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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by novelagent on June 15, 2012, at 11:14:10
It seems the only docs that will treat me after you've had one little tiny day of psychosis are either hospital residents who won't treat me and sit on any big decisions and wait to talk to their supervising docs before changing any meds, if they bother to change meds when it's needed at all--- or, you get docs who basically want to exploit the fact other docs won't see you by, in one case, quoting you $500 for the first appointment ($300 or up for each appointment thereafter, I would imagine, as is the going rate these days for that tier of pricing).
I got the $500 quote after finding a doc who advertising, among other conditions, treating schizophrenia. It's virtually unheard of that a doc adverrtises treating psychosis, even if they do treat psychosis. It's unfortuantely the thing that makes you black sheep in psychiatry-- docs assume you're a complicated case, and don't think it's worth it to treat you.
It doesn't help the odds of you being poor are high when you've got it, altough for me, that has more to do with cognitive impairment that cost me a job right after my episode, but I've since grown out of the cognitive impairment. I suppose it's possible to get a referral from docs, but I once asked a GP for a referral, and saw on my medical record later that "Patient called for a referral to a psychiatrist. Do you know of one? He asked for one that accepts insurance, but most don't accept insurance now, so I'm not sure what to tell him."
And that was before I had psychosis, so you can imagine how alone I feel when it comes to finding a doc now. And having residents means they don't even know the area-famous docs I once had when my family paid for expensive docs that cost $300 an appointment that any doc who's anyone in the area has heard the name of. So they don't know of any docs to refer me to, especially since referrals are basically favors the receiving doc is doing for the referring doc when the patient has psychosis in his history.
The thing is, I'm not a complicated patient. I have no positive symptoms, and I don't even think I have negative symptoms-- I have anhedonia when I don't have Vyvanse, but it's the same anhedonia I had years before my psychotic episode (which lasted a day-- I walked myself into a hospital and ever since have been on a long-acting injection). Thing is, I use to take high doses of amphetamine, as prescribed, because I thought I had a sleeping disorder (and my doc prescribed it thinking so, too). It turned out to be depression, combined with sedating meds. But it burnt my receptors, so now I need a stimulant to function (I have AD/HD, so I'd need it anyhow).
So that's it, I'm not complicated. I'd like to have some Aricept to help me in school, and hope to get that, but besides that, I jsut want to go back on klonopin, and up my Vyvanse to 140mg, so it's equal to 20mg 3x/day of Adderall, which I use to take and do well on. Right now, I'm just on 70mg, and my resident of a doc is only going by the PDR, because she's a resident and lame. Any private doc would be fine with the rationale to going to 140mg.
I use to see a private doctor that accepted my Medicare, and a modest $75 per visit extra payment in cash, but I happened to not tell him I had a psychotic episode. Instead, I saw him for what I use to see docs for-- AD/HD and social anxiety. He treated me with Dexedrine and Klonopin, and my resident doc focused on refilling my Risperdal Consta. At some point, the two found out I was seeing both docs, and I couldn't see that private doctor anymore.
Sad thing is, it sounded like he would have seen me had I told him everything up-front. But I called so many docs on my Medicare list of docs that wouldn't even see me just because I had Medicare that I didn't dare tell them yet another reason not to see me.
So I guess what I'm asking is, how do I find a doc who accepts Medicare, yet isn't a resident, and willing to see me even though I had a single psychotic episode (they call it "first contact psychosis" because these days, it's unclear what it would have evolved into had it not been treated so agressively and early).
How did you guys find your doc? Referral from a GP? Another psychiatrist's referral? Do you have a history of psychosis, and are you stuck with a resident doc?
I'm finding the difference between private psychiatry and public psychiatry (or psychiatry that accepts medicare/medicaid in general) is that private psychiatrists have higher treatment expectations, and prescribe to meet those expectations. Public psychiatry is risk-adverse, because they only get in trouble (or have to explain themselves through medical documentation) when a patient is re-hospitalized.
Posted by violetdream on June 15, 2012, at 16:56:59
In reply to How do i find a doc who will treat psychosis?, posted by novelagent on June 15, 2012, at 11:14:10
I can't answer that question, but I wanted to say it's not just psychosis and you're not alone. I have a very complicated and long case of treatment resistant depression with (guess what? Rejection sensitivity!) and doctors refuse to treat me.
Make absolutely sure that you can talk to the doctor and write something up about yourself in as much detail as you can and ask if the doctor is willing to take your case, so you don't waste your time. After a while it's awful, but it's better than those expensive timewasting first intakes.
The route seems to be either get someone who is an "expert" who is likely to not want to treat you because they don't need to, but can, or get someone who is awful and you tell them what to prescribe you. At this point I'd just opt for the latter, since I'm guessing most people on here have had the feeling they know way more about pscyh meds than most doctors...
Posted by bleauberry on June 18, 2012, at 6:13:26
In reply to How do i find a doc who will treat psychosis?, posted by novelagent on June 15, 2012, at 11:14:10
GPs do this all the time. You don't need any kind of specialist. Not all, but many regular family doctors are pretty well versed on psych meds and antipsychotics and they prescribe them like candy. Forget the specialists....you don't need one and you won't get as good care that way either. Not to mention the money thing.
One of my herbs is Berberine. I was just doing more research on it yesterday because I just like to know everything possible about stuff I take. I was surprised to learn that it has shown antipsychotic activity. I've been on it for a few months now, and I would agree it does have some mechanisms in the depression/anxiety/psychosis arenas.
For quick knockdown of any psychotic stuff, Lemon Balm has a long history of doing that. Sometimes maybe it isn't psychosis, but instead a form of panic/anxiety that feels "crazy", in which the calming herbs could do wonders.
Anyway, just some thoughts, hope something is helpful. Many people with schizo symptoms or mild psychosis chose to live without meds, because they feel the condition is actually a better choice than how the meds feel, I guess it all depends on how severe it is. Those same people can find very significant benefit and support from the plant medicines God gave us. The difference is....it'a a lot cheaper, much more health benefits, no doctor needed, requires being somewhat ok with directing one's own care. Which I think is important. Patients in this day and age need to be....required....pro-active in their own care because doctors are generally too busy to do that as well as you want them to. You have time, they don't.
Posted by papillon2 on June 19, 2012, at 20:53:44
In reply to Re: How do i find a doc who will treat psychosis?, posted by bleauberry on June 18, 2012, at 6:13:26
I'd try a university teaching hospital. Many have clinics attached, out of which the professors practice. Professors are more often up to date with the latest, evidence-based treatments, not all of them medical.
It doesn't mean you will be treated by a student, just that your doctor may ask if one of the students can sit in on a session as part of their studies. And it's completely your choice whether or not they do.
Bonus: these clinics often operate on a sliding scale and/or attract government subsidies, making them a lower cost alternative.
It may be different in your country. I am from Australia.
Posted by creepy on June 26, 2012, at 11:08:44
In reply to How do i find a doc who will treat psychosis?, posted by novelagent on June 15, 2012, at 11:14:10
I would say its time to find a new pdoc and leave that part of your history out.
If you relapse and have to admit it later on its a breach of trust, so you may have to be prepared for that.
Its unfortunate that the system is evolving into one where dishonesty is needed to get fair treatment. But it is what it is =(
Posted by novelagent on June 27, 2012, at 16:43:31
In reply to Re: How do i find a doc who will treat psychosis?, posted by creepy on June 26, 2012, at 11:08:44
> I would say its time to find a new pdoc and leave that part of your history out.
> If you relapse and have to admit it later on its a breach of trust, so you may have to be prepared for that.
> Its unfortunate that the system is evolving into one where dishonesty is needed to get fair treatment. But it is what it is =(I've tried this-- only I kept seeing my clinic doctor for my Invega injection, and let my private doctor not be up to speed with the fact I got a psychotic episode once, or that I see a doc for it.
It was going well-- the private doc gave me klonopin and dexedrine, along with Effexor, and the clinic doc gave me Invega. But the clinic doc was also giving me klonopin, and I didn't bother to pick up the klonopin script (ask for it) once, as I wasn't actually filling more than one script from both docs (didn't want to break any laws, of course).
Well, my clinic doc heard me earlier say that I got crazy once when I didn't have my klonopin the year before once, so that somehow triggered her to question how I was getting by without asking to remind her to give me a klonopin script. She called the phrmacy, and unfortunately, I was stupid enough to use the same pharmacy for both docs. So the pharmacy told her of all the meds I was on.
I played it off as what it was-- I didn't feel inclined to have the private doc know that part of my life, and I needed someone to treat my ADHD, because my clinic doc didn't care about that. The clinic doc was okay with it, but the private doc seemed to be willing to treat me as I was all along, if only I was more up-front with him. As a result, he felt I was dishonest, and terminated care.
But how was I suppose to have predicted he would have accepted me as I was had I told him? If I had to do it all over again, I would have explained the circumstances-- what it's like calling for docs, and being turned down because you need them to accept Medicare, and can't imagine how stacked your odds are against you if you mention psychosis (even if it's stabalized).
I'm seeing a new clinic doc in a couple of months. I initially went on the wait list to see this doc back in early February. It's still going to be a resident, but at least it's at a clinic that actually prescribed amphetamines to psychotics. The only reason why I'm on any amphetamine, and I'm under-prescribed it, is because I basically made every appointment a nagging fight to get them to cave on amphetamine.
It took like 9 months, including two outside consults involving an old doc nagging at them with me to consider it. I think the consult was mostly what did it, because then they could say a peer was advising them to do it.
They also took me off klonopin because of it all-- even though they caught me because I DIDN'T seek to fill my second klonopin prescription. It's like dealing with cops who misinterpret the most obvious, simply circumstances for the worst.
This is the end of the thread.
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