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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Kerry on June 6, 2000, at 0:13:29
I've been seeing the same pill doctor for about five years. I've never gone in there and suggested any medicines for him to prescribe...I always thought this was inappropriate and pushy...do you all just go to your pill docs and tell him/her what you want (speaking of meds only..) I'm going to make an appointment w/ my my doctor soon since I've had some good input/suggestions from here, but I feel a little funny going to him with a list.
Posted by Snowie on June 6, 2000, at 2:49:21
In reply to Do you ask your pill doc for certain meds?, posted by Kerry on June 6, 2000, at 0:13:29
Yep, I used to do that, and probably will continue to do it in the future. I would always research what I wanted to try in advance, and if it didn't work, nothing ventured-nothing gained. My pdoc rarely discussed the meds with me since I was only allowed 10 minutes per session with him. Consequently, I had to be informed. However, if you read above, I'm now his ex-patient. If your pdoc is easily intimidated, I'd find a new one.
Snowie
Posted by Jennifer on June 6, 2000, at 3:16:01
In reply to Re: Do you ask your pill doc for certain meds?, posted by Snowie on June 6, 2000, at 2:49:21
Absolutely! You know your body best. If your meds are working, don't change them! If there not, write down in advance what isn't working, and then jot down info on some meds you would like to consider. I wouldn't spout right off with being on-line with other patients who have ideas. You are a partner with him/her in your own health, and therefore, your input is valid. My best resource is a great pharmacist in town, I tend to run stuff by him sometimes first. Be sure to keep it positive, and really listen to his input regarding the meds you suggest. That shows him you're not just wanting meds, but to find the right meds that help you the most. Good luck! Jennifer
Posted by JohnL on June 6, 2000, at 4:39:31
In reply to Do you ask your pill doc for certain meds?, posted by Kerry on June 6, 2000, at 0:13:29
> I've been seeing the same pill doctor for about five years. I've never gone in there and suggested any medicines for him to prescribe...I always thought this was inappropriate and pushy...do you all just go to your pill docs and tell him/her what you want (speaking of meds only..) I'm going to make an appointment w/ my my doctor soon since I've had some good input/suggestions from here, but I feel a little funny going to him with a list.
Kerry,
I do indeed ask my doctor for specific drug trials. But it's not that easy. First we need a doctor without an ego complex. We need one who will treat each patient as unique individuals with unique personalities. There can't be any blanket strategies, favorite drugs, or anything like that. We're all different.I found three things helped when finding a doctor who would cooperate with my desire to take an active role in my own treatment:
1. Go with the doctor who has a reputation for good bedside manners, regardless of expertise or lack of it. If he has superb bedside manners, he probably doesn't have an ego complex.
2. Politely discuss with the doctor your desire to take an active role in researching drug choices before actually making drug requests. If they aren't open to it, find one who is.
3. Print out your research on two or three drug choices you want, show the doctor you are aware of the pros and cons of each. Ask him to help you weigh the pros and cons. His primary role with a patient who desires an active role in their own care should be to help the patient weigh the choices, and to make sure the patient doesn't do something that is dangerous.When your research is printed and from an esteemed source, it is very difficult for the doctor to argue against it. It's very easy for example for a doctor to critisize your 'internet friends', but it's not so easy to critisize a research paper just published by a prominent psychiatric hospital--maybe so recent he isn't even aware of it. I think it's very important to impress upon the doctor that you've done some diligent homework, that you aren't just going on the whims of your internet buddies. We all know that our internet buddies here at psychobabble are sometimes more expert in specialized ways than real psychiatrists. Try convincing a doctor of that. Forget it. Most doctors I think scoff at internet chatroom stuff. So choose printable sources from esteemed publications. You don't have to tell the doctor that your internet buddies steered you in this or that direction. But regardless of what direction you go at the suggestion of psychobabble participants, your own printed research from reputable sources is what matters.
Every drug choice I've made was backed up with printed research from two places:
1. Dr. Bob's Tips section (when your doctor sees in writing what other doctors are doing, it is rather impressive)
2. www.mentalhealth.com At this site you can research just about anything you want to know about any drug in the world. Print what you need to make your case. Everything you find is from researchers, hospitals, psychiatrists, medical schools, universities, trade magazines, etc. Reputable stuff. It makes you look like you know what the heck you're doing. I think our doctors will take us more seriously when we display to them that we have put some serious research into our requests. That's what's worked for me anyway. Except with the two pdocs I had that had ego complexes. I'm sure glad I don't go to them anymore. Not only were they egotistical and dictatorial, they were rather inferior, not at all any more expert than a regular doctor.
Posted by JohnL on June 6, 2000, at 5:34:54
In reply to Do you ask your pill doc for certain meds?, posted by Kerry on June 6, 2000, at 0:13:29
Kerry,
Snowie and Jennifer said it perfectly. I couldn't agree with them more. Hit the nail on the head.
I don't know about you, but I sometimes find realtime examples helpful in guiding me when I try to do something new. So if asking your doctor for specific medication requests is new to you, maybe these examples might be of help? Maybe, maybe not. But I thought I would share them just in case.
About a year ago I wanted to try augmenting my antidepressant with Pindolol. So I printed up my research from Dr. Bob's Tips and from Mentalhealth.com. The stuff I printed was pretty darn convincing, and all from reputable sources. When I sat down in the office, I said something like this, "I've been doing some research on what other psychiatrists and hospitals have been having success with, and one thing that really caught my attention was Pindolol. I'm sure you know all about it, but I brought you this research to read just in case you're interested to see why I want to try Pindolol. I do want to try it. I know there are other things we could do, and I know Pindolol might not work, but I would really like to give it a try and see. If these other hospitals are having success with it, maybe it will work with me too."
His response was first a chuckle, and then, "I've tried Pindolol with a lot of patients but I just haven't seen it work. But I guess anything's possible. It's a pretty safe medication. I don't have a problem with you trying it. If you want to try it, you have to promise me you'll give it a fair trial. If we are going to go with Pindolol, we want to do everything possible to give it a fair chance. But I have to tell you, I have not seen it work."
So at that point, the decision was mine...do I go with the research?...or do I go with my own doctor's experiences? Well, I asked him, "OK, well if you haven't had much success with it, then maybe I should rethink this. Do you have any other suggestions?" And then he posed a couple choices, we discussed the pros and cons of each, and I made my choice. Unfortunately Pindolol turned out to be the dud he was familiar with. But we both knew the failure rested on my shoulders, not his. He merely guided me through the pros and cons to be sure I had all the information I needed to make my own educated choice.
On another visit I sat down and asked him, "Have you ever prescribed Naltrexone with SSRIs?" He said, "No, but it sounds interesting. Do you have some information on that?" And I proceeded to pull out my research. He took a couple minutes to read through it. Then he said something like, "I don't have a problem with this. It could be interesting. Who knows, it might work. It's a very safe medication. It's a good a choice as anything else at this moment. Usually at this point we would try another SSRI. But if you want to try Naltrexone instead, that sounds OK. If it works, I have a couple other patients I might try it with. If you don't mind being my guinnea pig, let's try it"...with a smile and a chuckle. Unfortunately, another failure for me. Naltrexone didn't work. And, it didn't work on a handful of other patients he tried it with after me. Darn.
On another visit I said, "You know, I just get the sense that this whole serotonin thing is the wrong way to go with me. I think I'd like to try a norepinephrine medication for a change. We haven't tried that yet. I know this is real old, 1980 something, but I brought this research that shows that a positive response to Ritalin predicts a positive response to Desipramine. And a negative or neutral response to Ritalin predicts a response to Nortriptyline. Since I loved Ritalin (too much), then I think I would tend to want to try Desipramine. What do think?" His response, "I used to use Desipramine a lot in the old days. It's still a very good medication. I think it's been overshadowed by the SSRIs, but I have had a lot of success with Desipramine. If you want to try it, I have no problem with that." And as with previous visits, we then proceeded to talk technically about starting doses, possible side effects, pros and cons, etc.
This Thursday I have an appointment. I'm not sure exactly how I will say it, but it will be something like this, "Last time I saw you I was taking Zyprexa and Desipramine. The combination worked better than anything in years. My anhedonia was completely wiped out. But I really couldn't tolerate the side effects of Desipramine. (he'll stop me at this point and want to know what the side effects were, what the dose was, etc) I hope you don't get upset with me, but I stopped the Desipramine and tried a different non-prescription drug instead. You know me, always tinkering to find the right combination. There are some basic international antidepressants easily available from international pharmacies. I did a lot of research and was intrigued with a French antidepressant called Adrafinil. I love it. I've never felt as good as I do right now. I brought some information about it, since it isn't FDA approved in the USA and you may or may not have heard of it. Anyway, my problem is this...I don't like having to mailorder it, and I would rather stay with an FDA drug we are familiar with. Provigil is a very close derivative of Adrafinil. Adrafinil is its ancestor. Since it's the closest thing we have, can you write me a prescription for Provigil? If it doesn't work, I can always stay with Adrafinil. But it would be very cool if Provigil works as well as Adrafinil. I know it's prescribed for narcolepsy here in the US, but my research shows that it is used more commonly as an antidepressant in Europe."
Stay tuned. I'll let you know his response. Hopefully he won't kick me out. :-) I think because my request will be for a relatively safe FDA medication, he won't have a problem with it. And who knows, maybe it will pave the road for him to try it on some of his other difficult-to-cure patients. He probably is not aware of Provigils's use as an antidepressant, and this could open up some doors for other patients.
JohnL
Posted by ChrisK on June 6, 2000, at 6:41:44
In reply to Re: Do you ask your pill doc ...exmples., posted by JohnL on June 6, 2000, at 5:34:54
Kerry,
Ditto what JohnL said.
I have taken info in to the office about meds I was thinking might help. I have gone in with specific ideas and he has used his experience to guide me into a similar but slightly different med. I have also convinced him to try something new and he has let me go ahead.
I have had experimental periods with Naltrxone and Provigil because of what I have learned here. One successful, the other not but at least I am looking out for my own health.
I really like my pdoc but I only have 15 minutes a month with him and I have to squeeze everything in. I know best what happens to me every day. He knows that I am a user of the internet and he has since started to use it himself. I have no idea if he uses it for professional purposes but it's nice to know that he can get some of the same information I use.
Please don't be afraid to go into your doctor's office informed.
Chris
Posted by Greg on June 6, 2000, at 7:33:55
In reply to Do you ask your pill doc for certain meds?, posted by Kerry on June 6, 2000, at 0:13:29
Kerry,
Don't ever feel apprehensive about suggesting a med to your doctor. Share the knowledge you've gained here with him/her and make the decision together. Most docs won't have a problem with that, mine doesn't. The exception to this rule being pain meds. If you go in with with a headache and suggest he give you Morphine, that will definitely send up the red flag! :^) I wish you the best in finding the proper med.
Greg
Posted by Cari on June 8, 2000, at 17:28:37
In reply to Re: Do you ask your pill doc for certain meds? » Kerry, posted by Greg on June 6, 2000, at 7:33:55
You guys are awesome!!! I have an appt this coming Monday with the Virginia Mason clinic here in WA, a new insurance provider since I switched jobs. I'm on the perfect combo of meds right now and have felt normal for 15 months now, since I started Remeron, but when I told the doctor's office all I was on and the length of time I've been on meds, they about freaked and told me I need to bring in all medical reports of past doctors in order to stay on my meds. I'm very nervous about switching doctors from a brilliant doctor to someone I know nothing about in an HMO, but my brilliant doctor wasn't listed as a provider on my new insurance. I pray that I won't encounter the "Klonopin is an evil thing and we won't give you any" mentality. I'm definately going to check out the website you all suggested!
Posted by JohnL on June 9, 2000, at 3:47:06
In reply to Re: Do you ask your pill doc for certain meds?, posted by Cari on June 8, 2000, at 17:28:37
> You guys are awesome!!! I have an appt this coming Monday with the Virginia Mason clinic here in WA, a new insurance provider since I switched jobs. I'm on the perfect combo of meds right now and have felt normal for 15 months now, since I started Remeron, but when I told the doctor's office all I was on and the length of time I've been on meds, they about freaked and told me I need to bring in all medical reports of past doctors in order to stay on my meds. I'm very nervous about switching doctors from a brilliant doctor to someone I know nothing about in an HMO, but my brilliant doctor wasn't listed as a provider on my new insurance. I pray that I won't encounter the "Klonopin is an evil thing and we won't give you any" mentality. I'm definately going to check out the website you all suggested!
Cari,
I'm not exactly sure how to handle it or what to say, but you might want to plan in advance long and hard about what to say if they threaten to remove some of your medication. Whatever you say, keeping it professional and polite at first will go a long way. But if that doesn't work, I would not hesitate to strongly reject their plan of removing medication. As a matter of fact, I personally would probably refuse to leave the office if they intended to send me out in the world without the medication that keeps me well. That would be totally irresponsible, though perhaps well-intentioned. But good intentions don't count. Results do.You're having good results. That's what matters. The worst thing to do is to mess with it. The last thing we want to do is try to fix something that isn't broken.
It's easy to feel intimidated and hold back in the doctor's office. But don't. Do not under any circumstance accept anyone's notion of removing some of your medication. If that is threatened, it's time to be firm and bold, take the lead, be the boss, and stand up for yourself. But like I said, if this possibility really exists, it might be time well spent to really think hard of what and how to say the right things to defend yourself.
And one more thing...just because your doctor isn't listed under the HMO doesn't mean you can't continue with him. Most HMOs will chip in part of the payment for a non-HMO physician. And even if you have to pay outright cash, that might not be a bad option. Also, you can ask your previous doctor to call the new one in your defense. Tell him they are threatening to remove some of your medication. Ask him if he could please call so-and-so to discuss your case and why it might not be a good idea to remove any of your medication. Ask your doctor to go to bat for you.
JohnL
Posted by Cari on June 9, 2000, at 13:17:23
In reply to Re: Do you ask your pill doc for certain meds?, posted by JohnL on June 9, 2000, at 3:47:06
I would love to just pay out of pocket and stay with my current doc. He saved my life. Unfortunately I only make $8/hr and his $200 visits are not an option or I wouldn't be able to pay rent. As it is, I don't know how I'm going to make ends meet next month with making such a crappy salary and having $700/month to pay in rent. And because I was responsible and didn't get pregnant & go on welfare, and have no children, I don't qualify for any help. I wish I was Canadian... But thank you for your kind support. If the Virginia Mason clinic refuses the meds that have saved my life, I can try another doctor on the list of strangers and pray to God that I won't run out of meds in the meantime.
Posted by JohnL on June 10, 2000, at 3:58:19
In reply to Re: Do you ask your pill doc for certain meds?, posted by Cari on June 9, 2000, at 13:17:23
I sure understand the financial limitations. With that in mind, I think your best option at this time is to call your good doctor briefly and ask him to go to bat for you. It's very common for doctors to consult with each other about new patients. I think if this happens, your new doctor will be very unlikely to change anything in your medication. So definitely talk to your good doc and ask him to call the new one.
JohnL
This is the end of the thread.
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