Psycho-Babble Social Thread 16861

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Noa - Insurance Question

Posted by mair on January 17, 2002, at 8:12:53

In reply to Re: Between pdocs...., posted by Seamus2 on January 16, 2002, at 20:11:07

Noa,

Does your insurance require that you see one of a list of people on a provider list? My ex-pdoc didn't take most insurance either but I was able to submit my own claims. It did require that I "up-front" at least the first monthly bill, but for most of the time, anyway, my claims were paid quickly enough to provide me with most of the $$ I needed to cover the next month's bill. It wasn't ideal, but manageable, and I now have the same arrangement with my therapist, who also has no connection to my insurer. She used to, but broke away in frustration and fortunately, didn't jeopardize my ability to continue to see her.

Mair

 

Re: Between pdocs....continued

Posted by noa on January 17, 2002, at 17:24:39

In reply to Between pdocs...., posted by Noa on January 16, 2002, at 19:23:10

The new office is calmer, quieter. I notice the difference that not having to scramble for parking or stand in a crowded, chaotic waiting room makes. My pdoc seems to like venturing out on his own. He gives me the url to his new website, and his email address. He is going to use his computer nerdiness as an advantage. He even asks me to email him links he could put on his site for patients to get information on the web. I give him advice about a disclaimer. He is making eye contact more. I tell him he needs a sound screen because I can hear him and his patient from the waiting room. He thanks me for letting him know. The walls are freshly painted, there is new furniture. He is not so booked, so it is easier to get appointments.

He hires a part time secretary and installs a phone menu that gets you nowhere. I am frustrated again. He tells me to page him, but when I do he sounds unhappy to get a page that isn't really an emergency.

He has more regular secretarial assistance now, people who actually answer the phone or return calls. Paying the copay runs smoother; the secretary has good records of my account, unlike the big practice where they billed the wrong insurance company for three years. My pdoc starts to run late again as his practice books up. I notice myself running a little late in getting to his appointments, and realize I've been doing this for years without it being a problem. I start to book first thing in the morning appointments again. I arrive and wait in the hall, outside the locked office. Sometimes another patient is there, or arrives just after me. The emergency off-book appointments. He comes in late for both of us, unlocks and lets us in. He is not a morning person, clearly.

One day I am quite late and he is running on time. Murphy's law, I think. He is impatient with me. I apologize but let him know he is usually late. He says not anymore. I realize he's never apologized, ever, for being late. The next few appointments I notice that he's right. He has started running on time. It's hard to believe. I make an effort to be more on time.

But I screw up a couple of times. I write down 6:30 instead of 6:15. He's angry. Somehow my appointments get out of sync with my refill needs. I call in at the last minute to get a paper scrip for adderall.

I start to notice that the eye contact and smiles are infrequent. The appointments feel rushed. I have questions, concerns. He is watching the clock. But he works with me about some sleep problems I'm having. Suggests remedies, lets me try one med, lets me change it when it doesn't seem to be the right one. Still, the less concrete concerns and questions, the ones I want to discuss, don't seem to engage his interest. Sometimes he half-heartedly says I could try such and such if I wanted. But his enthusiasm is underwhelming. He doesn't seem interested in figuring it out. I think back to when he used to like figuring it out.

I decide I will seek an outside consult. The whole thing needs fresh eyes, I think. I don't feel in a rush to rock the boat. My cocktail has gotten me this far. I'm functional. I'm not depressed most of the time and even when I am it is not severe. My job performance is improving. I'm doing things, seeing people. But I want to start looking at the whole business more carefully. There are still those annyoing side effects. Tolerable but annoying. Nothing to make me want to rush into a big change, especially knowing how depressed I could get. But it's time for fresh eyes. I want someone to be curious and interested. To help sort it all out. The money isn't a problem like it had been before. I will splurge for the consult.

It occurs to me that I am not availing myself of one major medication that I know helps me with both the depression and some of the side effects. Well, not exactly a medication, but it works like one. Exercise. I haven't been to the gym in ages. I try to cojole myself by recalling how much I grew to love exercising at the gym despite the dread I felt before starting. But the dread I feel now is big. The whole thing makes me anxious. I strike a little bargain with myself, that I will start back at the gym just a little bit, so that when I go for a consultation, I'll be able to report how I feel with the exercise as part of my cocktail. The plan is I'll call for a consult in a month or two.

The plan seems to be going ok. I get myself to the gym for 15 minutes, then 30, then 60. Not often enough, but some.

It is just before the holidays and I am driving to my pdoc appointment. My car starts to veer into oncoming traffic. It rumbles. The steering wheel is fighting me. At the next traffic light, I get out and look at the tire. It is flat. I pull over, call the tow truck, call my pdoc office. The secretary calls back while I am waiting for the truck. We try to reschedule. Nothing until January 12. The tow truck comes, I take the 12th and say gotta run, thanks. I forget that this will get my off my refill rhythm.

One morning I decide to count my adderalls and realize I will run out before the 12th, make a mental note to call pdoc to arrange new scrip. The mental note goes where the others are, wherever that may be. Another morning I see that I only have a about a day and a half left. I call and leave a message asking if I can come in later today to pick up a scrip. The secretary calls back and leaves a message telling me to come between 5:30 and 7, just confirm when I will be coming. I call to let her know but the phone rings and rings. No menu picks up. I try again later and again later. Still no connection. I decide to go since she said it was ok. I bring a book knowing that there will be patients and appointments and I will have to wait. It's ok with me. Especially since I couldn't confirm the exact time I was coming.

The waiting area is busy. I talk to the secretary, explain the phone thing. She is surprised to hear I couldn't get through. She tells me to wait, tells me it could be a while because his next appointment is not a med-management, it's a therapy appointment. I try to imagine my pdoc doing therapy, I'm amused at the idea.

I have a good book and there is an open seat. I'm content. A school age girl and her father are there. I realize she is the therapy appointment. I wonder again how effective my pdoc could be as a therapist. I'm less amused, feel pity for her and her father. They probably don't know any better, it's too bad. The girl asks me about my book, I tell her and ask her about hers. It's about some kind of gory game Harry Potter and his gang play. She's very interested in the goriness of it, describes it to me in detail, looks me in the eye with a fierce stare. I think, she's trying to shock me and wonder if I'm disappointing her by listening without a flinch. I wonder what kind of nightmares this kid must have. We talk about the non-snow snow day that day. The schools closed but nothing came down, a freebie for her. I tell her I want to read some more now. She keeps on talking to me, so I tell her my book is kind of hard and I need to concentrate on it. She's ok with that and goes back to her gory wizard sports book. As she reads, she kicks the wall rhythmically, absentmindedly. The wall shakes, the bookshelf shakes. The glass window that frames the secretary's face shakes. Her dad tells her to stop, but he has to repeat it three times. Now it's not absentmindedly. After the third time, she stops. He tells her too bad we forgot to bring your behavior chart from school for the doctor to see--you've been doing so much better. The girl says no she doesn't want to show the doctor. She sits up suddenly from her reclining position and says dad, come sit with me, patting the chair next to hers, patting her coat on the chair. He is sitting across the room. He says, no thanks I'm fine over here. Please?? No thanks, I said I'm fine over here. Please?? I really want to sit together and there's only one chair over there, but there's two here. Here, I'll move my coat. She tosses her coat onto the remaining empty chair. Dad looks up from his magazine and smiles, gets up and joins her. She puts her head on his shoulder, smiles, cuddles. They look at magazine pictures together.

The pdoc emerges with a patient. The secretary goes into his office and they close the door. A moment later they both emerge, he on his cell phone, she with the office phone in hand. There is urgency in the air. They run around checking all the phone jacks. I hear a discussion about maintenance workers earlier in the day. The pdoc seems to be calling the building management.

He gestures, calls me into his office, but talks to me in the doorway. He is angry, tells me I gotta stop doing this. Can't just show up. I'm taken aback by his tone. He's really angry. I tell him I didn't just show up, I called ahead and the secretary told me it was ok to come between 5:30 and 7, just that I couldn't meet her request to confirm the exact time because the phones didn't go through. No eye contact. He is moving around, has his cell phone in his hand. He huffs she shouldn't have told you that. I think, that's not my problem. He says I shouldn't leave refills til the last minute. I say I'm sorry, I shouldn't have, I should have called a few days ago. I explained that I got thrown off because of the flat tire and not having the appointment before the refill came up. I said I had wanted an appointment sooner, but none were available. He asks when my appointment is. I tell him Saturday, which is 3 days away. He says what, you can't go three days without it? I say no. Now I'm really angry.

I'm still in the doorway, he is standing at a bookshelf near the door, pulling out his scrip pad, asking me what my dose is. I tell him. He gets huffier, says he is just giving me enough until Saturday, scribbles out the scrip hastily, angrily, tears it off. As he hands it to me, he says see you Saturday. I say, and that might just be our last appointment. He makes eye contact. I leave.

In the elevator I am thinking about how mad I am, but I notice I am not that shaken, that I really have decided to fire him and it feels right even though it seems impulsive. But not impulsive, really, since I'd considered it a few times before. This was the clincher. He was unprofessional, I didn't deserve to be treated that way, even if my disorganization is a pain in the butt. I'm angry but I notice it's not the old impotent rage situations like this would engender for me. That helps me feel comfortable with the decision.

In the car, I think about the girl in the waiting room behind me as I stood in the pdoc's office doorway, arguing with him. And her father. I find myself wondering how her therapy appointment went, what she thought of her angry pdoc.

to be continued again.............

 

Re: Between pdocs.... » IsoM

Posted by noa on January 17, 2002, at 17:47:44

In reply to Re: Between pdocs.... » Noa, posted by IsoM on January 16, 2002, at 19:52:11

Thanks. I am enjoying the process. I don't know if I said something about losing it as a writer. I know I've talked about not writing creatively as much, no poetry like in my younger days. Don't know if it was me or someone else, but thanks.

 

Re: Noa - Insurance Question » mair

Posted by noa on January 17, 2002, at 18:06:06

In reply to Noa - Insurance Question, posted by mair on January 17, 2002, at 8:12:53

Mair, Yes I can go out of plan, pay up front and get reimbursed. BUT, the "usual and customary fee" according to the insurance company is only a fraction of what the professionals actually charge. It is a terrible situation. I can't say I blame the doctors for not working with the insurance companies anymore. It is slave wages and a lot of headache. The insurance companies enticed a lot of professionals to sign on, promising referrals, lots of them. My psychologist told me that despite their promises, he has never, in the 15 years of working with my insurance company, gotten a single referral from them. But he has to do their paper work and accept their rates, which at present are about 55% of his normal fee. And, they delay paying a lot, and make mistakes in the bills that he has to contact them about correcting, etc. etc. As of 2002, he ended his relationship with them.


At this point, I am a bit more secure, financially, than I was when I first inquired with those pdocs, so I can deal with the fees.

 

Noa- please do continue (nm)

Posted by Mair on January 17, 2002, at 20:33:22

In reply to Re: Noa - Insurance Question » mair, posted by noa on January 17, 2002, at 18:06:06

 

Re: Between pdocs....

Posted by Mair on January 17, 2002, at 20:40:47

In reply to Re: Between pdocs.... » IsoM, posted by noa on January 17, 2002, at 17:47:44

Noa

Why doesn't this guy just phone in a prescription. I always get mine filled in the same place and my ex-pdoc always handled things this way. He didn't then need much notice and I didn't need to pick anything up. It also saved me the wait at the pharmacy.

My therapist ditched my insurer for much the same reasons you diescribe. The amount for services was a pittance, the paperwork awful, and the pay extremely slow. Half the time it seemed they would return claim forms to her as being incorrectly filled out when they really weren't. It took her awhile, but she figured out that she didn't get any benefits from them, and hardly any of her patients were disadvantaged by her leaving them.

Mair

 

Re: Between pdocs....

Posted by kiddo on January 17, 2002, at 21:47:15

In reply to Re: Between pdocs...., posted by Mair on January 17, 2002, at 20:40:47

Hi-

In my state, Adderall is a controlled substance and can't be called in, I did the same thing once and had to make a trip to pick it up for that reason. I don't know if it's the same everywhere or not, but I'd assume that's the case.

Kiddo

> Noa
>
> Why doesn't this guy just phone in a prescription. I always get mine filled in the same place and my ex-pdoc always handled things this way. He didn't then need much notice and I didn't need to pick anything up. It also saved me the wait at the pharmacy.
>
> My therapist ditched my insurer for much the same reasons you diescribe. The amount for services was a pittance, the paperwork awful, and the pay extremely slow. Half the time it seemed they would return claim forms to her as being incorrectly filled out when they really weren't. It took her awhile, but she figured out that she didn't get any benefits from them, and hardly any of her patients were disadvantaged by her leaving them.
>
> Mair

 

Re: Between pdocs....continued » noa

Posted by kiddo on January 17, 2002, at 21:52:43

In reply to Re: Between pdocs....continued, posted by noa on January 17, 2002, at 17:24:39

Noa-

Your ability to write awes me. If you ever have anything published please let me know. I hate to say that I'm so entranced by something that's happening to you, but, your talent for writing has me waiting for the next 'chapter' like a sequel in a novel.

I do hope things are going well and that you continue to do what's right for you.


Kiddo

> The new office is calmer, quieter. I notice the difference that not having to scramble for parking or stand in a crowded, chaotic waiting room makes. My pdoc seems to like venturing out on his own. He gives me the url to his new website, and his email address. He is going to use his computer nerdiness as an advantage. He even asks me to email him links he could put on his site for patients to get information on the web. I give him advice about a disclaimer. He is making eye contact more. I tell him he needs a sound screen because I can hear him and his patient from the waiting room. He thanks me for letting him know. The walls are freshly painted, there is new furniture. He is not so booked, so it is easier to get appointments.
>
> He hires a part time secretary and installs a phone menu that gets you nowhere. I am frustrated again. He tells me to page him, but when I do he sounds unhappy to get a page that isn't really an emergency.
>
> He has more regular secretarial assistance now, people who actually answer the phone or return calls. Paying the copay runs smoother; the secretary has good records of my account, unlike the big practice where they billed the wrong insurance company for three years. My pdoc starts to run late again as his practice books up. I notice myself running a little late in getting to his appointments, and realize I've been doing this for years without it being a problem. I start to book first thing in the morning appointments again. I arrive and wait in the hall, outside the locked office. Sometimes another patient is there, or arrives just after me. The emergency off-book appointments. He comes in late for both of us, unlocks and lets us in. He is not a morning person, clearly.
>
> One day I am quite late and he is running on time. Murphy's law, I think. He is impatient with me. I apologize but let him know he is usually late. He says not anymore. I realize he's never apologized, ever, for being late. The next few appointments I notice that he's right. He has started running on time. It's hard to believe. I make an effort to be more on time.
>
> But I screw up a couple of times. I write down 6:30 instead of 6:15. He's angry. Somehow my appointments get out of sync with my refill needs. I call in at the last minute to get a paper scrip for adderall.
>
> I start to notice that the eye contact and smiles are infrequent. The appointments feel rushed. I have questions, concerns. He is watching the clock. But he works with me about some sleep problems I'm having. Suggests remedies, lets me try one med, lets me change it when it doesn't seem to be the right one. Still, the less concrete concerns and questions, the ones I want to discuss, don't seem to engage his interest. Sometimes he half-heartedly says I could try such and such if I wanted. But his enthusiasm is underwhelming. He doesn't seem interested in figuring it out. I think back to when he used to like figuring it out.
>
> I decide I will seek an outside consult. The whole thing needs fresh eyes, I think. I don't feel in a rush to rock the boat. My cocktail has gotten me this far. I'm functional. I'm not depressed most of the time and even when I am it is not severe. My job performance is improving. I'm doing things, seeing people. But I want to start looking at the whole business more carefully. There are still those annyoing side effects. Tolerable but annoying. Nothing to make me want to rush into a big change, especially knowing how depressed I could get. But it's time for fresh eyes. I want someone to be curious and interested. To help sort it all out. The money isn't a problem like it had been before. I will splurge for the consult.
>
> It occurs to me that I am not availing myself of one major medication that I know helps me with both the depression and some of the side effects. Well, not exactly a medication, but it works like one. Exercise. I haven't been to the gym in ages. I try to cojole myself by recalling how much I grew to love exercising at the gym despite the dread I felt before starting. But the dread I feel now is big. The whole thing makes me anxious. I strike a little bargain with myself, that I will start back at the gym just a little bit, so that when I go for a consultation, I'll be able to report how I feel with the exercise as part of my cocktail. The plan is I'll call for a consult in a month or two.
>
> The plan seems to be going ok. I get myself to the gym for 15 minutes, then 30, then 60. Not often enough, but some.
>
> It is just before the holidays and I am driving to my pdoc appointment. My car starts to veer into oncoming traffic. It rumbles. The steering wheel is fighting me. At the next traffic light, I get out and look at the tire. It is flat. I pull over, call the tow truck, call my pdoc office. The secretary calls back while I am waiting for the truck. We try to reschedule. Nothing until January 12. The tow truck comes, I take the 12th and say gotta run, thanks. I forget that this will get my off my refill rhythm.
>
> One morning I decide to count my adderalls and realize I will run out before the 12th, make a mental note to call pdoc to arrange new scrip. The mental note goes where the others are, wherever that may be. Another morning I see that I only have a about a day and a half left. I call and leave a message asking if I can come in later today to pick up a scrip. The secretary calls back and leaves a message telling me to come between 5:30 and 7, just confirm when I will be coming. I call to let her know but the phone rings and rings. No menu picks up. I try again later and again later. Still no connection. I decide to go since she said it was ok. I bring a book knowing that there will be patients and appointments and I will have to wait. It's ok with me. Especially since I couldn't confirm the exact time I was coming.
>
> The waiting area is busy. I talk to the secretary, explain the phone thing. She is surprised to hear I couldn't get through. She tells me to wait, tells me it could be a while because his next appointment is not a med-management, it's a therapy appointment. I try to imagine my pdoc doing therapy, I'm amused at the idea.
>
> I have a good book and there is an open seat. I'm content. A school age girl and her father are there. I realize she is the therapy appointment. I wonder again how effective my pdoc could be as a therapist. I'm less amused, feel pity for her and her father. They probably don't know any better, it's too bad. The girl asks me about my book, I tell her and ask her about hers. It's about some kind of gory game Harry Potter and his gang play. She's very interested in the goriness of it, describes it to me in detail, looks me in the eye with a fierce stare. I think, she's trying to shock me and wonder if I'm disappointing her by listening without a flinch. I wonder what kind of nightmares this kid must have. We talk about the non-snow snow day that day. The schools closed but nothing came down, a freebie for her. I tell her I want to read some more now. She keeps on talking to me, so I tell her my book is kind of hard and I need to concentrate on it. She's ok with that and goes back to her gory wizard sports book. As she reads, she kicks the wall rhythmically, absentmindedly. The wall shakes, the bookshelf shakes. The glass window that frames the secretary's face shakes. Her dad tells her to stop, but he has to repeat it three times. Now it's not absentmindedly. After the third time, she stops. He tells her too bad we forgot to bring your behavior chart from school for the doctor to see--you've been doing so much better. The girl says no she doesn't want to show the doctor. She sits up suddenly from her reclining position and says dad, come sit with me, patting the chair next to hers, patting her coat on the chair. He is sitting across the room. He says, no thanks I'm fine over here. Please?? No thanks, I said I'm fine over here. Please?? I really want to sit together and there's only one chair over there, but there's two here. Here, I'll move my coat. She tosses her coat onto the remaining empty chair. Dad looks up from his magazine and smiles, gets up and joins her. She puts her head on his shoulder, smiles, cuddles. They look at magazine pictures together.
>
> The pdoc emerges with a patient. The secretary goes into his office and they close the door. A moment later they both emerge, he on his cell phone, she with the office phone in hand. There is urgency in the air. They run around checking all the phone jacks. I hear a discussion about maintenance workers earlier in the day. The pdoc seems to be calling the building management.
>
> He gestures, calls me into his office, but talks to me in the doorway. He is angry, tells me I gotta stop doing this. Can't just show up. I'm taken aback by his tone. He's really angry. I tell him I didn't just show up, I called ahead and the secretary told me it was ok to come between 5:30 and 7, just that I couldn't meet her request to confirm the exact time because the phones didn't go through. No eye contact. He is moving around, has his cell phone in his hand. He huffs she shouldn't have told you that. I think, that's not my problem. He says I shouldn't leave refills til the last minute. I say I'm sorry, I shouldn't have, I should have called a few days ago. I explained that I got thrown off because of the flat tire and not having the appointment before the refill came up. I said I had wanted an appointment sooner, but none were available. He asks when my appointment is. I tell him Saturday, which is 3 days away. He says what, you can't go three days without it? I say no. Now I'm really angry.
>
> I'm still in the doorway, he is standing at a bookshelf near the door, pulling out his scrip pad, asking me what my dose is. I tell him. He gets huffier, says he is just giving me enough until Saturday, scribbles out the scrip hastily, angrily, tears it off. As he hands it to me, he says see you Saturday. I say, and that might just be our last appointment. He makes eye contact. I leave.
>
> In the elevator I am thinking about how mad I am, but I notice I am not that shaken, that I really have decided to fire him and it feels right even though it seems impulsive. But not impulsive, really, since I'd considered it a few times before. This was the clincher. He was unprofessional, I didn't deserve to be treated that way, even if my disorganization is a pain in the butt. I'm angry but I notice it's not the old impotent rage situations like this would engender for me. That helps me feel comfortable with the decision.
>
> In the car, I think about the girl in the waiting room behind me as I stood in the pdoc's office doorway, arguing with him. And her father. I find myself wondering how her therapy appointment went, what she thought of her angry pdoc.
>
> to be continued again.............

 

I'm also eagerly waiting for the next installment (nm) » noa

Posted by jane d on January 17, 2002, at 23:32:16

In reply to Re: Between pdocs.... » IsoM, posted by noa on January 17, 2002, at 17:47:44

 

Re: Between pdocs.... » kiddo

Posted by mair on January 18, 2002, at 7:31:41

In reply to Re: Between pdocs...., posted by kiddo on January 17, 2002, at 21:47:15

> Is klonopin a controlled substance? I thought it was, and yet this is one of the prescriptions that was always called in.

Mair

 

Re: Between pdocs.... » Mair

Posted by noa on January 18, 2002, at 8:44:40

In reply to Re: Between pdocs...., posted by Mair on January 17, 2002, at 20:40:47


> Why doesn't this guy just phone in a prescription.

Because adderall is a controlled substance--scrips cannot be phoned or faxed.

 

Re: Between pdocs...thanks (nm) » kiddo

Posted by noa on January 18, 2002, at 8:45:43

In reply to Re: Between pdocs....continued » noa, posted by kiddo on January 17, 2002, at 21:52:43

 

Re: Between pdocs.... » mair

Posted by kiddo on January 18, 2002, at 8:59:52

In reply to Re: Between pdocs.... » kiddo, posted by mair on January 18, 2002, at 7:31:41

I'm sorry, that one I don't know about, I thought he was talking about Adderall. Am I confused, or is this question in addition too?

I'm sorry

Kiddo


> > Is klonopin a controlled substance? I thought it was, and yet this is one of the prescriptions that was always called in.
>
> Mair

 

Re: Between pdocs....continued » noa

Posted by Greg on January 18, 2002, at 14:13:29

In reply to Re: Between pdocs....continued, posted by noa on January 17, 2002, at 17:24:39

Noa,

I have known you for a very long time and have always enjoyed reading your posts, but I have never been so riveted by anything you have written before as I have this.

You should write professionally, you really should. Thank you for sharing this with us.

Greg

> The new office is calmer, quieter. I notice the difference that not having to scramble for parking or stand in a crowded, chaotic waiting room makes. My pdoc seems to like venturing out on his own. He gives me the url to his new website, and his email address. He is going to use his computer nerdiness as an advantage. He even asks me to email him links he could put on his site for patients to get information on the web. I give him advice about a disclaimer. He is making eye contact more. I tell him he needs a sound screen because I can hear him and his patient from the waiting room. He thanks me for letting him know. The walls are freshly painted, there is new furniture. He is not so booked, so it is easier to get appointments.
>
> He hires a part time secretary and installs a phone menu that gets you nowhere. I am frustrated again. He tells me to page him, but when I do he sounds unhappy to get a page that isn't really an emergency.
>
> He has more regular secretarial assistance now, people who actually answer the phone or return calls. Paying the copay runs smoother; the secretary has good records of my account, unlike the big practice where they billed the wrong insurance company for three years. My pdoc starts to run late again as his practice books up. I notice myself running a little late in getting to his appointments, and realize I've been doing this for years without it being a problem. I start to book first thing in the morning appointments again. I arrive and wait in the hall, outside the locked office. Sometimes another patient is there, or arrives just after me. The emergency off-book appointments. He comes in late for both of us, unlocks and lets us in. He is not a morning person, clearly.
>
> One day I am quite late and he is running on time. Murphy's law, I think. He is impatient with me. I apologize but let him know he is usually late. He says not anymore. I realize he's never apologized, ever, for being late. The next few appointments I notice that he's right. He has started running on time. It's hard to believe. I make an effort to be more on time.
>
> But I screw up a couple of times. I write down 6:30 instead of 6:15. He's angry. Somehow my appointments get out of sync with my refill needs. I call in at the last minute to get a paper scrip for adderall.
>
> I start to notice that the eye contact and smiles are infrequent. The appointments feel rushed. I have questions, concerns. He is watching the clock. But he works with me about some sleep problems I'm having. Suggests remedies, lets me try one med, lets me change it when it doesn't seem to be the right one. Still, the less concrete concerns and questions, the ones I want to discuss, don't seem to engage his interest. Sometimes he half-heartedly says I could try such and such if I wanted. But his enthusiasm is underwhelming. He doesn't seem interested in figuring it out. I think back to when he used to like figuring it out.
>
> I decide I will seek an outside consult. The whole thing needs fresh eyes, I think. I don't feel in a rush to rock the boat. My cocktail has gotten me this far. I'm functional. I'm not depressed most of the time and even when I am it is not severe. My job performance is improving. I'm doing things, seeing people. But I want to start looking at the whole business more carefully. There are still those annyoing side effects. Tolerable but annoying. Nothing to make me want to rush into a big change, especially knowing how depressed I could get. But it's time for fresh eyes. I want someone to be curious and interested. To help sort it all out. The money isn't a problem like it had been before. I will splurge for the consult.
>
> It occurs to me that I am not availing myself of one major medication that I know helps me with both the depression and some of the side effects. Well, not exactly a medication, but it works like one. Exercise. I haven't been to the gym in ages. I try to cojole myself by recalling how much I grew to love exercising at the gym despite the dread I felt before starting. But the dread I feel now is big. The whole thing makes me anxious. I strike a little bargain with myself, that I will start back at the gym just a little bit, so that when I go for a consultation, I'll be able to report how I feel with the exercise as part of my cocktail. The plan is I'll call for a consult in a month or two.
>
> The plan seems to be going ok. I get myself to the gym for 15 minutes, then 30, then 60. Not often enough, but some.
>
> It is just before the holidays and I am driving to my pdoc appointment. My car starts to veer into oncoming traffic. It rumbles. The steering wheel is fighting me. At the next traffic light, I get out and look at the tire. It is flat. I pull over, call the tow truck, call my pdoc office. The secretary calls back while I am waiting for the truck. We try to reschedule. Nothing until January 12. The tow truck comes, I take the 12th and say gotta run, thanks. I forget that this will get my off my refill rhythm.
>
> One morning I decide to count my adderalls and realize I will run out before the 12th, make a mental note to call pdoc to arrange new scrip. The mental note goes where the others are, wherever that may be. Another morning I see that I only have a about a day and a half left. I call and leave a message asking if I can come in later today to pick up a scrip. The secretary calls back and leaves a message telling me to come between 5:30 and 7, just confirm when I will be coming. I call to let her know but the phone rings and rings. No menu picks up. I try again later and again later. Still no connection. I decide to go since she said it was ok. I bring a book knowing that there will be patients and appointments and I will have to wait. It's ok with me. Especially since I couldn't confirm the exact time I was coming.
>
> The waiting area is busy. I talk to the secretary, explain the phone thing. She is surprised to hear I couldn't get through. She tells me to wait, tells me it could be a while because his next appointment is not a med-management, it's a therapy appointment. I try to imagine my pdoc doing therapy, I'm amused at the idea.
>
> I have a good book and there is an open seat. I'm content. A school age girl and her father are there. I realize she is the therapy appointment. I wonder again how effective my pdoc could be as a therapist. I'm less amused, feel pity for her and her father. They probably don't know any better, it's too bad. The girl asks me about my book, I tell her and ask her about hers. It's about some kind of gory game Harry Potter and his gang play. She's very interested in the goriness of it, describes it to me in detail, looks me in the eye with a fierce stare. I think, she's trying to shock me and wonder if I'm disappointing her by listening without a flinch. I wonder what kind of nightmares this kid must have. We talk about the non-snow snow day that day. The schools closed but nothing came down, a freebie for her. I tell her I want to read some more now. She keeps on talking to me, so I tell her my book is kind of hard and I need to concentrate on it. She's ok with that and goes back to her gory wizard sports book. As she reads, she kicks the wall rhythmically, absentmindedly. The wall shakes, the bookshelf shakes. The glass window that frames the secretary's face shakes. Her dad tells her to stop, but he has to repeat it three times. Now it's not absentmindedly. After the third time, she stops. He tells her too bad we forgot to bring your behavior chart from school for the doctor to see--you've been doing so much better. The girl says no she doesn't want to show the doctor. She sits up suddenly from her reclining position and says dad, come sit with me, patting the chair next to hers, patting her coat on the chair. He is sitting across the room. He says, no thanks I'm fine over here. Please?? No thanks, I said I'm fine over here. Please?? I really want to sit together and there's only one chair over there, but there's two here. Here, I'll move my coat. She tosses her coat onto the remaining empty chair. Dad looks up from his magazine and smiles, gets up and joins her. She puts her head on his shoulder, smiles, cuddles. They look at magazine pictures together.
>
> The pdoc emerges with a patient. The secretary goes into his office and they close the door. A moment later they both emerge, he on his cell phone, she with the office phone in hand. There is urgency in the air. They run around checking all the phone jacks. I hear a discussion about maintenance workers earlier in the day. The pdoc seems to be calling the building management.
>
> He gestures, calls me into his office, but talks to me in the doorway. He is angry, tells me I gotta stop doing this. Can't just show up. I'm taken aback by his tone. He's really angry. I tell him I didn't just show up, I called ahead and the secretary told me it was ok to come between 5:30 and 7, just that I couldn't meet her request to confirm the exact time because the phones didn't go through. No eye contact. He is moving around, has his cell phone in his hand. He huffs she shouldn't have told you that. I think, that's not my problem. He says I shouldn't leave refills til the last minute. I say I'm sorry, I shouldn't have, I should have called a few days ago. I explained that I got thrown off because of the flat tire and not having the appointment before the refill came up. I said I had wanted an appointment sooner, but none were available. He asks when my appointment is. I tell him Saturday, which is 3 days away. He says what, you can't go three days without it? I say no. Now I'm really angry.
>
> I'm still in the doorway, he is standing at a bookshelf near the door, pulling out his scrip pad, asking me what my dose is. I tell him. He gets huffier, says he is just giving me enough until Saturday, scribbles out the scrip hastily, angrily, tears it off. As he hands it to me, he says see you Saturday. I say, and that might just be our last appointment. He makes eye contact. I leave.
>
> In the elevator I am thinking about how mad I am, but I notice I am not that shaken, that I really have decided to fire him and it feels right even though it seems impulsive. But not impulsive, really, since I'd considered it a few times before. This was the clincher. He was unprofessional, I didn't deserve to be treated that way, even if my disorganization is a pain in the butt. I'm angry but I notice it's not the old impotent rage situations like this would engender for me. That helps me feel comfortable with the decision.
>
> In the car, I think about the girl in the waiting room behind me as I stood in the pdoc's office doorway, arguing with him. And her father. I find myself wondering how her therapy appointment went, what she thought of her angry pdoc.
>
> to be continued again.............

 

Re: Writing » noa

Posted by medlib on January 18, 2002, at 18:20:44

In reply to Re: Between pdocs...thanks (nm) » kiddo, posted by noa on January 18, 2002, at 8:45:43

Hi Noa--

I ditto everything Greg said! If you experience half the satisfaction writing that others do reading what you've written, I hope it is/becomes a big part of what you do and who you are.

How delightful to discover how far beyond succinct and empathetic your writing ability extends. It's hard enough to find the occasional flower in our landscape of misery; then you show us a whole field of them!

Wow! Please keep blooming---medlib

 

Controlled Substances

Posted by Cecilia on January 19, 2002, at 0:54:29

In reply to Re: Between pdocs.... » kiddo, posted by mair on January 18, 2002, at 7:31:41

> > Is klonopin a controlled substance? I thought it was, and yet this is one of the prescriptions that was always called in.
>
> Mair

Klonopin and other benzos are level 4 controlled substances and can be phoned in, stimulants are level 2 and cannot be.

 

Thanks for the Explanation (nm) » Cecilia

Posted by Mair on January 19, 2002, at 15:20:27

In reply to Controlled Substances, posted by Cecilia on January 19, 2002, at 0:54:29

 

Re: Between pdocs....continued » Greg

Posted by noa on January 21, 2002, at 13:11:05

In reply to Re: Between pdocs....continued » noa, posted by Greg on January 18, 2002, at 14:13:29

Thanks, Greg, but I think it is sort of something beyond my control--ie, this is just coming to me because it is, and I need it right now, the writing process, to work this through. I didn't expect this to be such a long bit of writing, but it is turning out to be very cathartic. I don't think I could just decide to write as "work". Know what I mean?

 

Re: Between pdocs....continued

Posted by noa on January 21, 2002, at 14:22:25

In reply to Re: Between pdocs....continued, posted by noa on January 17, 2002, at 17:24:39

OK, where did I leave off…..oh, yeah….

In the car, I realize I'm sad, not just angry. This feels like a loss. My pdoc and I had been through a lot together and he had helped me. I know I want to stop working with him, that I'm comfortable with the decision, but I am sad about it anyway.

When I arrive at the pharmacy it is more crowded than I've ever seen it before. In addition to the line at the pick up counter, there is a line at the drop off counter. And an angry woman at the ask the pharmacist counter. I wait.

There seems to be one pharmacist on duty, a substitute pharmacist. And two clerks, one of whom is moving at a snail's pace and seems to have no awareness of the lines that have formed. The other clerk is arguing with the angry woman about a prescription filled incorrectly but already taken out of the store. Right medicine, wrong number of pills. The woman insists she is entitled to 30 days worth, that it was only filled for 19. The clerk insists the insurance company won't pay for a corrected scrip because the woman had already taken the medicine home. She threatens to sue, threatens to report them to the pharmacy board, writes down the pharmacist's name, is oblivious to the clerk telling her the name on the board isn't the same pharmacist. The woman goes away.

A lady with two little kids is waiting, too. The kids are touching all the stuff that is at eye level. Seems logical to me, like kids' toyshelves. Only they're taking diabetic blood testing kits and chapstick and thermometers and home kits for testing yourself for aids off the shelves. Bright packages within reach. The woman is remarkably calm as she shoos them off the merchandise and tries to distract them while she deals with the slow clerk when her turn comes. Her older son, a preschooler, asks repeatedly about his pskiption. He looks so proud as he says this big, new, word.

I am two away from my turn. Suddenly the pace goes from slow to nonexistent. The guy in front of me says he thinks the computer is down. We wait.

Finally, my turn. I drop it off, they say come back in 30 minutes. I don't mind, even though my scrip is for 6 pills. I start to leave and a customer calls me back, tells me the clerk needs to talk to me. It's not the slow clerk, it's the other one. She caught a problem with the scrip, can't read my last name. I look at it and see how angrily and carelessly it was filled out. How had I not noticed that before? I guess I had shoved it into my pocket without looking. I see that you can't even make out the first letter of my last name. I tell her I'm in the system, have had this medicine filled here for years, she can check it. She says she needs to ask the pharmacist, comes back in a minute and says it isn't just the name. There is no date on the scrip, can't fill it by law. I'm not mad at her or the pharmacist. This rule sounds very reasonable to me. I take the scrip back and realize it is a worthless piece of paper. I decide to save it for Saturday to show my pdoc.

The next day I ration my adderall. I eke out a couple of half doses and save one dose for Friday. I drink a lot of coffee. I get by. On Friday, I talk to my therapist about it, tell him the whole story. He wonders if maybe I should line up my replacement pdoc before firing my current pdoc. I say, no, I'm done with him, enough is enough, I feel comfortable with it. I'd rather just have tomorrow be my last appointment. I tell him I'd thought about whether to bother going in, but needed refills, and besides, I really did want to say goodbye to him and tell him why I was leaving. I wasn't just mad, I was sad, too. He had helped me. My therapist seems satisfied with this.

It is Saturday morning. I try to leave with enough time to get there on time. I still care about getting it right. I have a book, which is good, because even though I am a few minutes late, my pdoc is still with a patient, and there is one waiting in the chairs. The door opens and a young man and his parents come out into the waiting room. The other patient goes in. The threesome that has just finished up with the pdoc are now scheduling an appointment with the secretary. The young man seems like someone who has been through a lot. His parents seem supportive, are respectful about negotiating the next appointment time. They seem happy together. I feel glad for him because he seems like he needs the support.

Now it's my turn. The pdoc is in his rocker, hunkering, looking up his notes. I start by telling him I couldn't fill the scrip--it was worthless, that he had made it so through his anger. He nods, um-hmms. I tell him I'm angry, feel he had been unprofessional, unfair. Um-hmm. I wait. He says, I was angry, but you have to understand what was underlying that anger. I give him a curious look and say, and? He tells me I have to realize he's human too, that I had been the 4th person that day to just show up for a refill. I say that may be, but I still think you acted unprofessionally. He um-hmms again. Pause. Then he says, look, I know you’re a fine person, you’re not one of those who is rude and demanding and doesn’t come in for an appointment for a year and then calls in demanding a refill, you should see how some people behave. I know you’re not like that. I say, their behavior is not my fault—the way you treated me was unprofessional. He says, look, you need to understand that I’m human and be able to accept that.

I say, I do understand that. I’ve been working with you for over 8 years, and you know I’ve had issues with all the disorganization, having to wait while you are running late, not being able to get in touch with you. I’ve considered going elsewhere before. Obviously I’ve accepted that you’re human if I’ve decided to keep working with you all these years. Um-hmm. And you never once apologized for all those late appointments.

I tell him about my plans to get an outside consult because he has been seeming blasé about my concerns regarding side effects. Um-hmm. I tell him that now, after the other day, I've made the decision to stop working with him and find a doctor who is more interested in figuring it out. In response, he throws me a bone—you could try a dopamine agonist It breaks my resolve for a few seconds. I am curious, want to know more. He suggests I look it up. My resolve returns.

He asks me if I need names, who am I thinking about going to. I tell him two names. He is familiar with one. He asks if they are on my plan, I say, no, practically no one even takes insurance. He nods. He says, I hear Dr. So-and-so is kind of disorganized, too--that he has to fish around on his desk for lab results, too. I am struck by his defensiveness.

We then turn to the business of what scrips I need right now, and he writes them out. I check them all before leaving the office—dates, names, etc. As I exit his office, he says see you later.

Later, I realize I had only referred to my pdoc once, and that was in my first year working with him. People had asked, and I’d told them honestly about his strengths and weaknesses, and they’d agreed he was hard to recommend. The past few days I find myself wondering about that—I hadn’t been able to recommend him, but have stayed with him myself all these years. Does this say something about my own self-respect? I’ve decided it is more complicated than that. I’d considered leaving, even consulted another doctor once, who seemed hard to connect to and didn’t seem as knowledgeable. I’d gotten names of other pdocs from friends but none of them took my insurance and at the time, I didn’t have the kind of money needed to put out up front. I had decided I could learn to deal with the lateness, the chaos, because my doctor knew his stuff, knew my history and reactions to medications, had helped me, and took my insurance.

But now, he was seeming complacent about my experience with my medication. And the anger toward me about being late. And then, the final straw.

I don’t know why this aspect of his work with me changed. Maybe the pressures of managed care. After all, when I started seeing him, his outpatient work was a supplement to his job at the psych hospital. His time was more flexible, there was no packed waiting room. And, it was almost a decade ago, a decade during which the burdens of managed care have managed to change the way many doctors run their practices. I’d seen the changes in my internist’s office, too. In these past few months when my pdoc had become a clock watcher, his waiting room fuller, that is when he went from being my disorganized, late, sometimes exasperatingly inaccessible, but still benevolent and helpful, pdoc, to being more distant, complacent, not so very interested in my concerns, and angry. Maybe that's it, maybe not. I'll never know.

Today I will call these other doctors. I will make an appointment, bring my records along, try to reconstruct the intricate history of my life on medication. I don't know if there are solutions to the problems I am experiencing. It isn't urgent. I am doing pretty well. Maybe it is a sign of how well I am doing that these side effect issues feel like they are detracting from my quality of life---that my life actually has quality to detract from.

I am sad, but content with the decision. I don't feel I've burned my bridges, either, that despite how unlikely, I really could go back to see my pdoc if need be. Afterall, he was the one who said see you later....



 

Re: Between pdocs....continued

Posted by noa on January 21, 2002, at 14:40:40

In reply to Re: Between pdocs....continued, posted by noa on January 21, 2002, at 14:22:25

I realize I left out that in that last appointment, I also told my pdoc this wasn't entirely easy--that it was sad for me, that he had helped me.

 

sniff (nm) » noa

Posted by susan C on January 21, 2002, at 15:53:47

In reply to Re: Between pdocs....continued, posted by noa on January 21, 2002, at 14:40:40

 

Re: Between pdocs....continued » noa

Posted by IsoM on January 22, 2002, at 2:04:13

In reply to Re: Between pdocs....continued, posted by noa on January 21, 2002, at 14:22:25

Noa, it's a shame that the doctors who know the mind & the meds necessary for 'fixing' us, the psychiatrists themselves, don't have more empathy for their patients. All the book knowledge & understanding of what chemicals & neurotransmitters are involved, aren't enough. Otherwise, in the future, robots could diagnose & treat us.

A doctor should want to enter this profession because of compassion. If a doctor doesn't have compassion for his patients, he shouldn't be practicing. Sounds like that's what happened to your old pdoc. We're not machines that need repairing - our healing needs to come from all the different facets of what makes us human.

I read the writings of a doctor who had to be treated for an illness & of his stay in hospital. It gave him a profoundly new insight into what it meant to be a patient. And as he said, the people involved in his treatment KNEW he was a doctor. How much more humiliating it is to be a non-doctor & to be treated like a non-person when ill. I dread the point when Canada's health care will suffer as resources get tighter.

 

Re: Between pdocs....continued » noa

Posted by jane d on January 23, 2002, at 0:50:59

In reply to Re: Between pdocs....continued, posted by noa on January 21, 2002, at 14:40:40

Thank you so much for posting that, Noa. I found that reading your story made it possible for me to think about my situation with my own doctor. Like you I have moved through several different practice settings with her. Like you, I realized that I have also avoided recommending her to my friends although I have thought I was happy there myself. I have no quarrels about disorganization or rudeness. I benefitted greatly at first but I am less sure now that I am getting what I need. And yet, I know that even being able to question that is due to what this woman has done for me. I haven't come to any conclusions about what I should do but your story has reminded me that it is necessary to reevaluate these relationships at times and that it is reasonable to decide to replace someone who is not all bad. I have a lot of thinking to do. Thank you. - Jane

 

Re: Between pdocs....continued

Posted by noa on January 23, 2002, at 6:14:58

In reply to Re: Between pdocs....continued » noa, posted by jane d on January 23, 2002, at 0:50:59

Have you shared any concerns with her? Maybe she would be responsive to them.

 

Re: Between pdocs....continued » noa

Posted by finelinebob on January 24, 2002, at 23:09:50

In reply to Re: Between pdocs....continued, posted by noa on January 21, 2002, at 14:22:25

> ... Maybe it is a sign of how well I am doing that these side effect issues feel like they are detracting from my quality of life---that my life actually has quality to detract from.

Sounds good to me.

One of the hardest lessons I had to learn once I started taking my condition seriously is that feeling "good" is not the same thing as "good enough". I put off getting the help I needed for sooooo soooo long because I was always telling myself I was doing good enough on my own. Then, once I started serious therapy I felt guilty about taking meds because I was doing good enough. Then, being afraid to switch from one med to another because--in spite of side effects, whatever -- I was doing good enough that I didn't want the new med to make things worse.

So maybe having complaints is a better barometer than feeling "good".

That's kinda how I realized I had been making some significant progress with my therapist -- we had gotten beyond what I **needed** to talk about (immediate concerns, that is) and what I **wanted** to talk about and finally started discussing stuff I really did NOT want to talk about at all! (It only took about five years or so, but who's counting?)

cheers,
flb


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