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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Kate on September 4, 1999, at 9:52:29
recently I again went on the frustrating rounds
of trying to find a psychiatrist. I found out that medicare and HMOs do not have to publish or tell you the names oof participating psychiatrists. When asking about 'specialities' of the pschiatrists in the HMO - I was told that "they all work with adults and children" and when asking for someone good with pharmcology (I'm on meds for other problems) the HMO said "they all studied drugs in medical school"
The HMO's contracting group for mental health also told me that they couldn't accept me because I have medicare as primary (therefore they have to file with medicare) After MANY long distance calls I got an appt. I meant with an MD for 45 minutes of a 50? minute session and THEN he said he only works with adults (I'm 5'8" and over 50yr - who did he think I wa when I walked in?) Bottom line - cost; I think he wanted to give me to a LCSW.
How does one "research" pdoc if you can't even get a listing of the names in the group.?
With the number of meds - how does one insist on MD rather than LCSW?
FYI - I was told it would take state and federal legislation to require listing of particaipating MDs.
for HMOs or those accepting medicare patients.
In the meantime, I was told to call all the MDs lisited in the yellow pages and ask if they are in the HMO or accept medicare. Most pdocs aren't in yellow pages, are they?
What is up with all this?
How do I make an "informed" decision in obtaining medical care?
Posted by Tom on September 4, 1999, at 18:59:07
In reply to Info on selecting psychiatrist, posted by Kate on September 4, 1999, at 9:52:29
Psychiatry is based on a medical model: Mental illness + medicine= cure. The problem is the very material of psychiatric diagnosis is peoples subjective experience which is paraphrased into medical speak. The underlying assumption is that your mind isn't correct in feeling the way you do about things, therefore a medicine will redress the balance. I'm a physician and I think this approach is not only a serious oversimplification of the nature of human experience, but it also initiates cycles of drug dependancy by disassociating cognition and emotion. It is a medical fact that after the ingestion of various antideprssants the artificial stimulation of the relevant neurones leads to downregulation of postsynaptic receptors for the neurotransmitters that are being boosted. In other words a dependancy cycle is initiated. I'd recommend the cheaper alternative of a psychotherapists where your moods and experience mean something more than a DSM classification. Of course I may be entirely wrong.
Posted by Noa on September 4, 1999, at 21:24:32
In reply to Re: Info on selecting psychiatrist, posted by Tom on September 4, 1999, at 18:59:07
There is depression and there is *depression*. I believe psychotherapy works, but I know from my own experience that it can't do it all for me. I would agree that a person with a milder depression might only need psychotherapy to turn things around. But, with my chronic, severe depression, I know that I need the medication in conjunction with the psychotherapy.
Kate, many HMO psychiatrists only do psychopharmocology, and the therapy is with a psychologist or social worker. You can have excellent treatment this way. In other words, you see the MD for medication, and the LCSW for talk therapy. Both can be helpful. Good luck.
Posted by Kate on September 5, 1999, at 0:55:10
In reply to Re: Info on selecting psychiatrist, posted by Noa on September 4, 1999, at 21:24:32
Maybe I didn't express what I consider the real problem to be -- How can you make an intelligent choice of any 'therapist' if the patient isn't given a listing of therapists in the group. How can we understand which "therapist' has a greater skill in the area we need, if they won't release ANY names of the groups' MDs, PhDs, or LCSWs, and when asking for someone who could help me, I given to an MD who at the END of the session says he doesn't handle adults.
Bottom line-how do I make an informed choice for my medical treatment in thiis enviroment. thanks .
Posted by Dr. Bob on September 5, 1999, at 1:04:28
In reply to selecting psychiatrist-yes,but ?, posted by Kate on September 5, 1999, at 0:55:10
> How can you make an intelligent choice of any 'therapist' if the patient isn't given a listing of therapists in the group. How can we understand which "therapist' has a greater skill in the area we need, if they won't release ANY names of the groups' MDs, PhDs, or LCSWs, and when asking for someone who could help me, I given to an MD who at the END of the session says he doesn't handle adults.
It might be possible to "screen" psychiatrists to some extent over the phone before meeting with them. And if one coverage plan isn't reasonable, it might be worth complaining or (if possible) switching to another...
Bob
Posted by Dee on September 5, 1999, at 7:38:47
In reply to Info on selecting psychiatrist, posted by Kate on September 4, 1999, at 9:52:29
I know how frustrating it can be dealing with HMOs. I was with HIP until about a year ago until I left my job, and I have been spending hours in telephone for any smallest peice of information I needed.
I consider myself almost fortunate that I am now without insurance. In my present condition I don't think I'd need the extra frustration and agitation that dealing HIP brings. On the other hand, this is not cheap...I am seeing a psychiatrist for my medication, and a therapist in another facility and the two communicate. I find this to be working pretty well. I didn't know anything about either one of them at the time I started, but I guess I was lucky. I don't know exactly what your situation is, but if I was in your shoes, I'd probably see the specialist that my PCP sends me to, and if I then really felt that things are not going to work with that one, I'd try to switch. I personally wouldn't want the things to take any longer than absoltely necessary, don't want to subscripe to more pain than necessary.
Let us know how things are turning out.
Love
Dee
Posted by JohnL on September 5, 1999, at 9:52:37
In reply to Info on selecting psychiatrist, posted by Kate on September 4, 1999, at 9:52:29
Hi Kate. As you've already experienced there are unfortunately no easy answers. I think screening is the way to go, though it takes time and frustration. I once made a letter describing briefly my current status, history of treatment, and my goal. I sent this letter to every psychiatrist in the yellow pages. I figured only a doc passionate with their work would read it and respond. It seems to me the best in any profession are those in love with their work. I wanted someone like that. Anyone not responding was either too busy or professionally insincere for me to care about dealing with. Of the 30% responders I followed up with phone calls. Accessibility to talk to the doc directly by phone, waiting period for an appointment, cost, general gut feeling...all further screened the list. I got down to 3 names. One was in his 60's (obvioulsy seen it all), knew and worked with many of the popular names here on the web, and was able to come in early or stay late to meet with me if his schedule was already too booked up. Also checked and returned voicemail even when on vacation. Willing to offer a sliding scale to fit my budget. It would have been nice if he was in my HMO plan, but with this kind of quality and reasonable cost I didn't mind. There are lots of creative ways to do it, but I like screening to narrow choices to the best for you.
Other than the yellow pages, I also called hospitals and clinics asking for names. I was looking for a pattern of a name being recommended from different sources. I was also looking for names not listed in the yellow pages. I guess I'm saying that by putting in a major effort in hunting and screening pdocs, you will hopefully make a great discovery and never have to worry about it again.
Even with the best, pharmacology in depression is an art, sometimes not much better than throwing darts I think. But at least a doc in love with their work can guide the journey with the inherent experience, study, and passion that comes with loving one's work. They will give the patient a lot of control and leeway over making drug suggestions and choices. I care more about this than whether they are in my HMO or not.
I found psychotherapy to not be helpful until I was on medication. Granted I learned a lot in sessions, gained a great deal of understanding, insight, wisdom, comfort, encouragement. But my brain in disrepair just couldn't make progress without medical intervention. Only then did counseling play a major role. I found counseling most beneficial in that 4 week period after starting medication. It helped in maintaining focus, encouragement, and believing in the light at the end of the tunnel. I think it's extremely important to have someone support us and remind us that things will get better, even if we have to pay them to say it. The good thing about this website is we get that support for free.
Sorry no easy answers. I hear you on the frustration and complications. I'm just sharing my experience in hopes it might spark an idea or two for you. Best wishes for you. JohnL.
Posted by Stephan on September 5, 1999, at 11:17:28
In reply to Re: Info on selecting psychiatrist, posted by JohnL on September 5, 1999, at 9:52:37
I am also (again) in the process of finding a truly expert psychiatrist experienced in treating treatment-resistant depression. I live in a major metro area (Minneapolis-St. Paul), but have so far not been able to find a psychiatrist even remotely as skilled as Ivan Goldberg, Dr. Bob and other posters to psychopharmacology tips. Where are they all hiding? Do they even exist? A national directory covering all major metro areas would be of immense value to users of this site. As I have found, educating oneself on all aspects of psychopharmacology is of limited value when one's doctor is either unwilling or unable to implement the broad array of treatments available.
What say you, Dr. Bob?
Posted by Dr. Bob on September 5, 1999, at 11:42:15
In reply to Psycho-Babble national directory of expert p-docs?, posted by Stephan on September 5, 1999, at 11:17:28
> A national directory covering all major metro areas would be of immense value to users of this site.
This isn't exactly what you're suggesting, and I see it still has only 58 entries, but I did try to start something sort of along these lines:
http://www.dr-bob.org/tips/tipsters/
Bob
Posted by saintjames on September 5, 1999, at 16:19:54
In reply to Psycho-Babble national directory of expert p-docs?, posted by Stephan on September 5, 1999, at 11:17:28
> I am also (again) in the process of finding a truly expert psychiatrist experienced in treating treatment-resistant depression. I live in a major metro area (Minneapolis-St. Paul), but have so far not been able to find a psychiatrist even remotely as skilled as Ivan Goldberg, Dr. Bob and other posters to psychopharmacology tips.
James here....
I would guess liability and other issues make it hard for Dr. Bob to post such a list. The question of what qualifies a doc in this area is a sticky one. Try these ideas:
1) ask you primary doc
2) Use the internet, You might do a new post asking if anybody knows of someone good in your area, on this board. Join some list-serves and ask this question.
3) Call the local mental hospitals and ask for the head nurse. Ask him/her who they would recommend for a member of their family with complex problems. Wording it this way often gets around the "I can't advise people about their problems if they are not a patient here" problemIf it were me, I would do #3 first , then run the names by your primary. Good luck, and let us know your progress.
james
Posted by claudea on September 5, 1999, at 21:45:26
In reply to Re: Psycho-Babble national directory of expert p-docs?, posted by saintjames on September 5, 1999, at 16:19:54
> 1) ask you primary doc
> 2) Use the internet, You might do a new post asking if anybody knows of someone good in your area, on this board. Join some list-serves and ask this question.
> 3) Call the local mental hospitals and ask for the head nurse. Ask him/her who they would recommend for a member of their family with complex problems. Wording it this way often gets around the "I can't advise people about their problems if they are not a patient here" problem
>
I would add a fourth (4), go to a NAMI or NDMDA meeting and ask the folks their who there docs are. Both have web pages. NDMDA had a list of POC's for every state/region. It is a thought.Claudea :P
Posted by Stephan on September 6, 1999, at 8:37:35
In reply to Re: Psycho-Babble national directory of expert p-docs?, posted by saintjames on September 5, 1999, at 16:19:54
> James here....
>
> I would guess liability and other issues make it hard for Dr. Bob to post such a list. The question of what qualifies a doc in this area is a sticky one.
I fail to see the liability problem-a disclaimer should take care of any. (It's paranoia like this that often leads to substandard care in the first place). And doctors wouldn't neccessarily have to "qualify" for the list (other than proving they are licensed to practice medicine in the state). They would simply be able to offer their name to the list-if they truly believed they were expert in the field of psychopharmacology. It would be up to us to see if they can make good on their claim. My guess is doctors who would want to be listed would be far more able and dedicated than your average run-of-the-mill doc.
Try these ideas:
>
> 1) ask you primary doc
> 2) Use the internet, You might do a new post asking if anybody knows of someone good in your area, on this board. Join some list-serves and ask this question.
> 3) Call the local mental hospitals and ask for the head nurse. Ask him/her who they would recommend for a member of their family with complex problems. Wording it this way often gets around the "I can't advise people about their problems if they are not a patient here" problem
>
> If it were me, I would do #3 first , then run the names by your primary. Good luck, and let us know your progress.
>
> jamesI truly appreciate your ideas. Unfortunately, I currently have no primary doctor, have tried the internet posting thing and am not entirely convinced cold-calling psychiatric nurses would be helpful (although I will consider it). I've also tried calling my local DMDA chapter (but thanks for the thought, claudea). When they finally got back to me (four weeks after I called!!), the woman I talked to was unfriendly, unhelpful and sounded more depressed than I did. Didn't exactly make me want to rush out and join their support group.
Somebody throw me a frickin bone, here!
Posted by mme_l on September 10, 1999, at 11:53:31
In reply to Re: Psycho-Babble national directory of expert p-docs?, posted by Stephan on September 6, 1999, at 8:37:35
I recently tried to find my son a p-doc after his social worker suggested that he may need meds. Dealing through the HMO, although I kept stressing that the address must state that it is in Chicago, the care facilitator kept insisting on giving me people in the burbs. She finally sent my son to a woman at the opposite corner of the city from us. This alleged p-doc then told my son that he needed to snap out of it, that there was no 'magic pill' tha would cure him, and that she thought he just needed exercise. I don't know, but in the worst of my depression, there was nothing that could get me out of bed, so much as exercise. She also told him that acupuncture would help him. After I questioned if the insurance company would pay for it, she told me that they would bill it as a normal psychiatric visit.
The irony? I live 10 min from Dr. Bob's shop!
The insurance companies can make you more depressed than you were originally...
L
Posted by Jody on September 13, 1999, at 21:41:37
In reply to finding a psychiatrist - personal experience.., posted by mme_l on September 10, 1999, at 11:53:31
> There is a web site names www.healthgrades.com that lists doctors by zip codes. They also say where they work and what kind of insurance they take. Hope that this helps.
This is the end of the thread.
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