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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by denise1904 on August 19, 2004, at 14:25:18
Exactly what do these psychiatrists get paid to do accept write out prescriptions for antidepressants, like one of them said to me "it's not an exact science" so what the hell are they doing? What expertise am I relying on when I go and see one??? They ask you the same standard questions and dole out the same drugs.
I suppose you could say it's the same with Doctors but I just think the Psychiatrists are only as good as the drugs they can prescribe, suppose the same thing goes for Doctors too.
More money should go to the researchers and less to the psychiatrists.
Denise
Posted by mcp on August 19, 2004, at 18:21:06
In reply to exactly what do these psyciatrists get paid for?, posted by denise1904 on August 19, 2004, at 14:25:18
*
> Exactly what do these psychiatrists get paid to do accept write out prescriptions for antidepressants, like one of them said to me "it's not an exact science" so what the hell are they doing? What expertise am I relying on when I go and see one??? They ask you the same standard questions and dole out the same drugs.
>
> I suppose you could say it's the same with Doctors but I just think the Psychiatrists are only as good as the drugs they can prescribe, suppose the same thing goes for Doctors too.
>
> More money should go to the researchers and less to the psychiatrists.
>
>
> Denise
>
>
Posted by waki on August 19, 2004, at 18:26:05
In reply to exactly what do these psyciatrists get paid for?, posted by denise1904 on August 19, 2004, at 14:25:18
aren't you being a little hard on them?
any profession that breaks new ground is experimental.
general practioners know less about mental illness.
look at how many people in this country are helped by p-docs.
if a p-doc just saved 1 life in their entire career, they have paid their dues back to society.
Posted by chemist on August 19, 2004, at 18:52:22
In reply to exactly what do these psyciatrists get paid for?, posted by denise1904 on August 19, 2004, at 14:25:18
hello there, chemist here....i was going to reply earlier but wanted to see what rolled in. my personal opinion is closest to that of waki. more specifically, in answer to your question, my psychiatrist gets paid more or less to write prescriptions. period. as much as i like him, i like my less-expensive and more-frequently-seen therapist just as much. all parties are satisfied, and i have signed consent forms for open communication between psychiatrist and therapist. there is more than a small degree of my having steered the situation in the direction it now lies: i have had my share of bad experiences, on both medication and personal levels, and have tried to identify the right people with whom i can work. i am keenly aware that, when all is said and done, i am *not* running the show, but i did assemble the cast and crew. i wish you (and all others) well, and all the best, chemist
Posted by Emme on August 19, 2004, at 22:17:10
In reply to exactly what do these psyciatrists get paid for?, posted by denise1904 on August 19, 2004, at 14:25:18
It's not just the tools available, but how one uses them.
I pay my psychiatrist to:
- Be a good diagnostician. She knows as well as the rest of us that diagnoses can change and that we don't all fit into categories. But she is thinking about the whole picture, sometimes teasing out patterns with the input of my therapist and trying to make sure she's not missing important information.
- Be up to date on current research and theories in addition to drugs.
- Be creative in trying to find a regimen that will address symptoms for the individual and have a tolerable side effect profile. This includes using a wide variety of ADs, ACs, parkinson's drugs, benzos, beta blockers, alzheimer's drugs, you name it. She's not super knowledgable about alternative therapies, but is open minded.
- Listen to my ideas. Answer all my questions.
- Not prescribe dangerous combinations. (well, that's a pretty basic necessity. But she really is a very skilled pharmacologist.)
- Think of other possible causes for the illness (for exmple, check B12, Lyme disease, ) and make sure they get ruled out. Order bloodwork periodically if I haven't seen my primary care physician in a while. Look the results the minute they come back and call me if there's a problem.
- Acknowledge and respect the interactions between biochemical and psychological/social factors and sometimes offer good therapeutic advice.
- Always return phone calls or at the very least have someone from the office leave a message so that questions get answered that day.
Is she perfect? No. Sometimes we don't try something long enough or make other errors. Have we tried things that didn't work well? You bet. Psychopharmacology as we know it right now is trial and error. So...ultimately the main product is a written prescription. But a lot of thought and consideration goes into it.
And yes, we need more funding for research!
Posted by iris2 on August 20, 2004, at 0:22:43
In reply to Re: exactly what do these psyciatrists get paid fo, posted by Emme on August 19, 2004, at 22:17:10
Emme,
I want your pdoc!!!I do not know if you realise how lucky you are.
irene
Posted by Cecilia on August 20, 2004, at 1:44:01
In reply to Re: exactly what do these psyciatrists get paid fo, posted by iris2 on August 20, 2004, at 0:22:43
As far as I`m concerned, they get paid for nothing. Every med I`ve tried (dozens) I`ve told the pdoc what I wanted to try next and he`s written the prescription. A chimpanzee could do it. Cecilia
Posted by waki on August 20, 2004, at 2:04:52
In reply to Re: exactly what do these psyciatrists get paid fo, posted by iris2 on August 20, 2004, at 0:22:43
What do p-docs do? They also continue to learn improved treatments. Thats why they call it "continious improvement". Face it, it's a new science. Ritlan and ADHD was just introduced in the mid 70's to children. Look how much more treatment the p-docs now offer then the just 30 years ago.
I'm a part of a multi university research treatment program. I meet with them once to twice a week. The team is on 24 hour call.
Some things they try are fda, other things they try are non fda. The federal government is paying for this research. Which gives credit to the administration in washington.
My point is the p-docs, research scientists, therapists, nurses, med companys, federal government, and the test patients are all working together to "build a better mouse trap".
Believe me, this is costing me a fortune. I gave up an extremely well paid career to get well, but also take some chances to help the science along.
If i I truely saw p-docs there just collecting paychecks and just giving prescriptions i'd go back and make the hay I was used to.
I see their commitment, they really are sincere about curing mental illness. It's amazingly obvious these people all have one goal, and that goal is to improve treatment results for mental illness.
These type of programs show a commitment from everybody to treat mental health.
As research evolves, it is shared with all p-docs; in turn prescribe it to you.
Take this board for instance, sure everyone has the downs which is why they are here. However everytime you read about someone feeling good, that just supports the p-docs more.
You can be rest asured that every prescription you get has entire support teams behind the scenes collecting and processing data.
Posted by Emme on August 20, 2004, at 6:54:31
In reply to Re: exactly what do these psyciatrists get paid fo, posted by iris2 on August 20, 2004, at 0:22:43
You bet I do. :)
Actually, the woman who treated me before her was similar...except that she returned phone calls w/in 2 hours instead of waiting till she was done with patients. Which is probably why she always ran a little late. But she moved away. I've been quite lucky. And still I'm "treatment resistant". These illnesses can be devastatingly nasty in spite of having careful, attentive doctors. But it does help me keep trying just knowing I have a safety net in a terrific therapist and good pdoc.
> Emme,
>
>
> I want your pdoc!!!
>
> I do not know if you realise how lucky you are.
>
> irene
Posted by Emme on August 20, 2004, at 7:01:37
In reply to Re: exactly what do these psyciatrists get paid fo, posted by iris2 on August 20, 2004, at 0:22:43
I'm not trying to make anyone jealous because my pdoc is good. :) I guess what I should say is...really good ones exist. They're out there. Don't get discouraged if you have to suffer through some bad treatment before you find good treatment.
Posted by iris2 on August 20, 2004, at 13:24:48
In reply to Re: exactly what do these psyciatrists get paid fo, posted by waki on August 20, 2004, at 2:04:52
> What do p-docs do? They also continue to learn improved treatments. That’s why they call it "continuous improvement". Face it; it's a new science. Ritlan and ADHD was just introduced in the mid 70's to children. Look how much more treatment the p-docs now offer then the just 30 years ago.
>
> I'm a part of a multi university research treatment program. I meet with them once to twice a week. The team is on 24 hour call.
>
> Some things they try are fda, other things they try are non fda. The federal government is paying for this research. Which gives credit to the administration in washington.
>
> My point is the p-docs, research scientists, therapists, nurses, med companys, federal government, and the test patients are all working together to "build a better mouse trap".
>
> Believe me, this is costing me a fortune. I gave up an extremely well paid career to get well, but also take some chances to help the science along.
>
> If i I truely saw p-docs there just collecting paychecks and just giving prescriptions i'd go back and make the hay I was used to.
>
> I see their commitment, they really are sincere about curing mental illness. It's amazingly obvious these people all have one goal, and that goal is to improve treatment results for mental illness.
>
> These type of programs show a commitment from everybody to treat mental health.
>
> As research evolves, it is shared with all p-docs; in turn prescribe it to you.
>
> Take this board for instance, sure everyone has the downs which is why they are here. However everytime you read about someone feeling good, that just supports the p-docs more.
>
> You can be rest asured that every prescription you get has entire support teams behind the scenes collecting and processing data.
>
>That all sounds great. Do you pay for this "service"? Where are you located? Or are you familiar with other programs around the country like this? I am in Pennsylvania but will travel.
I commend you on your positive attitude but I do not think that your experience is common!
I am looking for a new pdoc. I really have no choice. I keep putting it off because when he is mentally available he is brilliant, but that is not often anymore and I am know is he no longer continuing to learn new things.irene
Posted by CareBear04 on August 20, 2004, at 13:45:32
In reply to Re: exactly what do these psyciatrists get paid fo ?waki, posted by iris2 on August 20, 2004, at 13:24:48
it's been about a year and a half since i first saw a psychiatrist. since then, i've had some hospital stays, and i've been treated by about a dozen pdocs. some of them have very nearly killed me in various ways (e.g., prescriptions for large amounts of potentially lethal meds when i was actively suicidal, not returning phone calls in emergencies, not listening when i talked about awful side effects to the point that i just took myself off all meds, etc.) in this context, i've learned the word "iatrogenic," meaning doctor-induced and have been told by later doctors that most of my problems were just that. but amidst all this, i've also had some wonderful, caring pdocs who have gotten me through rough spots and one who i can say genuinely saved my life and got me turned around from hospitalized and hopeless to back in good form and in school full time within a month.
i've never had a good experience with pdocs who only prescribe meds without much talking to you. the best pdocs i've had are the ones who have received analytic training, so they do mostly therapy and analysis but usually do prescribe drugs, too. when i go to one person for therapy and drugs, i feel like the doctor has a better idea of what i'm like and what m yproblems are and can make a better guess as to what meds would help. when i comes down to it, i think it's all a guessing game, anyway, with some probability and experience thrown in.
there are a lot of unworthy pdocs out there, but if you look hard, you just might find a great one. if you're not satisfied with the care you're getting, i would look around some more to the extent that your finances and insurance allows you.
Posted by iris2 on August 20, 2004, at 14:25:17
In reply to Re: exactly what do these psyciatrists get paid fo, posted by waki on August 20, 2004, at 2:04:52
Waki,
I am getting angry just thinking about your post. I know you meant well and honest.
I used to be on many very well intentioned working groups, some included doctors, nurses, patients, and family members and were funded by the University Hospital. The people on the board I was on were dedicated and serious about our mission. There were different ones specific in nature. But after many meetings over say a year as an example. Having the research data printed up, bound and distributed for all to see I have to say I was generally disappointed in the final result. Commissioned to institute change the outcomes ended up collecting dust somewhere.Another example is my current pdoc years ago did research on a med currently approved in Europe. He was after years of study generally done. No doubt he had many well-intentioned people on his staff, one whom I got to know a little, who were doing this because it was the right thing to do. Anyway after all this the drug company withdrew from putting in for further FDA approval because it was decided that the market in the US would not be big enough. Even though the med had fewer side effects, and worked, from similar ones currently on the market. The company did not care, as all they were concerned about was the bottom line. I have read of other instances of these things happening.
For instance I would be interested to know the actual reason amineptine was taken off the market? Not just no FDA approved but shoved off the market in Europe where many doctors and patients had great objections. As far as I can tell the side effect profile is generally better than most AD's already on the market. I think it is interesting that the timing is such that viagra was to be introduced into the market within months after this fiasco and that amisulpride is one of the only AD's that does not have a negative effect on libido. In fact in a small number of cases it has shown to have a positive affect. Great reason to take it off the market!!! Would not want someone with depression to have a sex life!! At least not one that is not paid for with viagra!!
irene
Posted by Dave001 on August 20, 2004, at 17:22:27
In reply to exactly what do these psyciatrists get paid for?, posted by denise1904 on August 19, 2004, at 14:25:18
> Exactly what do these psychiatrists get paid to do accept write out prescriptions for antidepressants, like one of them said to me "it's not an exact science" so what the hell are they doing? What expertise am I relying on when I go and see one??? They ask you the same standard questions and dole out the same drugs.
>
> I suppose you could say it's the same with Doctors but I just think the Psychiatrists are only as good as the drugs they can prescribe, suppose the same thing goes for Doctors too.
>
> More money should go to the researchers and less to the psychiatrists.
>
>IMO, the real problem is not the psychiatrists but the government regulatory agencies, which decide for adults (including the doctors) the medications they will "permit" you to use. I feel that adults should not be robbed of their freedom to decide what is in their own best interest, to the extent that their actions do not trample on their neighbors freedom to do so either.
Dave
Posted by karlak13 on August 20, 2004, at 20:42:30
In reply to Re: exactly what do these psyciatrists get paid fo, posted by Emme on August 19, 2004, at 22:17:10
I agree with Emme 100%. I have seen many different shrinks due to insurance changes, second opinions, etc. I think they do alot to help me and earn their keep. I was very deeply depressed for many years over chronic pain and had come to a point in my life where I was suicidal and phycotic. I called my dr who put me in touch with a shrink asap. I was seen and admitted to a hospital that day. I was put on an antidepressent and antiphycotic. I have also been put on xanax for anxiety. There have been many times over the last 5 years that my shrink has saved me from myself. I thank God for their profession and compassion.
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