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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Tom Twilight on June 6, 2006, at 15:44:26
Hi everyone
Evenings like this you just wondering there’s any point in going on!
I’ve just had a terrible appointment with my GP
UK Mental health services are often bad, especially the ones you see on the NHS (UK state health service)
I think that partly because your not paying directly for their services they have a really funny attitude.
It’s a sort of an “I’m in charge & you’ll listen to me!” attitude.Saw the GP I normally see, and usually he’s ok, so I was a bit taken aback by how unhelpful he was this time.
I think partly its because he thinks I’m a time waster.A private doctor prescribed me Marplan, which my GP agreed to administer, which I thought was really decent of him.
Anyway I didn’t see much improvement in social anxiety or depression/dysimphia even at 60mgs after 3 months, so I discontinued.Since discontinuing the Marplan, I’ve had a really bad few months with depression and anxiety.
Right now I'm just *Blah* DysmphicI tried to explain to the GP that I was feeling depressed, how low I was feeling, that I wasn’t really turning up to work, taking care of myself e.c.t.
Unfortunately I’m quite socially anxious, and so find it a bit difficult to explain myself in these situations.
My GP responded by saying that since I’d tried about six ADs it was clear that there was not a chemical solution to my problems.He’s already referred me to a CBT therapist, unfortunately the wait in the UK is nine months(!)
Brought up ADD possibility but he didn't even want to discuss it.*Sigh* Think I’m going to go to bed and dream I don’t live in the UK!
Posted by fca on June 6, 2006, at 16:12:20
In reply to Really Bad Doctors Appointment!, posted by Tom Twilight on June 6, 2006, at 15:44:26
Sorry your appointment was so unsatisfactory--please do not give up--I am guessing the trials of 6 ADs has more to do with dosage and proper augmentation than the fact that there is nothing that will chemically help you--I know about the waiting lists in the UK as I do some consulting with the MH trusts and Partnership trusts in the UK--where are you located--I don't have any strings to pull (or at least I do not think so but I am just curious). It really is a challenge to find a good pdoc and CBT no matter where you live. I am very fortunate in that I can pay out of pocket for the services I need in the US--but If I could not or did not have excellent health insurance it could be a challenge.
Whatever, do not give up--just a question which you can feel free to answer or not--how much alcohol have you been using while on these different drugs. I believe your current drug is an MAO inhibitor so I assume you were not drinking at all Take Care Fca
Posted by Tom Twilight on June 6, 2006, at 16:34:35
In reply to Re: Really Bad Doctors Appointment!, posted by fca on June 6, 2006, at 16:12:20
> how much alcohol have you been using while on these different drugs.
Hey Fca
I actually don't drink (or can't drink)
Alcohol makes me feel kind of pro-social for about 20mins, then I start to feel depressed!Weired and annoying since drinking is big in the UK
I'm actually thinking of traveling abroad to get treatment, maybe US or Canada.
I find the prospect very daunting though!Seeing a US doc wouldn't be such a problem, but unfortunatly many of them want a doc in the UK to supervise treatment.
When I asked my GP if he would consider following directions from a US Pdoc, he said rather ominiously "It deppends what they want me to do."
You don't know of any good US Pdocs do you?
Posted by fca on June 6, 2006, at 17:42:27
In reply to Re: Really Bad Doctors Appointment!, posted by Tom Twilight on June 6, 2006, at 16:34:35
Thanks for your candor--I never cease to be amazed how many of us consume a bit to much alcohol and then become disappointed with the antidepressants we are taking. Sure , I know very good pdocs in the US--I run a large mental health center in Ohio and know quite a few psychiatrists. I am trying to imagine getting a physician here to take you on as a patient--it would be difficult except on an emergency basis or without the agreement that a physician in the UK would follow up--Rememeber--in the States we have the best of the best and the worst of the worst when it comes to health care in industrialized countries. where are you in the UK? Just the general area
Posted by blueberry on June 6, 2006, at 18:28:00
In reply to Really Bad Doctors Appointment!, posted by Tom Twilight on June 6, 2006, at 15:44:26
If you responded even just a tiny little bit to any of the meds you've already tried, you might consider something simple and cheap like st johns wort.
Hey, when it works it really works. The statistical odds of it working are the same as meds. Of all the antidepressants I ever took (a lot), st johns wort blew them all in the weeds.
Posted by Racer on June 6, 2006, at 21:27:18
In reply to Re: Really Bad Doctors Appointment!, posted by fca on June 6, 2006, at 17:42:27
Hi, FCA, I wonder if you'd babblemail me? I'll be in Ohio, and wonder if I could learn more about your center?
Nope, no reason for my interest. I'm just always curious, and especially about MH centers...
Posted by alohashirt on June 6, 2006, at 22:20:46
In reply to Re: Really Bad Doctors Appointment!, posted by Tom Twilight on June 6, 2006, at 16:34:35
I asked my internist (GP) about seeing foreign patients because I was curious. He specializes in a some obscure conditions ( that don't have ) and sometime gets foreign patients. he said he also knows people who travel to Switzerland to see doctors there. Said that seeing patients who aren't local really isn't a big deal.
> > how much alcohol have you been using while on these different drugs.
>
> Hey Fca
>
> I actually don't drink (or can't drink)
> Alcohol makes me feel kind of pro-social for about 20mins, then I start to feel depressed!
>
> Weired and annoying since drinking is big in the UK
>
> I'm actually thinking of traveling abroad to get treatment, maybe US or Canada.
> I find the prospect very daunting though!
>
> Seeing a US doc wouldn't be such a problem, but unfortunatly many of them want a doc in the UK to supervise treatment.
>
> When I asked my GP if he would consider following directions from a US Pdoc, he said rather ominiously "It deppends what they want me to do."
>
> You don't know of any good US Pdocs do you?
>
>
>
>
>
>
Posted by Phillipa on June 6, 2006, at 22:22:58
In reply to Re: Really Bad Doctors Appointment!, posted by alohashirt on June 6, 2006, at 22:20:46
Tom start a Thread on good US Doctors I know Robert David has one. Don't recall his name though. Love Phillipa
Posted by Meri-Tuuli on June 7, 2006, at 3:41:56
In reply to Really Bad Doctors Appointment!, posted by Tom Twilight on June 6, 2006, at 15:44:26
Hi Tom!
I'm really sorry to hear about the bad GPs appointment, although sad to say it doesn't surprise me. I usually burst into tears on the way home after one. I really hate the appointments.
> It’s a sort of an “I’m in charge & you’ll listen to me!” attitude.
Yeah this is very true!
> I think partly its because he thinks I’m a time waster.
Oh don't think that! You pay tax don't you?? Then you're entitled to whatever you need from the NHS.
As for the actual GP, well just see a different one at the practice. I regulary see different ones, just to see which is most sympathetic and clued up about mental health and the drugs, which sadly none of them are really.
Also try and take print outs about the different drugs you want to try, and sort of suggest them, and not sort of really try. Also, can you take someone along with you to the appointment? Would that help make you feel more comfortable? Anyway just see a different doc at the practice. Try to see a youngish one - I thought that if I'd see the most senior one it would be better, but he wasn't much good. The young ones are better I think. Also, I've started making notes about the different docs, so I can remember which one was which, and therefore which one was the most unhelpful.
> Unfortunately I’m quite socially anxious, and so find it a bit difficult to explain myself in these situations.
This sounds really corny, but I've considered doing it myself, which is to write it all down in a letter, and at the appointment, simply say you have problems expressing yourself, and here's what you want to say, and hand the GP the letter.
I get so frustrated too with them. Its like they don't listen, or take you seriously enough, or think you are making it up.
> My GP responded by saying that since I’d tried about six ADs it was clear that there was not a chemical solution to my problems.
Wow, this is awful!!! But again, this doesn't surprise me, it happened to me. I can't believe that they can say things like that. Talk about not giving you hope! I mean, if you had cancer, they won't be so blunt would they?? Are you being seen by a pdoc on the NHS? Well if the GP doesn't think your solution is chemical, ask him/her to refer you to a pdoc, because cleary the GP isn't an expert, so how do they know your problems aren't chemical?
> Brought up ADD possibility but he didn't even want to discuss it.
Apparently ADD doesn't exisit in the UK in adults. Can you believe it!? Well, there are some good links and stuff that paulbwell and pysnoname (I think) posted about ADD and the UK. see this post:
http://www.dr-bob.org/babble/20060520/msgs/647880.html
Argh! I am not liking the mental health care system in the UK one bit -- I've lost all faith in my pdoc too after telling me with certainty that reboxetine had been discontiued, when it hadn't. If he doesn't know you can still get it, then what else doesn't he know!? I mean, there could be some unknowledgeble patient out there who is the prefect fit for rebox, but doesn't get it because the pdoc thinks it isn't available.
Sigh. I wish I didn't live in the UK too. I wanna move to finland and be with my finnish family and mother!!!!
Kind regards
Meri
Posted by MSWGradStudent on June 7, 2006, at 5:51:44
In reply to Re: Really Bad Doctors Appointment!, posted by Tom Twilight on June 6, 2006, at 16:34:35
Healthcare, especially mental health care, is a pet topic of mine. I try to stay as objective as possible about the issue even though I serve a dual role as a patient and a provider within the US system.
I'll leave my academic/professional opinions out of this and speak entirely from a personal stand point. I think that we sometimes put too much responsibility on our doctors to fix us.
I know I saw the psychiatrist as the answer to all of my problems a year ago. Now, I see him as a man with a degree who tries to help people as best he can but is still falliable.
Doctors are people and they will NEVER know us as well as we know our own bodies. EVER! Regardless of their location in the UK, US, or planet Venus... we are the experts for our own bodies and should be the experts in our own care.
What do you feel has worked the best for you since you started treatment? Are you able to further pursue that line of therapeutic intervention?
I think you are strong to be looking for resources outside of your primary physician but maybe even look past physicians altogether for a bit... I'm NOT saying to discontinue meds or ignore medical advice... I'm saying that there are ways we can supplement what they offer that can benefit our lives tremendously.
Personally, I wish I would have relied more on ME and less on MD last year when I decided to take an antidepressant. I'm horribly affected now and I don't see any signs that it'll be healing up any time soon.
I thought he had the answers...and it took a year of my life to realize that I'm NOT one of those people who need meds to survive. I should have listened to ME earlier in the game.
Good luck and hope this makes some sort of sense. Take care.
Posted by Tom Twilight on June 8, 2006, at 13:39:25
In reply to Re: Really Bad Doctors Appointment!, posted by Phillipa on June 6, 2006, at 22:22:58
Just wanted to say thanks to everyone who responded!
Admittedly a very belated thanks
Posted by ramsea on June 9, 2006, at 0:58:56
In reply to Thanks for response everyone!, posted by Tom Twilight on June 8, 2006, at 13:39:25
Hi, I live in the UK and have also lived in the US, using mental health services there too. My own experience is that both places offer up very varied care---it can be superlative, supportive care--quite user friendly--and it can be middling care, good enough--and it can be neglectful and/or harmful care.
Really the stories I could tell about UK/US services would be at times funny and at times frightening.
Most recently I was gobsmacked in the UK by a young doctor at ER (and I do NOT make a habit of going there--it was toxicity from lithium, which was NOT caught at the time by the ER doctor and in addition, I had been told to go there by the GP receptionist because I had hurt my finger badly as well, with very painful muscles and joints and clumsiness, etc).
I told this ER doc I needed badly to consult with the on-call pdoc about my meds, and mentioned how sick and depressed I had been getting--and he laughed. "We all get depressed", he said, "I know I am. Tell me, what should I do to get better?" I advised him to try a lightbox.
But at least he wasn't like the public health clinic pdoc I saw in the US many years ago who upped my anti-psychotic because--as he told the nurse who was sitting in with me--the shirt I was wearing was too orange!!! I am serious. He didn't even address his words to me, but talked as if I wasn't there. I won't go into the more disturbing examples.
In the UK you could try private pdocs, as at the Priory clinic in Birmingham (google it). My results with such places is mixed. The quality of pdocs is not necessarily higher---most private pdcos also work for the NHS so if they are good or not so good they are likely to turn up in both places offering the same type of care.
And the relationship between the private and public sector isn't clear. One private pdoc, several years ago, prescribed Xanax for my social anxiety (which can be disabling). I could fill it privately a few times, but then the GP was supposed to take over. I took the script to my NHS GP and got shouted at. He literally shouted that he wasn't going to give anyone Xanax, etc., and acted like I was the one who had come up with the idea and like I was "drug-seeking". Now I had never even heard of Xanax at this point and didn't have a clue. When I tried to tell this to the private pdoc who was the prescriber, she didn't want to know and was also rude.
(Note**They since have banned it from the NHS formulary anyway. Truth is, Xanax and me didn't get on at well--it precipitated mania in my bipolar brain. But I am NOT anti-benzo, or anti-Xanax--and take Ativan as needed in severe anxiety episodes.)
In fact the very best pdocs I have seen ever in my 40-something years of life, and I've seen a fair few in the UK and US, have been UK NHS pdocs. So it's kind of the luck of the draw. I wouldn't be deadset against the UK, it just varies a lot.
ramsea
This is the end of the thread.
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