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catches the flowers
Member Since Jul 2019
Location: Downtown Vibes, California
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#1
Psychiatrists. What do they want us to do, behave, act, not act, tell them and not tell them...What do they want? They seem to have such a ridged agenda.
What exactly do they want and expect from a patient? If you have had/have a successful relationship with your med prescriber, what makes it work? __________________ |
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MickeyCheeky
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Ford Puma, MickeyCheeky
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#2
My psychiatrist wants me to tell him what is going on as faithfully as I am capable of. He wants me to take my meds as prescribed. He wants me to call him if I am in crisis or getting there. And he wants me to know he is there to go to bat for me if need be. Oh, and he doesn't want me ever to commit suicide (I struggle a lot with this).
I have basically been with him since 2008. If he has an agenda, I would say it is that he would (secretly, he'd never admit this outwardly) very much like to be the best psychiatrist on the planet. He is competitive. He reads absolutely everything. He's always three steps ahead of me. His fund of knowledge is absolutely mind-boggling. Harvard-trained (not that that matters, as I am sure there are outstanding psychiatrist from, say, the University of Florida as well), which again, I think just speaks to how competitive and hungry for helpful knowledge he is. In short, he is always learning and I have been the beneficiary of that. He doesn't judge me. When I d/c'd my Abilify a while back without telling him, his response was to immediately try to figure out the next move. He never freaks. What have I done to contribute to this relationship working? I always tell him the truth--including when I have been psychotic. I go to the hospital when he tells me to. And I try to read a lot and bring him ideas about maybe what we might try next. He loves that. It seems to be working. The only downside is that he does not accept insurance and is quite expensive. But if I am going to spend money on anything right now, my mental health is as good a place as any. I'd rather have him than eat way better. __________________ When I was a kid, my parents moved a lot, but I always found them--Rodney Dangerfield |
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lizardlady, MickeyCheeky, SlumberKitty
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lizardlady, MickeyCheeky, SlumberKitty
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#3
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I count my blessings that I found him. I've heard horror stories about others. Dealt with my share of idiots before I found him. I told him he's never allowed to retire. |
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bpcyclist, MickeyCheeky
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bpcyclist, MickeyCheeky
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#4
My Pdoc just wants me to be honest with how I’m doing , how I’m feeling etc. He listens to my concerns about meds.. anytime I’ve been interested in a medication , we talk , we both agree to whatever treatment. He has never nor will he ever demand I take anything I’m not comfortable with.
I think that’s honestly what any Pdoc can hope for.. honestly and no game playing. __________________ Helping others gets me out of my own head ~ |
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bpcyclist, MickeyCheeky
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bpcyclist, lizardlady, MickeyCheeky
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#5
My doctor is great! I'm very involved in my treatment and we discuss how I feel about my medications and she respects if I'm uncomfortable with anything. I just make sure to be honest and trust her because she always has my best interest at heart. I've been seeing her for 4 years and am thankful to have such a wonderful doctor.
__________________ R.I.P mom 8/6/55-1/15/16 “All the darkness in the world cannot extinguish the light of a single candle.” -St. Francis of Assisi
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*Beth*, bpcyclist, MickeyCheeky
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*Beth*, bpcyclist, lizardlady, MickeyCheeky
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#6
The biggest thing I've found is they want you to tell them how you are feeling as honest as possible and expressing the outcome you want with treating a particular symptom. I think honesty is huge.
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*Beth*, bpcyclist, MickeyCheeky
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*Beth*, bpcyclist, lizardlady, MickeyCheeky
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catches the flowers
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Location: Downtown Vibes, California
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#7
Thank you, each of you, for your replies. It is a blessing when we have a skilled psychiatrist, isn't it?
I posted this because I have been angry at my pdoc, Dr. W. And I'm wondering what I might be doing wrong (if anything). I am on Medicaid and receive my care from a clinic. I feel very fortunate to have the care I do - especially because psychiatrists, even paid out of pocket, are scarce around here. I am always honest with my Dr. W. 2 weeks ago I (very honestly) explained to her that I had made some changes in my Abilify. I was having severe side effects that truly prevented me from functioning "normally." For example, I was falling asleep all day. Wherever I was, falling asleep. I was washing dishes and awoke when my knees bent as I was dropping to the floor, sound asleep. Of course, no way would I drive in that state. Dr. W. reamed me for changing my med without her approval. She didn't seem to hear my explanation of how I felt; she seemed only to hear that I had changed my Abilify dose on my own. Now, here's the tricky part. Dr. W. is in the clinic 4 days per week. On Saturdays, Sundays, and Mondays, there is zero back-up for psychiatry. (In fact, there is no back-up for standard medical care, either.) This week, she's out tomorrow (Tuesday), too. When she lectured me, 2 weeks ago, about changing my Abilify I reminded her that I'm not clear on the protocol for the days when she is out of the clinic. Her answer was that I should go to the ER. A ridiculous suggestion, because the ER will not touch (change) psych meds unless there's a life-threatening reaction or unless the patient is IP. In addition, to get to the ER I need to drive. My husband is not always available to drive me places and no way do I have the $ to take a taxi or some other hired driver. I told Dr. W. that I believe I deserve credit for keeping notes and for being honest with her about the changes I made. She seemed unwilling to budge. I will say that when my pdoc is there in the clinic she is usually concerned, helpful, and does go the extra mile to assist me (for example, she'll call my pharmacy during our appointment to be sure they have a certain medication in stock to save me a trip over there). She seems to be aware of the various med options and has experience with them. Anyway, this week-end I dropped the Abilify altogether. The stuff is not working for me, despite my 5 weeks of trying hard to make it work. I hadn't slept for more than a 3 hour stretch during that entire five weeks. Last night I stopped the Abilify and took 12.5 mg. of Seroquel and slept! I feel alive today. Anxious, agitated - but alive. I can function. I have an appt. with Dr. W. on Thursday. I'm nervous about it; I don't want another lecture. A different psychiatrist is not an option, as I live in a town that has 2 psychiatry options for those on medicaid - the county and my pdoc. The county would take a couple of months to get hooked into, plus there are problems with seeing a pdoc outside of the clinic where my therapist is. So that's where I'm at today. __________________ |
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bpcyclist, possum220
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bpcyclist
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#8
It's understandable that you felt she was not hearing you about why you changed the dose. Since Abilify is an antipsychotic maybe she was concerned about making an abrupt change. Is she available by phone if she's not at the clinic?
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catches the flowers
Member Since Jul 2019
Location: Downtown Vibes, California
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#9
Hi Liz, Yes, I'm sure she was concerned, which I appreciate. Oddly, at the higher does (which was still quite low) I was paranoid. My mind had gotten the idea that I was being watched through fans that I had running in my apartment. And there were other issues...akathesia that was just about pushing me over the edge.
Anyway, I lowered the dose to one that seemed to work best.Dr. W. didn't like that one bit. Maybe I'm all wrong here, but once in a while I have the thought that pdocs are annoyed when a patient works out an effective med dose with them (the pdoc). To answer your question - no, there is no way to reach Dr. W. or any back-up pdoc during the 3 days she's not in clinic. Honestly, it seems irresponsible to me; I'm surprised they don't cover their own rear-ends by ensuring some kind of back-up psychiatry. __________________ |
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possum220, SlumberKitty
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#10
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! __________________ When I was a kid, my parents moved a lot, but I always found them--Rodney Dangerfield |
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*Beth*, SlumberKitty
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*Beth*
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#11
I think your Pdoc sucks to be honest.
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. 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. 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. 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. __________________ Helping others gets me out of my own head ~ |
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lizardlady
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#12
I adore my doctor. Unfortunately after 20 years with her she is retiring. I have a new appointment with a new doctor in November and I hope this one is as good as her.
__________________ "I carried a watermelon?" President of the no F's given society. |
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*Beth*, SlumberKitty
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*Beth*
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catches the flowers
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#13
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catches the flowers
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#14
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~Christina
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#15
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. __________________ Helping others gets me out of my own head ~ |
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SlumberKitty
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catches the flowers
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#16
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In my vast experience of psychiatrists .....I've never met one, even the kindest and most capable, that wasn't, um...ODD __________________ |
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SlumberKitty
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~Christina
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#17
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.
__________________ Dx: Me- SzA Husband- Bipolar 1 Daughter- mood disorder+ Comfortable broken and happy "So I don't know why I'm tongue tied At the wrong time when I need this."- P!nk My blog |
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*Beth*, SlumberKitty
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*Beth*
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catches the flowers
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#18
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SlumberKitty
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catches the flowers
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#19
So I saw Dr. W. yesterday. She always starts the damned appointment with the same question, "How can I help you today?"
What, really, am I supposed to say to that? Her question makes me feel like she doesn't remember what we've done in the past, so she's pushing all the responsibility off on me. I would like her to say, "Last time we decided to give 'X' a try at a higher dose. How is that working?" I have to keep reminding her of which meds I'm taking, and oftentimes, why I'm taking them. She almost never looks at me, except to glance occasionally, because she's typing like mad on her computer or searching for something on her computer. She keeps asking me what I want to do with my medication - yet she went off on me for altering the Abilify dosage. My dear therapist offered to accompany me to an appointment with Dr. W. I would agree to that in a New York minute - except that there really isn't anything my therapist can do about Dr. W. I mean, the Good Doctor needs an entire personality make-over, what can I say? Anyway, Dr. W. suggested that I drop the Abilify - I've given it the best I could for 5 weeks and it's just not doing anything, plus when I was at a higher dose I became paranoid and had akathesia. So there's no room to increase the dose without problems popping up. She prescribed Zyprexa instead. I'm willing to give it a try, sure, fine. I so wish I could recreate the woman. Somewhere in there she has the potential to be an effective psychiatrist - but she needs to be rearranged. And I cannot go to a different psychiatrist because my insurance is for that clinic only. So I'm in this awkward marriage with Dr. W. Fortunately, I am feeling increasingly able to simply use her to prescribe and not become as emotionally involved with her as I was. Thanks for hearing my vent. __________________ Last edited by *Beth*; Oct 18, 2019 at 04:43 PM.. |
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bpcyclist
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#20
Electronic medical records have done a lot of damage to the doctor-patient relationship. Docs can't look up very often, because they are too busy checking boxes and typing to do that. So, they often come off as disinterested. It's just not a good situation when you can't really keep any kind of eye contact. Problem is, most clinics and insurers in the US are requiring their providers to use EMRs as a condition for getting paid. So, we seem to be stuck with this.
It is a bit weird to me that she has to ask you what you're on every time she sees you. Part of this a style thing. She has her way of conducting visits and she has probably been doing it that way for awhile. It's just her way. But part of it also is that she really should require little prompting after having seen you several times about what your basic med situation is. Oh well. I wouldn't expect it to change. This is probably just who she is. I was on Zyprexa for a long time. It def worked for me. Wishing you all the best with it. __________________ When I was a kid, my parents moved a lot, but I always found them--Rodney Dangerfield |
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