The Ideal Patient

I am sorry you have had to deal with this Abilify mess, @BethRags. So frustrating.

The truth is, she is supposed to have coverage when she is not available. Apparently you are in this situation where there are few providers in your area, so I don't understand why she hasn't worked something out with the doc at the county to cover for her when she is not available. That's the logical thing to do. In any event, I don't know about the issues involving your therapist and the county, but you might want to reconsider possibly getting your care there. I know it's a huge deal to change pdocs, but it's possible it could be worth it for you in the long run. I have gotten good p care at even a very rural county mental health clinic. So, it can be quite good. Just a thought. Hang in there!

You make an excellent point about the clinic working something out with the county. The clinic has existed since the 70's - I wonder if they've ever had off-hours doctors available for medical, dental, or psych?

It does seem (very) odd and a potentially legal mess for the clinic if someone has a life-threatening med reaction that goes unchecked. I'm thinking of something like the severe Lamictal rash, which can kill a person. The only option I can come up with is for someone to call an advice nurse from our own insurance - maybe that's how the clinic covers itself legally. Of course, an advice nurse won't change a psych med or even offer suggestions on that topic (except to go to the ER).

Thank you for your support and experience, bpc

I think your Pdoc sucks to be honest.

Thank you for your honesty I genuinely appreciate it.

It's so weird, Christina! The woman needs a mood stabilizer, I swear it. 3/4 of the time she's bright, intuitive, and caring. 1/4 of the time she's an effin' sh it - like a different person. NOT a good feeling, nor a safe one, to wonder which Dr. W. I will get when I walk into my appointment.

You lowered your dose for a legit reason.. her scolding you ? Nope that’s ridiculous. But you went ahead and tried your best .. Abilify just isn’t for you...

I know you don’t really have any options right now ( call the other price office and get an appt it’s likely weeks to months away anyway)

I think I’d go to see her and open up with something like....

Hiya Dr X.. I know your were angry I changed my doseage before but I felt I had to and of course it happened when you were not available. So I now have really tried to take it, it just isn’t working for me , I’m not sleeping and that is going to really cause me to deteriorate quickly. So i really want US to work together to find a good medication that will help me and I can tolerate any side effects.

If you guide the conversation in a way like this it might get her to swallow her ego and focus on the next course of treatment. Make sure “ work together” is emphasized.

She has major ego.

EGO - you are spot on!That's the word I've been searching for.

I also go to our county mental health services because well it’s a rural town only one other Pdoc in town.. my providers are both stellar !!! they don’t care if you have Medicaid or penthouse top notch insurance. They treat a person not a insurance company.

As they should!!

I can't say that I've ever heard her indicate anything about me being on Medicaid; she seems fine with it. But I have wondered if my insurance is a part of her attitude - maybe even not consciously.

What she has mentioned, in a slightly "weary" way, is that she has to be cautious with my treatment because I have strong reactions to med adjustments - which is annoyingly true to me. But hey, every patient can't be easy, right?

My Pdoc covers 3 counties !!! But he is available by phone if I need a change during the week , office hours.. usually he responds through his nurse in 24-48 hours if not sooner.

But ... he does not have a 24 hour service to cover nights and weekends. Hell I wouldn’t want some unknown Pdoc on call to fiddle with my meds..

That said ..... if a medication is causing me unbearable side effects I would indeed lower it or more likely I’d just stop it. Also half life of meds needs to be taken into consideration. Just because you stop Med X on a Friday night doesn’t mean it’s out of your system right away.

If I am really a mess? If I can’t stay safe then I’d be referred to the Er anyway.

I think you need to ask about a PRN you can use in an emergency. It’s usually a Med that typically snows someone under.... Seroquil, Zyprexa, Haldol, Thorazine..

In the past when I haven’t slept for 5-6 days and I’m shattering I have fallen back on taken Thorazine and just slept a day or 2 away until I can get ahold of my Pdoc.

I'll tell you what...I have a load of Seroquel that I have left over from previous 'scripts. I mean, it's enough to easily last me a year. I rarely use it, but it certainly works as a good prn if I'm severely sleep-deprived.

Call any other Pdoc’s available and get an appt set even if it’s a couple months from now. Maybe your Pdoc will stop being a shyt human being and start working WITH YOU to find something that you benefit from.

Right now the plan is for me to have 1 appointment with Dr. W. on Thursday and tell her essentially what you posted above- that I'm feeling confused by her lecturing me, because I believe I was taking action that was responsible, and that I was completely honest about the change I made since we are WORKING TOGETHER on my stability. If she can hear me and is receptive to compromise, good. If not, my therapist is going to accompany me to my appointment next week to mediate.

I'm stuck with Dr. W. as long as I'm with my therapist because my insurance won't allow me to see a pdoc in one place & a t in another. As annoying as my pdoc is, my t is that helpful. That said, I like your idea. Getting an assessment by the county is doable and well worth looking into. Not only for a second opinion, but I have found that oftentimes there are loopholes when it comes to "the rules", especially if one happens to connect with an employee that cares enough to check out all possibilities.


Thank you much, much Christina. Your input gives me valuable thought for options.

I hope you can get this mess figured out. I think it’s fantastic your T is willing to go with you ..

My Pdoc is odd in numerous ways. He just hates making eye contact, like he will here and there during our appt but mostly he’s blinking and looking at anything other than me haha ..

My T warned me ahead of time. They have worked together for almost 25 years! And my T said he’s the same with colleagues and office staff. lol

I think he’s probably got numerous mental health diagnosis. But he’s brilliant and always helpful kind and caring.

Good luck, look up the APs your willing to take and cross reference it with what your insurance will accept. Take that list with you.