Psycho-Babble Medication Thread 888772

Shown: posts 1 to 12 of 12. This is the beginning of the thread.

 

finding a pdoc - any experiences appreciated

Posted by desolationrower on April 5, 2009, at 4:43:37

i was thinking i should just say i have adhd+SA and take parnate and ask if they frequently augment MAOIS, but not sure if this will be too 'drug-seeking', or even just say i don't want to have nri/stimulant/alpha2agonist/benzo ruled out if diagnosis warrants it.

or has anyone ever emailed someone like a research university psychiatric head gave some info and asked if they could reccomend a pdoc who had the right specialization

i don't have money or follow through really to just doctor shop until i find one who prescribes the correct drugs. plus i'm not really patient (no pun intended lol).

-d/r

 

Re: finding a pdoc - any experiences appreciated » desolationrower

Posted by bleauberry on April 5, 2009, at 6:40:09

In reply to finding a pdoc - any experiences appreciated, posted by desolationrower on April 5, 2009, at 4:43:37

I did a thorough search at one time. I used the Yellow Pages to start. Wrote a letter to every pdoc listed, and included a stamped self addressed envelope to prompt their reply. In the letter I asked specific screening questions that were important to me. Stuff like accessibility, experience with MAOIs, who they would refer their treatment resistant spouse to, whatever was important to me personally.

Every one of us probably has our own set of unique screening questions that are important to us.

About 60% of them did not reply. That's ok, that automatically screened them out. They were too busy to be of any good to me, too uncaring, too unorganized, or something. Whatever, I didn't want them.

Most of the others didn't answer my screening questions the way I hoped. That ruled them out.

Somewhere in the process a name of a doctor they all seemed to look up to came up several times. I was puzzled because this special person wasn't in the Yellow Pages. I did some phone calls to find out more. He was semi-retired but still taking a few patients. I contacted him and he took me. That best I ever had.

For complicated stuff, as a general rule, but by means competely accurate, keep an eye on the older clinicians. They have seen more in their lifetimes. Maybe they were around when MAOIs and TCAs were more common.

In any case, you kind of have to get out in the trenches and make phone calls, ask questions, write letters. You don't know where the road is going or where the story ends, only that the journey is going in your direction because you are behind the steering wheel.

I found letters better than phone calls, because it was too easy for a Receptionist to shrug me off..."the doctor is too busy", "the doctor doesn't do phone calls if you aren't a patient", "you have to schedule an appointment for an evaluation first", etc etc. The self addressed stamped reply envelope did a good job at eliminating a good percentage of that stuff.

Some of us get lucky and find someone great without much effort. Some of us have to do some digging. Some of us get stuck with no-so-great care and lose strength to get unstuck and then basically receive a life sentence to continued non-progress, poor recovery, and suffering with no end in sight.

It is especially hard for those of us who are so ill, but creativity and work goes a long way to finding the right care provider. It can be broken down into small tasks and small chunks, done piece by piece, day by day, rather than approaching it as a huge project, if it seems too overwhelming on the whole.

 

Re: finding a pdoc - any experiences appreciated » desolationrower

Posted by garnet71 on April 5, 2009, at 9:30:31

In reply to finding a pdoc - any experiences appreciated, posted by desolationrower on April 5, 2009, at 4:43:37

That will almost def. be a problem if you go to a new PDoc and bring up the S-word, and gradually working it in the question might have the same effect..but you're probably going to have to do that so here's a few things, not sure if it helps..

If you do find a new doctor who is willing to experiment, make sure you bring all your records from old PDoc-that might help in showing you don't have a history of taking 'addictive' meds. (And everyone should look in their record and see what is written about them).

When I recently went back to old PDoc after not seeing him for a year, right away I asked to be screened for ADD--and after observing my thought patterns and listening to everything I told him about school, inability to do boring stuff, etc., he prescribed me a stimulant. But every time I'm there, I pick up my record and look through it-like when he's writing the script and the record is sitting right there on the desk. I noticed they wrote in my record in the medication history part "refused Xanax, refused Ativan, refused all". I think that's one of the reasons my doc trusts me, to be honest. One new PDoc I tried before wrote "Ativan seeking?" at the bottom of my chart and underlined it 3 times, during our very first visit. I got up and read it and i was pissed. I told him- you didn't have to write that, I'm not asking for Ativan...I was only telling you what has worked for anxiety in the past. So he tainted my record right at the initial appt. He was a lousy doctor anyway.

That's the thing about shopping for new docs, many will be suspicious. And a confident doctor--some doctors are afraid of getting in 'trouble' w/the controlled meds; in your case, maybe afraid of experimentation for safety issues. I think a confident doctor would be reasonable in assessing your request. I noticed no all docs are self assured--I've had experiences where I could tell the treatment revolved around preventing a malpractice lawsuit rather than clinical eff. A newly minted/graduated doctor will also more likely be scared to go into that realm. For example, I had one who was a primary care physician - right out of med school - I really liked her, but she refused to scribe me 7 days' worth of benzos to help me through panic attacks while awaiting a PDoc appt. and I had to go to the ER because of her lack of self-assurance. No drug seeking/abuse history, so that's the only rational explanation I can think of. I think it's really drilled into their heads at med school (I wonder if the DEA comes in and gives presentations to docs and scares them?) - perhaps much more than older docs who went to school decades ago.

Contacting universities is a great idea - also, you might want to look at the authors of some studies/papers you've read and contact them for a 'referral'. If you do see a new PDoc, I think it would be wise to be honest and candid, telling them right off that you are only being treated for your social anxiety and not your ADD (as opposed to asking for a stim), thus your treatment has been inadequate. Otherwise, if you try to work in that question after say, the 3rd appt, they will be very suspicious.

Yeah, and it sux paying for that initial appt. whether or not you can afford it, just to find out you don't feel compatable with the doctor. Best of luck.

Still, I don't think we should accept less than treatment that allows for our full potential, so even if it doesn't work the first time, don't give up. :))

- from an accused 'drug seeker' lol

 

Re: finding a pdoc - any experiences appreciated » desolationrower

Posted by garnet71 on April 5, 2009, at 9:40:56

In reply to finding a pdoc - any experiences appreciated, posted by desolationrower on April 5, 2009, at 4:43:37

oh-I'd be hesitant to say over the phone about not being treated for ADD - wait till your first appt. and talk to them in person about it? But like you said, asking if they have experience with augmenting MAOIs and extensive MAOI experience when making an initial appt. seems wise.

 

Re: finding a pdoc - any experiences appreciated

Posted by Zana on April 5, 2009, at 12:16:57

In reply to Re: finding a pdoc - any experiences appreciated » desolationrower, posted by garnet71 on April 5, 2009, at 9:40:56

Boy is this a hot topic for me.
I am in the middle of looking for a new Pdoc. I worked with the same woman for 15 years. Two weeks ago she announced that she had taken on new administrative responsibililties (she's hospital based) and would no longer be able to see me. I was floored and too proud and wounded to ask her for referrals. I am still in the process of finding a replacement.
I had a consult with one pdoc who I was referred to and didn't really like and who didn't offer to see me more than once. He did give me several names but I figured if I didn't really like him, I probably wouldn't like his referrals.
My therapist gave me the name of the person he uses, someone I had used for a consult a year and a half ago. I liked him but he is very busy and unavailable until May and has not gotten back to me to set up an appointment. So I am not sure whether or not he will be able to see me.
He gave me some names. I have seen one of his referrals (all of this is expensive and only partially covered by insurance) and the woman seemed smart but all over the place - very unsettling to be with. I came home and collapsed into tears. I have a 2nd appointment with her Tuesday and have still not decided whether or not to keep it. I don't think she is a good choice but right now she is my only choice.
One thing I have learned the hard way: if I tell people right off that I was dropped by my previous doc, they assume I am a "difficult" patient and refer me on. Boy does that feel rotten!
I think sending out letters sounds like a brilliant idea but I don't think I would have the energy to do it. So I have been calling people I know, my therapist, a friend's therapist, the friend of a friend and asking who they refer to or go to.
So far it doesn't seem to be working very well.
I don't think this is much help to you but I couldn't help but tell my story. It is a very frightening, helpless feeling place to be.
Zana

 

Re: finding a pdoc - any experiences appreciated

Posted by Phillipa on April 5, 2009, at 12:41:23

In reply to Re: finding a pdoc - any experiences appreciated, posted by Zana on April 5, 2009, at 12:16:57

And different parts of the country or cities have different policies as here two large practices and if you see one in the practice if not a good fit not allowed to change. Hence we still make the 8 hour total drive to old pdoc. She did do Maois and still has one patient on one. But no longer prescribes them. She had bad expeneriences when Emsam came out also so she doesn't even do cocktails anymore feels that one or two meds only or side effects get lost in the mix. Phillipa

 

Re: finding a pdoc - any experiences appreciated

Posted by desolationrower on April 6, 2009, at 3:18:56

In reply to Re: finding a pdoc - any experiences appreciated » desolationrower, posted by bleauberry on April 5, 2009, at 6:40:09

what do you mean your 'records'. all i have is copies of blood work.

i don't really think its practical to hide the fact i know some psychopharm. stuff so it seems better to let them know right away and screen doctors suspicious of that. i would guess those would be the same doctors that wouldn't want to prescribe useful stuff in the ifrst place.

the only person i found who has published on maois doesn't live here but did go to med school at the local research university

-d/r

 

Re: finding a pdoc - any experiences appreciated » desolationrower

Posted by garnet71 on April 6, 2009, at 8:31:58

In reply to Re: finding a pdoc - any experiences appreciated, posted by desolationrower on April 6, 2009, at 3:18:56

Well, silly, I didn't say to hide psychopharmacological knowledge, but you can't just call doctors on the phone and say, for example, "will you prescribe Adderall w/a MAOI?".
It might have a better outcome if you call and ask "how much experience do you have with MAOIs, including augmentation for comorbid conditions" or even something like "I'm currently being treated for SA with an MAOI, but not for my ADD, and I'm looking for someone experienced in ______ because inadequate treatment for ADD is adversely affecting my life"

If you can get a positive response to that, then go into more detail during initial appt. about specific stimulants. :))

Your medical records - you know that big file - all those notes they write about you - your self reported symptoms and history, all the details written about your course of treatment, history of medications prescribed while w/that doctor, etc. Ask for a *complete* copy next time you go to your PDoc.

 

Re: finding a pdoc - any experiences appreciated

Posted by garnet71 on April 6, 2009, at 8:50:26

In reply to Re: finding a pdoc - any experiences appreciated, posted by desolationrower on April 6, 2009, at 3:18:56

Well I guess you could call around and/or email and ask specifically - but not give your name - then if that doesn't work, make the same rounds again trying a more subtle approach similar to what I mentioned?

 

Re: finding a pdoc - any experiences appreciated » desolationrower

Posted by metric on April 6, 2009, at 14:10:11

In reply to finding a pdoc - any experiences appreciated, posted by desolationrower on April 5, 2009, at 4:43:37


For the most part, just be honest and forthright. Stimulants are used all the time in psychiatry so it's not that big a deal. It's not like asking for an opioid. The type of person that doctors are afraid of is going to go through a circuitous charade to obtain what he wants instead of asking outright and any doc worth his salt knows this. It may be advantageous to omit certain details if they will hinder your cause, but don't come across as though you're hiding something.

 

Re: finding a pdoc - any experiences appreciated » garnet71

Posted by rvanson on April 12, 2009, at 9:25:46

In reply to Re: finding a pdoc - any experiences appreciated » desolationrower, posted by garnet71 on April 6, 2009, at 8:31:58

> Well, silly, I didn't say to hide psychopharmacological knowledge, but you can't just call doctors on the phone and say, for example, "will you prescribe Adderall w/a MAOI?".
> It might have a better outcome if you call and ask "how much experience do you have with MAOIs, including augmentation for comorbid conditions" or even something like "I'm currently being treated for SA with an MAOI, but not for my ADD, and I'm looking for someone experienced in ______ because inadequate treatment for ADD is adversely affecting my life"
>
> If you can get a positive response to that, then go into more detail during initial appt. about specific stimulants. :))
>
> Your medical records - you know that big file - all those notes they write about you - your self reported symptoms and history, all the details written about your course of treatment, history of medications prescribed while w/that doctor, etc. Ask for a *complete* copy next time you go to your PDoc.
>

Don't expect them to hand them over without trying to send them to another doctor, before they do. Funny, some of the observations they make in their notes, they don't want the patient to ever see. Then again, some of the Pdocs wouldnt want to see what I thought of them :-)

 

Re: finding a pdoc - any experiences appreciated

Posted by desolationrower on April 14, 2009, at 1:09:24

In reply to Re: finding a pdoc - any experiences appreciated » garnet71, posted by rvanson on April 12, 2009, at 9:25:46


>
> Don't expect them to hand them over without trying to send them to another doctor, before they do. Funny, some of the observations they make in their notes, they don't want the patient to ever see. Then again, some of the Pdocs wouldnt want to see what I thought of them :-)
>
i don't think i undestand hwat this means??

also, i heard back from one researcher, recommended a pdoc...but he's at the university, and last time i called for an apt there, they said the wait was several months. i'm get an appointment, but i'm not sure if want to keep trying other pdocs to see if i can see someone else sooner...only other thing would be see current pdoc again, maybe try to get a higher benzo dose out of him, to see if that helps with the SA.

-d/r


This is the end of the thread.


Show another thread

URL of post in thread:


Psycho-Babble Medication | Extras | FAQ


[dr. bob] 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.