Psycho-Babble Medication Thread 704811

Shown: posts 1 to 25 of 48. This is the beginning of the thread.

 

Doctors underestimate our intelligence/knowledge ?

Posted by ronaldo on November 18, 2006, at 7:58:00

It seems to me that lots of people have questions in this forum that could have been best answered by their own doctors who wrote the prescription or made the diagnosis. Personally I often find myself left with a lot of unanswered questions about five minutes after my appointment with the doctor ended. It seems I was too reluctant to take up some more of the doctors time; was too in awe of the doctor's expertise; underestimated my own intelligence and knowledge. It seems to me that we get short-changed by the medical profession. Maybe some patients have a much more constructive relationship with their doctors. What I would like to know is how to get the best out of the appointment with my doctor. Boards like this would not exist if we had better communication with our doctors.

Does anyone have any thoughts on this?

I wish I knew more about agonists and antagoists and receptors and neurotransmitters etc...etc...etc...

...ronaldo

 

Re: Doctors underestimate our intelligence/knowled ronaldo

Posted by Squiggles on November 18, 2006, at 8:14:55

In reply to Doctors underestimate our intelligence/knowledge ?, posted by ronaldo on November 18, 2006, at 7:58:00

I'm currently reading a book "Buffoonery", by an
experienced and very witty nurse. And if this
has any reflection of truth about hospital life,
I would say, count your blessings that you can
get 5 minutes of quality time with your doctor. And remember that thousands of people in underdeveloped countries, are dying from diseases with absolutely no medications or medical attendance. Just go to WHO to check out the situation in these countries.

There may be an exception for very wealthy
people who have private doctors-- the Queen
of England, I imagine has many specialist attendants, and can be expected to live for a very long time in good health.


Squiggles


 

Re: Doctors underestimate our intelligence/knowledge ?

Posted by linkadge on November 18, 2006, at 8:52:18

In reply to Doctors underestimate our intelligence/knowledge ?, posted by ronaldo on November 18, 2006, at 7:58:00

The problem is that flimsy neurotransmitter knowledge such as ours has only a limited capacity to predict outcome of any of our drug trials.

People like myself have gone in with all sorts of crazy wacko ideas of why this drug or that drug needs to work, based on its activity at such and such a recptor but it really doesn't amount to anything. I'd urge you to find anybody who has found the right drug based on neurotransmitter theory.

I guess what I am saying is that how a drug is thought to work dosn't really mean much in the end. I'd say the experience that a psychiatrist has with what works and what doesn't is a much more valuable tool.

Even if a person correcly predicts what drug affects what neurotransmitters. That is a far strech from matching it with ones underlying biology. Many people for instance, incorrectly assume that if a SSRI doesn't work then they must have a dopamine problem. Other incorrect assumptions are that if unipolar drugs don't work, the person must be bipolar. Unfortunatley it doesn't work in such a binary manner.

Let me give another example. Many people think that Wellbutrin is working primarily via dopamine. People come on the board convinced that they have some sort of dopamine defiiciancy and that Wellbutrin is the answer.

The problem is that more recent and detailed invesitation into the workings of Wellbutrin reveal that it has only negligable affinity for the dopamine uptake pump. At maximal doses, a person might only achieve 20% inhibition of the uptake pump. Other findings about the drug have called for a reconsideration of its principle mechanisms.

Another example is straterrra/reboxetine. Both are potent inhibitors of noradrenaline uptake, yet on shows significantly more antidperessant potential than the other.

So, does a good doctor underestimate our "knowledge"? A good doctor doesn't and probably shouldn't (IMHO) care about our petty knowedge of the flimsy proposed mechanisms of a drug which in the end, only serve as weak guidposts to drug selection.


Just my 2 cents.


Linkadge

 

Re: Doctors underestimate our intelligence/knowled

Posted by linkadge on November 18, 2006, at 8:53:04

In reply to Re: Doctors underestimate our intelligence/knowled ronaldo, posted by Squiggles on November 18, 2006, at 8:14:55

Not to say that some doctors aren't idiots.


Linkadge

 

Re: Doctors underestimate our intelligence/knowled ronaldo

Posted by emme on November 18, 2006, at 9:14:09

In reply to Doctors underestimate our intelligence/knowledge ?, posted by ronaldo on November 18, 2006, at 7:58:00

> What I would like to know is how to get the best out of the appointment with my doctor.

Thoughts:

People may get short-changed time-wise. I have half-hour appointments with my doctor. I can't imagine doing 15 minute appointments.

I try to use the time as efficiently as I can by jotting down notes ahead of time about symptoms, med side effects, questions, etc. The more succinctly we get caught up on what's been going on between appointments, the more time we have to discuss options and answer questions.

If I have a pressing question after I leave - something about dosages, serious side effects, or bloodwork for example, I call. If it's not urgent, I either look online or wait until the next appointment. I sometimes have to pick and choose which questions are the most important for planning treatment vs. things that are interesting but not immediately useful. My doctor would happily answer a billion questions - but there's not enough time.

I'm not a passive patient and my doctor accepts and respects that. I do try to be considerate of her and honest with her. She treats me like an intelligent being, answers my questions, and takes my ideas into account in planning treatment. It's really been pretty good. :)

I think both the doctor and patient have to look at treatment as a team effort, a partnership. Can you let your doc know that you think your communication could be improved? A responsible practitioner will want you to be comfortable working with them. If it ends up not working out with your current doc, know that there are good ones out there.

> Boards like this would not exist if we had better communication with our doctors.

Well, it's always nice to have other sources of support even if it works out well with your doc.

> I wish I knew more about agonists and antagoists and receptors and neurotransmitters etc...etc...etc...

You can always study up. I've chosen to not put a lot of time into it. I know less than many people on this board, but enough to grasp the big picture, know the classes of drugs, and know what it is I'm taking.

Good luck,
emme

 

Thanks for your valuable 2c worth (nm) linkadge

Posted by ronaldo on November 18, 2006, at 9:19:25

In reply to Re: Doctors underestimate our intelligence/knowled, posted by linkadge on November 18, 2006, at 8:53:04

 

Re: Doctors underestimate our intelligence/knowled

Posted by emme on November 18, 2006, at 9:31:03

In reply to Re: Doctors underestimate our intelligence/knowledge ?, posted by linkadge on November 18, 2006, at 8:52:18

What Linkadge noted about limited predictive power is one reason I don't bother to go beyond a certain point in learning about psychopharmacology. Treatment decisions aren't made only on theory. My pdoc's clinical experience is an important factor in deciding what to try.

emme

 

Re: Doctors underestimate our intelligence/knowled emme

Posted by Squiggles on November 18, 2006, at 10:00:47

In reply to Re: Doctors underestimate our intelligence/knowled, posted by emme on November 18, 2006, at 9:31:03

> What Linkadge noted about limited predictive power is one reason I don't bother to go beyond a certain point in learning about psychopharmacology. Treatment decisions aren't made only on theory. My pdoc's clinical experience is an important factor in deciding what to try.
>
> emme

"Clinical experience" is the key when this
field is rather experimental emme.

I think that the net is amazing for providing
information. I wish someone like Bill Gates
would install these engines in poor countries and far off villages where there is doctor shortage in Canada's north for example.

Squiggles

 

Re: Doctors underestimate our intelligence/knowled Squiggles

Posted by ronaldo on November 18, 2006, at 10:09:44

In reply to Re: Doctors underestimate our intelligence/knowled ronaldo, posted by Squiggles on November 18, 2006, at 8:14:55

> And remember that thousands of people in underdeveloped countries, are dying from diseases with absolutely no medications or medical attendance. Just go to WHO to check out the situation in these countries.

> Squiggles

Hello Squiggles,

One might also remember the position/condition these countries were in some fifty years ago when there was peace, order and the rule of law. They could not get rid of their colonial masters quick enough. Take Zimbabwe for one example; take the AIDS situation in South Africa for another. I might have more sympathy for the plight of the third world if Zimbabwe had treated her white farmers with more compassion and respect. They were after all the country's bread winners and bread providers...

...ronaldo

 

Re: Doctors underestimate our intelligence/knowled

Posted by linkadge on November 18, 2006, at 10:38:10

In reply to Re: Doctors underestimate our intelligence/knowled Squiggles, posted by ronaldo on November 18, 2006, at 10:09:44

The rate of mental illness in Canada's north is horrable. Many many factors involved.

Linkadge

 

Re: Doctors underestimate our intelligence/knowled ronaldo

Posted by Squiggles on November 18, 2006, at 10:39:52

In reply to Re: Doctors underestimate our intelligence/knowled Squiggles, posted by ronaldo on November 18, 2006, at 10:09:44

> > And remember that thousands of people in underdeveloped countries, are dying from diseases with absolutely no medications or medical attendance. Just go to WHO to check out the situation in these countries.
>
> > Squiggles
>
> Hello Squiggles,
>
> One might also remember the position/condition these countries were in some fifty years ago when there was peace, order and the rule of law. They could not get rid of their colonial masters quick enough. Take Zimbabwe for one example; take the AIDS situation in South Africa for another. I might have more sympathy for the plight of the third world if Zimbabwe had treated her white farmers with more compassion and respect. They were after all the country's bread winners and bread providers...
>
> ...ronaldo

Ronaldo,

I don't know much about the politics of this
transition -- maybe they were better off under
a "benevolent" babysitter; but you can't treat
people like refugees in their own country. That things got worse is just unfortunate, not something to be reversed to colonialism.

Anyway, there are many other countries whose medical systems sucks, mainly because of poverty and ignorance. When the West intervenes to clean things up, there isn't necessarily an improvment.

Squiggles

http://en.wikipedia.org/wiki/British_involvement_in_Rhodesia

 

Re: Doctors underestimate our intelligence/knowled Squiggles

Posted by ronaldo on November 18, 2006, at 10:58:12

In reply to Re: Doctors underestimate our intelligence/knowled ronaldo, posted by Squiggles on November 18, 2006, at 10:39:52

Latest move on the Zimbabwe dollar, and what does this hold in store for the country's health service?

http://www.thezimbabwean.co.uk/viewinfo.cfm?id=2632

 

Re: Doctors underestimate our intelligence/knowled linkadge

Posted by Squiggles on November 18, 2006, at 11:05:02

In reply to Re: Doctors underestimate our intelligence/knowled, posted by linkadge on November 18, 2006, at 10:38:10

> The rate of mental illness in Canada's north is horrable. Many many factors involved.
>
> Linkadge

I've seen the documentaries on CBC. There is
a lot of substance abuse and a degeneration
of their living standards. It's bad. Despite
the programs for community improvement (such
as Indian leaders graduating from schools there)
i can't help but wonder if the majority of
natives would not want to mingle in the bigger
cities. It is argued that they would then lose
their culture, but that is not an argument used
by other ethnics groups. I have my doubts that
natives can go back 100 years to their original
culture of life.

Squiggles

 

Re: Doctors underestimate our intelligence/knowled Squiggles

Posted by Phillipa on November 18, 2006, at 11:20:49

In reply to Re: Doctors underestimate our intelligence/knowled linkadge, posted by Squiggles on November 18, 2006, at 11:05:02

Original question. My pdoc thinks I know too much or she knows too little as she always asks me what I want to try and at what dose. I've tried others and 5 minutes was all I got and they both really didn't care about my notes. The one I'm seeing just said let them fix your thyroid first, that endo said no your thyroid can't be making you feel tired, a Gastro said you may have autoimmune hepatitis. They all say that's not my specialty. So my question is do docs know anything at all? Seriously. Love Phillipa

 

Re: Doctors underestimate our intelligence/knowled Phillipa

Posted by Squiggles on November 18, 2006, at 11:45:44

In reply to Re: Doctors underestimate our intelligence/knowled Squiggles, posted by Phillipa on November 18, 2006, at 11:20:49

> Original question. My pdoc thinks I know too much or she knows too little as she always asks me what I want to try and at what dose. I've tried others and 5 minutes was all I got and they both really didn't care about my notes. The one I'm seeing just said let them fix your thyroid first, that endo said no your thyroid can't be making you feel tired, a Gastro said you may have autoimmune hepatitis. They all say that's not my specialty. So my question is do docs know anything at all? Seriously. Love Phillipa

I think the answer is YES and NO. :-)

Squiggles

 

Re: Doctors underestimate our intelligence/knowled Squiggles

Posted by Phillipa on November 18, 2006, at 11:51:50

In reply to Re: Doctors underestimate our intelligence/knowled Phillipa, posted by Squiggles on November 18, 2006, at 11:45:44

Squiggles could you explain a bit more? Love Phillipa

 

Re: Doctors underestimate our intelligence/knowled ronaldo

Posted by Squiggles on November 18, 2006, at 12:18:12

In reply to Re: Doctors underestimate our intelligence/knowled Squiggles, posted by ronaldo on November 18, 2006, at 10:58:12

> Latest move on the Zimbabwe dollar, and what does this hold in store for the country's health service?
>

Well, my naive guess would be that people's
work and productivity will be devalued and
more predatory economies will take advantage
of them?

Squiggles
> http://www.thezimbabwean.co.uk/viewinfo.cfm?id=2632

 

Re: Doctors underestimate our intelligence/knowled

Posted by Racer on November 18, 2006, at 13:37:30

In reply to Doctors underestimate our intelligence/knowledge ?, posted by ronaldo on November 18, 2006, at 7:58:00

From reading here, I've gotten very interested in neurotransmitters -- so much so that I've started taking classes to learn more about neurochemistry. Fascinating stuff.

But I very much doubt it will do anything towards teaching me which medications will be most likely to help me.

What has been helpful to me is seeing a pattern to the drugs that have been helpful to me: they have all had significant effects on NE, along with effects on DA and 5HT. Beyond that, though, it's a crap shoot.

The new pdoc I just started seeing asked a question I'd never been asked before, though, which I thought was pretty inspired: he asked me about recreational drug use, and I told him I'd been to high school, where it was pretty much mandatory. He asked me what drugs I'd liked! He said that often told him what sorts of drugs might be helpful. Makes sense, if you think about it. "When you self medicated, what drugs did you find helpful?" Yeah, uh huh, OK, that makes sense to me. (Answers: speed and heroin. Heroin being why I stopped taking drugs -- it scared me to enjoy it, since I'd seen what it could do to people.)

As for the whole thing with doctors, it does depend on the doctor, of course, but there are a lot of doctors out there who don't necessarily seem to see an informed patient as helpful to treatment. This is an older model of psychiatry, for the most part, and it's not helpful for a lot of people like those on this board. There are, though, a lot of people walking into psychiatrists' offices who want the doctor to tell them what to take and how it's going to make them feel, who don't want to have to participate beyond taking a pill every day. It gives them comfort to think that The Doctor will make them better. It must be hard for doctors to have to adjust between the two sorts of patients, you know? On the one hand, they have to be The Doctor who is in charge; on the other, they have to avoid insulting patients like us who want to be involved. Especially when you get into the whole "is there time to see the patient AND do the paperwork for the insurance AND earn enough to pay the office staff" thing, it's got to be hard to be a doctor these days.

Then again, considering some of my own experiences with doctors, it's awfully hard to be a patient, too...

 

Re: Doctors underestimate our intelligence/knowledge ? ronaldo

Posted by erik98225 on November 18, 2006, at 13:46:50

In reply to Doctors underestimate our intelligence/knowledge ?, posted by ronaldo on November 18, 2006, at 7:58:00

> It seems to me that lots of people have questions in this forum that could have been best answered by their own doctors who wrote the prescription or made the diagnosis. Personally I often find myself left with a lot of unanswered questions about five minutes after my appointment with the doctor ended. It seems to me that we get short-changed by the medical profession.

I could not agree more, and I fired a total of SEVEN pdocs. I knew more than they did about my condition. I am currently seeing a pdoc who is a Psychopharmacologist (expert in the effect of drugs on the mind), and he's expensive but worth every penny. First pdoc I've ever seen who is open to nonconventional treatments and open to suggestions from the patient.

Erik

 

Re: Doctors underestimate our intelligence/knowled erik98225

Posted by Squiggles on November 18, 2006, at 13:58:20

In reply to Re: Doctors underestimate our intelligence/knowledge ? ronaldo, posted by erik98225 on November 18, 2006, at 13:46:50


> I could not agree more, and I fired a total of SEVEN pdocs. I knew more than they did about my condition. I am currently seeing a pdoc who is a Psychopharmacologist (expert in the effect of drugs on the mind), and he's expensive but worth every penny. First pdoc I've ever seen who is open to nonconventional treatments and open to suggestions from the patient.
>
> Erik

Well call me a tree-hugger if you like,
but I think that psychopharmacologists should
be part of the public health care system
staff - as in the hospitals to treat mentally
ill patients-- not private owners of Mercedes
SUVs, trophy wives, private school brats,
and mansions on the hill, with the left wing
turned into a private practice office, and
the right for the peroxide mistress/receptionist/secretary/public relations assistant. Oh, and did i mention the drug company perks in executive shares;

Squiggles

 

Corrected link Squiggles

Posted by Racer on November 18, 2006, at 13:58:36

In reply to Re: Doctors underestimate our intelligence/knowled ronaldo, posted by Squiggles on November 18, 2006, at 8:14:55

> I'm currently reading a book "Buffoonery", by an
> experienced and very witty nurse.

I think the link should be "Sheer Buffoonery" by Nurse X?

 

Re: Corrected link Racer

Posted by Squiggles on November 18, 2006, at 14:00:25

In reply to Corrected link Squiggles, posted by Racer on November 18, 2006, at 13:58:36

> > I'm currently reading a book "Buffoonery", by an
> > experienced and very witty nurse.
>
> I think the link should be "Sheer Buffoonery" by Nurse X?

Yes, you are right. Thank you. Funny book :-)

Squiggles

 

Re: Doctors underestimate our intelligence/knowled Squiggles

Posted by erik98225 on November 18, 2006, at 14:06:50

In reply to Re: Doctors underestimate our intelligence/knowled erik98225, posted by Squiggles on November 18, 2006, at 13:58:20

> Well call me a tree-hugger if you like,
> but I think that psychopharmacologists should
> be part of the public health care system
> staff - as in the hospitals to treat mentally
> ill patients-- not private owners of Mercedes
> SUVs, trophy wives, private school brats,
> and mansions on the hill, with the left wing
> turned into a private practice office, and
> the right for the peroxide mistress/receptionist/secretary/public relations assistant. Oh, and did i mention the drug company perks in executive shares;

Yeah, he makes a lot of money ($395 an hour is what... $6 million a year?), but he helps me more than any pdoc I've had in the past. My insurance pays 80% once I've satisfied the deductible (which will happen after only two visits), so he costs ME $79.00 a visit. Not unreasonable -- a trip to the local Safeway easily costs more.

Erik

 

Re: Doctors underestimate our intelligence/knowled Racer

Posted by Quintal on November 18, 2006, at 17:01:05

In reply to Re: Doctors underestimate our intelligence/knowled, posted by Racer on November 18, 2006, at 13:37:30

I agree very much with your post Racer. It sounds like arrogance when I say I know more and have more experience of what works for *me* after being in treatment for seven years than my last pdoc. My last pdoc wasn't much older than myself, was a recent graduate and tried to pull some sneaky moves on me that made my hackles rise right from the start [Sure Mr. Pdoc, Zyprexa is a regular antidepressant just like Prozac.....].

Personally, I started to learn about pharmaceuticals and neurotransmitters because I was curious and at one point became so enthusiastic that (encouraged by my then wise, experienced and kindly pdoc) I decided to go back to college and train to be a doctor myself.


I am able to work together with my pdoc as a team so long as I feel the pdoc is genuine has my best interests at heart, otherwise I begin to feel like a passive victim and when the meds fail or have terrible side effects it feels much like chemical torture.

I would dearly like to be able to find a pdoc that really did have some useful experience behind him, but that isn't the case where I live so I feel forced to take initiative and request my own treatments. It's worthwhile remembering not all pdocs are created equal.

Q

 

Re: Doctors underestimate our intelligence/knowled Racer

Posted by Phillipa on November 18, 2006, at 18:34:57

In reply to Re: Doctors underestimate our intelligence/knowled, posted by Racer on November 18, 2006, at 13:37:30

Racer are you now saying you shouldn't have blind faith in a pdoc as I started a thread on that a while back and I think you thought that the pdocs knew more than us and we should listen to them and do what they say. I stand to be corrected. And I've heard that less docs are going into psychiatry today hence the pdoc shortage. Love Phillipa


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