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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Shirley on November 21, 2000, at 20:21:21
Since alot of us are in similar situations with difficult med cases, I was wondering what your idea of a good psychiatrist is and does he/she exist? If you are happy with yours and want to describe the positive traits, that's fine. If you're not and want to describe your ideal P-doc, that's ok also. Whatever you feel comfortable doing.
My reasons for asking these questions: Without
elaborating, I am getting the sense that I expect too much. Also, in my situation, having LD complicates the picture. Anyway, maybe I need a reality check and that's why I am asking for your feedback.Since I've had the day from hell today and am feeling gun shy (having a fear of being attacked even though I know you all are nice people), I hope you don't mind if I refrain from writing my own definition for a few days.
I know it's something I need to think about because if I do decide to switch, I have to know what I'm looking for.
Shirley
Posted by LouF on November 22, 2000, at 0:23:00
In reply to Your idea of a good psychiatrist+does he/she exist, posted by Shirley on November 21, 2000, at 20:21:21
> Since alot of us are in similar situations with difficult med cases, I was wondering what your idea of a good psychiatrist is and does he/she exist? If you are happy with yours and want to describe the positive traits, that's fine. If you're not and want to describe your ideal P-doc, that's ok also. Whatever you feel comfortable doing.
>
> My reasons for asking these questions: Without
> elaborating, I am getting the sense that I expect too much. Also, in my situation, having LD complicates the picture. Anyway, maybe I need a reality check and that's why I am asking for your feedback.
>
> Since I've had the day from hell today and am feeling gun shy (having a fear of being attacked even though I know you all are nice people), I hope you don't mind if I refrain from writing my own definition for a few days.
>
> I know it's something I need to think about because if I do decide to switch, I have to know what I'm looking for.
>
> ShirleyA good psychiatrist is a lot like my current pdoc...caring, considerate, helpful, confrontive in a supportive way.
Posted by JohnL on November 22, 2000, at 5:25:24
In reply to Your idea of a good psychiatrist+does he/she exist, posted by Shirley on November 21, 2000, at 20:21:21
Shirley,
In my experience finding an ideal pdoc is not easy. It's just as difficult as finding the right drug. The ideal pdoc should be compatible with your preferences.When I was on the hunt for one, I called all clinics, my GP, my counselor, hospitals, and universtities asking for references of who they would prefer if their own family member needed a pdoc. A few names came up more than once. Those went on my priority list, while the others went on a secondary list. I also wrote a one page letter describing briefly my diagnosis, treatment history, and desires in treatment.(This was sent to pdocs in the yellow pages, and was a pain because I had to call each to get the address and zip code). I included a self addressed envelope and my phone number for the pdocs to respond to me if they felt they could meet my needs. I specified in my letter I wanted a pdoc who was in love with their work and found satisfaction in treating difficult patients. I didn't think any would respond, and my GP said they wouldn't because no pdoc wants to take on a difficult case on purpose. So I was surprised when about 30% of them called me to set up an appointment. That was pretty cool.
I then attempted to call them. If I could manage to talk to the pdoc personally on the phone and ask some screening questions, that was a definite plus. Depending on my gut feeling after the short conversation, I either kept them on the list or scratched them off. If they were unreachable, I scratched them off the list. I absolutely did not want a pdoc who was not easily accessible. Obviously too overbooked to give me the attention I want.
After all was said and done, I ended up choosing a pdoc on the secondary list. He had a reputation for handling difficult cases, he was mentioned by others as having excellent bedside manners, and one pdoc during a screening conversation mentioned that this guy was who he sent his more difficult patients to. (Yeah, you might even get one pdoc recommending another. That's a plus. You could even ask this during a screening conversation.) He was also easily reachable and did return my phone call personally. That was a real good sign.
I had to decide ahead of time what I personally wanted in a pdoc. Not what someone else wanted. These were things I was looking for:
1. Easily reachable.
2. Not too overbooked.
3. Willing to let me take an active role in drug choices.
4. Open minded...that is, no favorite drugs, no favorite strategies, willing to mold treatment to fit me. (In my case that meant being able to sample perhaps 3 drugs in a 6 week time period instead of just 1.) And I definitely didn't want some jerk who treated everybody with SSRIs (don't need a pdoc to do that, any nurse practitioner would be just fine). If a pdoc wasn't open to trying things like Lamictal, Naltrexone, stimulants, or antipsychotics, well, forget it, they were scratched off the list.It might be worth the exercise to decide what YOU want in a pdoc, and then get creative and go hunting. It's a lot of work, and no fun, but it could be time very well invested. It was very very hard for me because I was quite depressed at the time and everything was a real effort. I had to push push push to even just pull out the phone book. But I needed a good doctor, and I didn't want to just surrender to one blindly. I didn't see that I had a choice. I could either do it right and do it thorough, or not do it at all. In the end I got lucky, I found the ideal pdoc, but I think all my efforts had greatly increased the odds of getting lucky. I didn't leave it to chance. I tried to stack the cards in my favor. It wasn't easy. But it was definitely worth it.
You could always try changing direction with your current pdoc. It's never too late to be open and honest and say hey, we've been on this particular path that I'm not happy with, I want to change course and take this other path instead, will you work with me on this? You might find your pdoc to flexible. If not, well...
Your ideal pdoc does exist. Finding him/her is kind of like doing a little detective work. Don't be afraid to bang on doors, ring phones, and ask questions. After all--always remember--who's paying who? You are the paying customer and you are ultimately the boss, so you should receive the service you desire.
These are all, of course, just my opinions. They may or may not be appropriate for someone else.
John
Posted by Noa on November 22, 2000, at 14:10:32
In reply to Re: Your idea of a good psychiatrist+does he/she exist, posted by JohnL on November 22, 2000, at 5:25:24
It is not easy finding one, and often you are limited by factors such as geography, insurance plan, finances, etc.
I would look for some of these qualities:
available, approachable, forthcoming about his/her approach, reachable by phone (reasonably so), a good listener, loves this field, is dedicated to finding the right combo of meds for his or her patients, keeps up with the literature and exchange of ideas among pdocs that is not published---ie, more up to date than the books, flexible, respectful of the patient's observations, wishes, ideas, but up front with his or her professional perspective, works in collaboration with the patient, is available for close monitoring as appropriate, will go to bat for the patient to advocate for coverage of appropriate meds if denied by insurance.
Posted by coral on November 23, 2000, at 6:54:03
In reply to Your idea of a good psychiatrist+does he/she exist, posted by Shirley on November 21, 2000, at 20:21:21
You've been given some really good advice and it's tricky, because you need to rely on them.
The same thing I insist on from any health care/medical professional (or anyone in my employ, for that matter). The short list; competence and chemistry (no pun intended). I define competence as being knowledgeable within the given field of expertise which includes knowing what he/she doesn't know, operating with respect, compassion, integrity and honesty. I'm not someone's lab rat and I don't want a push-over "yes-person" either.
My situation is different because I don't use a p-doc. I know what meds work on me (which came from an endocrinologist), and my gynecologist writes the scripts. My therapist (psychologist) doesn't prescribe, won't give medical advice, but listens to me as I assess my prescription needs and offers his guidance. For me, the meds allow me to utilize his therapy when I'm in the black hole.
Good luck!
Coral
Posted by stjames on November 23, 2000, at 23:47:47
In reply to Your idea of a good psychiatrist+does he/she exist, posted by Shirley on November 21, 2000, at 20:21:21
Expect Pdocs to be medical doc's and not counslers because that
is what they are trained in.james
Posted by R.Anne on November 24, 2000, at 3:06:29
In reply to Your idea of a good psychiatrist+does he/she exist, posted by Shirley on November 21, 2000, at 20:21:21
1. That he/she listens to what I say and believes me, too. In other words, takes me seriously.
2. Will change the med. if and when there is a problem. But I've had to be persistant with this, too.
3. Will be helpful with medical forms and paper work stuff, too.
4. Responsive to phone calls and refill requests by phone.
Then I need to be:
1. Willing to listen to his/her ideas and opinions.
2. Understand he/she, like me, will make mistakes, too, at times.
I learned all this from experience. :-)
Posted by cole on November 26, 2000, at 18:40:48
In reply to Your idea of a good psychiatrist+does he/she exist, posted by Shirley on November 21, 2000, at 20:21:21
I have had bad and good experiences with pdocs, but I have to say my current doc is the best I've ever had. She has her PhD in Neuroscience along with an MD from Johns Hopkins. She is extremely bright, but amazingly down to earth and empathetic at the same time. She is the first doc who agreed that I had a right to find a med that I actually felt good about, and worked hard with me to find that med. She is always interested to hear what I have learned off the net, and is willing to give almost anything a try. She respects me, and encourages me in my studies (I am currently studying premed) while maintaining just the right level of boundaries. If I am in crisis she calls me daily until I stabilize. I think it takes time to find the right doc, but now that I have, I will still see her even though it takes me 3 hrs by car since I moved away. If it doesn't feel totally right, I would have to say it probably isn't.
cole
Posted by Cece on February 16, 2001, at 1:57:15
In reply to Re: Your idea of a good psychiatrist+does he/she exist, posted by JohnL on November 22, 2000, at 5:25:24
> Shirley,
> In my experience finding an ideal pdoc is not easy. It's just as difficult as finding the right drug. The ideal pdoc should be compatible with your preferences.
>
> When I was on the hunt for one, I called all clinics, my GP, my counselor, hospitals, and universtities asking for references of who they would prefer if their own family member needed a pdoc. A few names came up more than once. Those went on my priority list, while the others went on a secondary list. I also wrote a one page letter describing briefly my diagnosis, treatment history, and desires in treatment.(This was sent to pdocs in the yellow pages, and was a pain because I had to call each to get the address and zip code). I included a self addressed envelope and my phone number for the pdocs to respond to me if they felt they could meet my needs. I specified in my letter I wanted a pdoc who was in love with their work and found satisfaction in treating difficult patients. I didn't think any would respond, and my GP said they wouldn't because no pdoc wants to take on a difficult case on purpose. So I was surprised when about 30% of them called me to set up an appointment. That was pretty cool.
>
> I then attempted to call them. If I could manage to talk to the pdoc personally on the phone and ask some screening questions, that was a definite plus. Depending on my gut feeling after the short conversation, I either kept them on the list or scratched them off. If they were unreachable, I scratched them off the list. I absolutely did not want a pdoc who was not easily accessible. Obviously too overbooked to give me the attention I want.
>
> After all was said and done, I ended up choosing a pdoc on the secondary list. He had a reputation for handling difficult cases, he was mentioned by others as having excellent bedside manners, and one pdoc during a screening conversation mentioned that this guy was who he sent his more difficult patients to. (Yeah, you might even get one pdoc recommending another. That's a plus. You could even ask this during a screening conversation.) He was also easily reachable and did return my phone call personally. That was a real good sign.
>
> I had to decide ahead of time what I personally wanted in a pdoc. Not what someone else wanted. These were things I was looking for:
> 1. Easily reachable.
> 2. Not too overbooked.
> 3. Willing to let me take an active role in drug choices.
> 4. Open minded...that is, no favorite drugs, no favorite strategies, willing to mold treatment to fit me. (In my case that meant being able to sample perhaps 3 drugs in a 6 week time period instead of just 1.) And I definitely didn't want some jerk who treated everybody with SSRIs (don't need a pdoc to do that, any nurse practitioner would be just fine). If a pdoc wasn't open to trying things like Lamictal, Naltrexone, stimulants, or antipsychotics, well, forget it, they were scratched off the list.
>
> It might be worth the exercise to decide what YOU want in a pdoc, and then get creative and go hunting. It's a lot of work, and no fun, but it could be time very well invested. It was very very hard for me because I was quite depressed at the time and everything was a real effort. I had to push push push to even just pull out the phone book. But I needed a good doctor, and I didn't want to just surrender to one blindly. I didn't see that I had a choice. I could either do it right and do it thorough, or not do it at all. In the end I got lucky, I found the ideal pdoc, but I think all my efforts had greatly increased the odds of getting lucky. I didn't leave it to chance. I tried to stack the cards in my favor. It wasn't easy. But it was definitely worth it.
>
> You could always try changing direction with your current pdoc. It's never too late to be open and honest and say hey, we've been on this particular path that I'm not happy with, I want to change course and take this other path instead, will you work with me on this? You might find your pdoc to flexible. If not, well...
>
> Your ideal pdoc does exist. Finding him/her is kind of like doing a little detective work. Don't be afraid to bang on doors, ring phones, and ask questions. After all--always remember--who's paying who? You are the paying customer and you are ultimately the boss, so you should receive the service you desire.
>
> These are all, of course, just my opinions. They may or may not be appropriate for someone else.
> John
I just want to say thanx for your post. I need to find a new doc and feel boosted by your good advice and shared experience.
I have worked with one pdoc for 7 years- a long time! When I first started with him, he was fresh out of residency. teaching at and closely associated with his med school, and very interested in my case. But returning calls promptly was never his strong suit, and a problem for me, which I attempted again and again to resolve. Now he has written a book, has a full patient load, and is basking in the limelight of his success. He often does not respond to my calls, even when I am in considerable distress. I've asked him along the way if he thought I called excessively, or expected to much, and he always said no, that he was just not good at responding, especially to complex questions.
Well, I've had it! He's smart, personable, up to date, very present during sessions, and willing to try unconventional treatments- and he knows all my history- a lot to give up. But all my learned helplessness is reinforced by his unresponsiveness and I realize that it is time to move on, like it or not.
Your story gives me support to do the footwork and to believe in the validity of my needs.
Cece
Posted by dalukens on February 17, 2001, at 2:33:54
In reply to Re: Your idea of a good psychiatrist+does he/she exist, posted by Cece on February 16, 2001, at 1:57:15
---O.K., I've got to add my own 2¢ worth to this discussion. I've been "doctor shopping" many times in my history (I'm 40 now, and have been one or another form of bi-polar all my life), and I've had some real losers in my time, but I'd rather not get into that now (it'd just depress me, and God knows I don't need that). At present, I have _finally_ found a pdoc I can honestly say is good (maybe not great, but a lot better than average). Some salient facts:
---He _listens_ to me. He doesn't have a one-size-fits-all treatment that he uses on everyone, he tries to tailor treatment to the patient's needs (what a concept!). I react strangely to many medications; previous pdocs I've had simply wouldn't believe what I reported as my reactions to a new med. If something is making me feel worse, he doesn't try to talk me into taking it longer. (When I reported adverse reactions to a drug a previous doctor had put me on, so severe that I felt I had to refuse to take it any more for fear of my life/sanity, he simply terminated the relationship, and refused to see me again. Just as well.) In contrast, my present pdoc has me taking 12.5mg. of Lamictal a day; a microscopic dose, but he believes me when I say that I'm hypersensitive to it. He suggested today that I might try going up to 25mg. in a week or two, but it's up to me.
---He's reasonably easy to reach. Although he's spread out over 2 hospitals and 3 clinics, he's given me the number for his answering service, and they're polite about having him paged. And he's apparently always wearing his pager. When we first started therapy (I was a mess), I made emergency calls at least weekly; I don't recall ever having to wait even overnight for him to call back.
---He understands about financial limitations. Not only was he very helpful when I applied for Medicaid, but while we were waiting for me to be approved, he would frequently give me samples of drugs he'd gotten from the manufacturer's representative, rather than writing a prescription I'd have to fill and pay for. He maintained me on Zoloft (which is rather pricy at the pharmacy) for months that way, giving me entire cases of sample bottles (7 pills in a bottle). I don't know how he talked the Pfizer rep into parting with that much.
---He doesn't take personally things I might say in a moment of mania-induced rage. I know, no health professional should do this, but some of them do. I once swore at him and said that I was going to sue him for malpractice; when I later apologized, he laughed it off: he knew it was just the mania talking. I've lost more friends (and one job) that way...
---He's willing to discuss treatment, and listen to my suggestions. My father was a pharmacist, and owned his own store; I often say that I "grew up in a drugstore." My brother is a caseworker in a mental health clinic. I know quite a bit about drugs, from reading about them, from discussing them with my father and brother, and from seeing customers who were taking various of them. My current pdoc will usually present more than one alternative as to what to try next, and let me choose.
---He knows his stuff, and he believes in continuing education. In spite of what I've learned about drugs, I've never caught him in a mistake, and I've never suggested something that he'd never heard of. On the other hand, as it's been awhile since I've been in a drugstore as anything but a customer, my knowledge is slightly out-of-date; he has routinely suggested things that I'd never heard of before. He's not stuck in a rut, making diagnoses and suggesting treatments that were in vogue twenty years ago.
---And last, but most important, HE KNOWS WHAT CONFIDENTIAL MEANS! When I was in junior high, I made the mistake of telling my then therapist that I was depressed to the point of being suicidal. The next day at school, all the teachers were looking at me funny. I was an assistant in the science lab (yeah, I was a geek; still am, really); the teacher took me aside and gave me a lecture about how someone could hurt themselves if they were to deliberately pour acid on their hands, and said "now you wouldn't do that... would you?" My guidance counsellor actually took my hands, turned them over, and inspected my wrists for slash marks (and then made a joke about it, about as funny as a dead baby in a punch bowl). Sure enough, when I confronted my therapist, he admitted it: he'd broken confidentiality. For the rest of our abbreviated relationship, I didn't tell him anything that I wouldn't feel comfortable shouting out loud in a crowded room. Naturally, this meant we made no further progress.
---I don't mean to imply that he's perfect. He's a bit shy about prescribing opiates (but then again, I'm not quite shy enough about taking them, so perhaps we balance out). He can be a bit abrupt during our sessions, particularly if he's running behind. (I've found it helps to make a list of what I want to discuss during our sessions; I don't forget anything that way, and as long as I'm still visibly checking items off my list, he doesn't try to end the session.) These are minor quibbles, however. I finally feel I've found a pdoc with whom I can make some real progress. First, we're going to have to try to undo what all the other doctors have done to me.
DaL
P.S.: D***, this is long! I hadn't realized I felt this strongly about this 'til I sat down and wrote it out. Maybe I should print out a copy and show it to my doc. Maybe I'm just hypomanic tonight. Whatever... :)
This is the end of the thread.
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