Posted by Eric on March 28, 2001, at 21:07:30
In reply to Bad doctors (Dr. Bob, someone, help!), posted by PhoenixGirl on March 28, 2001, at 16:37:15
> I am really struggling to find a good doctor. The doctor-patient relationship can have a big power imbalance, which I don't like -- I want a doctor and I to work TOGETHER on helping me, I don't want to just do whatever he says. Yesterday I went to a doctor for the first time, and withing 15 minutes he thought he had everything all figured out, and wanted to change me over to Effexor. He said "Depression is treated with serotonin, not norepinepherine", even though I told him that the norepinepherine drugs tend to work better for me than the more serotonergic ones. Right now I take desipramine, levothroid, and Wellbutrin, and I wanted to switch the Wellbutrin to Provigil because Wellbutrin doesn't help my depression. He said "If you want me to help you, I can help you, but I won't fight with you. I'm not going to do what you want me to do. I've been a pharmacologist since before you were born." What the hell is this power struggle crap?! I was very shy and passive during the whole appointment, and I quietly said that I don't want to mess with serotonin drugs again (I've tried 4 without success), and that's the reaction I got! When we were walking out of the office, he told his
> receptionist to make an appointment for me with the therapist he works with, even though I never said I wanted a therapist, much less that one. Clearly, he is controlling, egotistical, and thinks he knows it all. I've had depression for 11 years, and a doctor should not make decisions about my treatment within 15 minutes of meeting me. What can I do? I need a doctor who will try new things with me and tailor the treatment to me, since I've tried at least a dozen antidepressants, all with insufficient effectiveness and awful side effects. I live in Atlanta, and need to find a doctor in the area. Psychiatrists shouldn't belittle you and leave you in tears. Please someone help if you can.
Here are my personal rules for dealing with psychiatrists and all other mental health professionals.1) Let them know you are depressed(you have to) but make it clear you are NOT actively suicidal or anything else of that nature. Avoid the self cutting thing that some are into. Thats another thing that can give a Pdoc power over you. If they can see visible cut marks on you that can possibly give them power over you. Psychiatrists in the USA have absolutely no power over you unless they TRULY believe you are actively suicidal or homicidal. Dont give them a reason to think you are actively suicidal, for this can give them legal power over you sometimes. Psychiatrists basically dont have much power over their patients like back in the old days. Thank God.
2) I make it clear to them that I dont take shit from doctors. I have on occasion used mild scare tactics on them and have let them know that I was not happy with some of the services I received in the past from prior doctors. And I give them the impression I am the type of person who will actively seek out a malpractice lawsuit if they treat me poorly. I have on occasion mentioned to my psychiatrists that I have filed complaints against one or two of my doctors with the State Medical Board. That always makes them realize I dont take crap from asshole doctors. Many times the underlying possibility of a Medical Board complaint is more scary to a psychiatrist than the possibility of a malpractice lawsuit.
Of course, telling a Pdoc that kind of stuff will also get you a "paranoid" diagnosis real fast. Oh well. LOL
3) Be polite but firm. Dont be a pushover with your Pdoc, but dont be rude either. I dont talk to my Pdocs in a rude way...but I let them know that I am in control.
4) Psychiatry tends to attract control freaks I have observed. Unfortunately its the nature of the beast. Fight back by being somewhat of a control freak yourself. You can do this by becoming an "educated patient." Some Pdocs will like the fact you are an educated patient. Others however, wont like it and will see it as a threat to their big doctor ego. Learn all you can about the meds, the treatments, the diagnoses themselves. That way the psychiatrist will quickly pick up that you are an educated patient and cant be bullshitted or controlled and mindlessly bossed around.
5) Basically I avoid Pdocs who are excessively dictatorial or jerky acting. If I go to one whom I find is that way, I dont return and I may possibly file a written complaint against them with the Medical Board and tell the Medical Board that the Pdoc has an attitude problem and has poor communications and listening skills. One time I even wrote the board that a certain Pdoc I used needed to be "rehabilitated."
Unfortunately the way psychiatry currently is you have to be like the above if you want to avoid getting jacked around. Its sad so many people have problems with their Pdocs but if you consider how crude, subjective and backwards psychiatry really is its not surprising.
Your psychiatrist's statements about norephinephrine are somewhat unfounded. While its true that serotonin is the biggie neurotransmitter for depression, OCD and anxiety, other neurotransmitters ARE important quite frequently. The strongest modern class antidepressant on the market, Effexor, heavily increases norephinephrine levels in addition to increasing serotonin levels. This effect on norephinephrine is a big part of what gives Effexor its "punch power" and is part of the reason it is so stimulating of an antidepressant. Tell that to your Pdoc next time you talk to him.
Also, there are one or two new meds scheduled to come out which specifically target norephinephrine rather than serotonin. Reboxetine is the most well known. It is an SNRI...Selective Norephinephrine Reuptake Inhibitor. Eli Lilly has another SNRI drug in the pipeline, I cant remember the name of it but its probably coming in a few years.
Basically your Pdoc is a jerk. Find another one. And remember, become an educated patient. Your future Pdoc will quickly pick up on that if you are an educated patient. Become familiar with your State Medical Board as well. Dont overuse it and write a complaint everytime you have a bad Pdoc experience. But be aware that it is there for when shit hits the fan and you feel like you were not treated that well. Save it for when you really need it.
Eric
poster:Eric
thread:57824
URL: http://www.dr-bob.org/babble/20010327/msgs/57859.html