestions on what might help. How do you find a real expert pdoc for TRD? I've googled til my fingers were blue and came up empty. It's not an easy thing to find, despite there being lots of pdocs, there are relatively few with the level of competence I want and need.
Stargazer
Posted by Phillipa on March 20, 2007, at 21:49:22
In reply to Unable to find one/Suggestions??????, posted by stargazer on March 20, 2007, at 21:45:30
Stargazer how bout another state close by for a consultation? Love Phillipa
Posted by stargazer on March 20, 2007, at 22:09:57
In reply to Re: Unable to find one/Suggestions?????? » stargazer, posted by Phillipa on March 20, 2007, at 21:49:22
How could there be no one in Connecticut???
We have UCONN and Yale and we're close to NYC and Boston, so there must be someone who is good. I'd rather stay in CT if at all possible. I know someone had suggested McLean outside Boston, but I want a name, not the institute. There must be at least one excellent psychopharmocologist in CT, how can I find him or her. Can anyone help with a way to find on line? Can you do some sort of doctor search? There must be a way to do this, you can search for everything else online.
Posted by Phillipa on March 20, 2007, at 22:45:16
In reply to Re: Unable to find one/Suggestions??????, posted by stargazer on March 20, 2007, at 22:09:57
Stargazer I did a doc search for Charlotte and UNC Chapel Hill. I will check and see if I can find what I typed in but it was probably pdoc and not psychopharmacologist. Love Jan
Posted by FredPotter on March 20, 2007, at 23:25:58
In reply to Something I don't understand..., posted by football on March 20, 2007, at 12:12:41
Good point Football. But then I've got a Dr who gives me what I ask for but knows sod all about it. I'd better know my stuff that's all Fred
Posted by yxibow on March 21, 2007, at 11:40:26
In reply to Re: Unable to find one/Suggestions??????, posted by stargazer on March 20, 2007, at 22:09:57
> How could there be no one in Connecticut???
> We have UCONN and Yale and we're close to NYC and Boston, so there must be someone who is good. I'd rather stay in CT if at all possible. I know someone had suggested McLean outside Boston, but I want a name, not the institute. There must be at least one excellent psychopharmocologist in CT, how can I find him or her. Can anyone help with a way to find on line? Can you do some sort of doctor search? There must be a way to do this, you can search for everything else online.
One way as a "consumer" (one of the new terms for patient) you may find a place to get referrals is NAMI Connecticut
http://www.nami.org/MSTemplate.cfm?MicrositeID=146State of CT Department of Mental Health and Addiction Services
American Psychiatric Association
http://www.healthyminds.org/locateapsychiatrist.cfm
Not to mention the national office of the OC Foundation is in New Haven
Connecticut Psychiatric Society, division of American Psychiatric Association
http://www.ctpsych.org/index.asp
General resources, UC Health Center Library, includes some of above
Posted by notfred on March 21, 2007, at 12:35:20
In reply to Something I don't understand..., posted by football on March 20, 2007, at 12:12:41
I have always picked meds together with my pdoc. Sometimes they ask flat out, "what do you have in mind". I have never had to take a med I was strongly
opposed to. I find itt easier to lead the pdoc toward what I want to take and then when they mention a med I want to try, jump on it.Knowing the names for a few neurotransmitters and reading some studies does not an expert in their own care make.
Posted by stargazer on March 21, 2007, at 21:19:21
In reply to Re: -- Associations and Resources, CT » stargazer, posted by yxibow on March 21, 2007, at 11:40:26
Thanks for help with finding a new pdoc. It is very difficult to get a name unless you have been given a referral from a doctor or patient.
I have been sent two names which another poster got from his pdoc, who affiliated with a large medical center. One is in CT, the other in RI, both affiliated with a medical school, both have background in research and both are highly published. I just googled them.
I have much difficulty searching randomly through lists of "untested, unproven" docs. That's like pulling a name out of a phone book.
IMO, you have to get a name from someone who has a personal affiliation with the recommended doctor.
SG
Posted by notfred on March 22, 2007, at 16:11:19
In reply to Unable to find one/Suggestions??????, posted by stargazer on March 20, 2007, at 21:45:30
" Try finding another pdoc who takes insurance."
Does your insurance offer out of network coverage ? Mine does 70/30 % for out of network docs. Does your job offer flex spending accounts ? Put aside a small amount each paycheck & then you can draw on it to pay medical bills. It is pre-tax so your dollar buys more.
I decided to see one of the really good pdocs in my area that takes no insurance. The initial hour consult was expensive but after that it is not bad. A years worth of med checks is $ 170 to $340.
I was paying $100 a year in co-pays with the HMO pdoc, the extra $100 to $240 a year was worth it.
Posted by stargazer on March 22, 2007, at 18:37:41
In reply to Re: Unable to find one/Suggestions??????, posted by notfred on March 22, 2007, at 16:11:19
Fred, I'm no longer able to work but I still have my insurance until that runs out in a few months.
I think when I looked into it there was a dollar amount which has to be paid before insurance kicks in? I think it was $250 or $500.
SG
Posted by notfred on March 23, 2007, at 11:22:32
In reply to Re: Unable to find one/Suggestions??????, posted by stargazer on March 22, 2007, at 18:37:41
> Fred, I'm no longer able to work but I still have my insurance until that runs out in a few months.
>Bummer, sorry to hear that.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.