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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by paxvox on August 2, 2001, at 19:48:42
When do you decide your Pdoc is not providing the best possible treatment for you? I would be interested in some stories "from the gallery" on your experiences. I feel my guy was ok for a bit, but his recent treatment options seem contradictory to his diagnosis of 300.3 OCD (when I sought him out for depression treatment after Prozac pooped out on me, as well as to try and find a sleep solution). He has me on Wellbutrin, which is a mood lifter, but he has never suggested Paxil or that new med that has yet to be FDA approved for depression , but is for OCD (related structurally to current SSRIs, but acts on different receptors). I'm wondering if this guy has just square-pegged me. Any thoughts?
Posted by jojo on August 2, 2001, at 23:07:26
In reply to When do you switch Pdocs?, posted by paxvox on August 2, 2001, at 19:48:42
> When do you decide your Pdoc is not providing the best possible treatment for you? I would be interested in some stories "from the gallery" on your experiences. I feel my guy was ok for a bit, but his recent treatment options seem contradictory to his diagnosis of 300.3 OCD (when I sought him out for depression treatment after Prozac pooped out on me, as well as to try and find a sleep solution). He has me on Wellbutrin, which is a mood lifter, but he has never suggested Paxil or that new med that has yet to be FDA approved for depression , but is for OCD (related structurally to current SSRIs, but acts on different receptors). I'm wondering if this guy has just square-pegged me. Any thoughts?
Speak to him. Make suggestions. If he reacts to it badly, find another physician who will work with her patient.
jojo
Posted by Gracie2 on August 3, 2001, at 1:30:46
In reply to Re: When do you switch Pdocs? » paxvox, posted by jojo on August 2, 2001, at 23:07:26
First of all, whether it's your psychiatrist or your neighbor or the guy that sprays your shoes at the bowling alley, you simply will not "click" with everyone you meet. If you don't like your psychiatrist as a person, I would forget about him or her right away. You have too many other issues to work through without being distracted because you're talking to a jerk.I don't like it when doctors will not answer your questions, particularly about medication.
You have a right to know what sort of pills you are taking, why you are taking them, what effect they are supposed to have, what side-effects you might expect, and how long they will take to work.
The "trust-me-I'm-a-doctor" attitude is outdated and patronizing. As far as I'm concerned, that dog will not hunt.If you are afraid of being square-pegged, prehaps
your doctor is not keeping up with current information or is afraid to try new things. I am familiar with this mindset, as I work in an orthopedic office. Two little boys came in with minor arm fractures; one of them saw a young doctor, and one of them saw a doctor nearing retirement. The boy treated by the young doctor emerged from the exam room with a lightweight fiberglass cast decorated in neon sports emblems.
The other boy emerged with a heavy, uncomfortable, white plaster cast. If the boy in fiberglass accidently wets his cast, he can blow it dry with a hairdryer. If the boy in plaster wets his cast, the skin underneath will deteriorate and he will probably require a new cast.*It is so important for your doctor to stay informed and be willing to try new things. If you have a suggestion for a different medication or treatment and your psychiatrist disagrees, he should take the time to explain the reasons why
your suggestion is not practicable.The worst psychiatrist I ever had did two things thatI found unforgivable. She pointedly watched the clock during our appointments and would practically stop me in mid-sentence when it was time for me to go. She also made several unannounced trips home to Pakistan without referring me to a doctor that I could contact in her absence. I thought this was highly unprofessional.
Anyway, there are many doctors to choose from and no reason to stay with one you find unhelpful.
Good luck in your search-
Gracie*Footnote - fiberglass casts are suitable only for minor fractures. Severe fractures and post-operation casts require the stability of plaster.
Posted by paxvox on August 3, 2001, at 6:53:21
In reply to Re: When do you switch Pdocs?, posted by Gracie2 on August 3, 2001, at 1:30:46
Thanks for the feedback. Although my doc is in his middle 50's, he does seem to be more "cutting edge" in his med use. For instance, I had never heard of Wellbutrin for depression (and how it interacts with dopamine and the GABA receptors)and he does explain his rationale. It's more like because I only see him every 4 months for med refills (he's not a Freudian therapist, and I have had limited success with that type of treatment...it works for a while, then the therapist is just telling me what I already have figured out). My main gripe is that I recently had a really blue week or two that I think was a situationally-related experience, and his "solution" was to put me on 200mg SR Wellbutrin x 2 (after he first told me to take 300mg SR x 2...and it casued bad chest pains) and to add Depakote, which is hardly an innocuous med, to help me sleep. I stopped both, and went back to my 150mg SR x 2 (and Tranzene, which he wants to take me off of) and I have been "back to normal" since then. I have been on this particular med combination for two +/- years with fairly static mood, and I have been OK, except for the aforementioned blue weeks. Why is he so quick to chuck out what has been working as opposed to perhaps just listening to what I had told him about my symptoms? I have been considering asking my GP if he will prescribe me the meds I have been taking, and boot the Pdoc (especially since he provides no therapy). I am currently seeing a Christian counselor to help me with some family problems, and he has been helpful. Is this a unique situation, or do others of you have similar experiences?
Posted by susan C on August 3, 2001, at 11:05:16
In reply to Re: When do you switch Pdocs? » Gracie2, posted by paxvox on August 3, 2001, at 6:53:21
puzzle puzzle puzzle. When I first started with pdoc, over 12 years ago, he was the only one in town who approached 'biochemical' basis of depression. I knew I 'loved myself' and the problem had to be biochemical and somehome attached to my cycle. Bipolar did not exist. No one knew prozac could activate underlying BP, No one knew progesterone, a kind derived from yams instead of pregnant mares urine, made a difference.
The final straw for me, and this is hard, because I wasn't feeling well, was I went to him with a list of areas of medicine I wanted to be sure to eliminate (rhumetology, neurology, immunology) and a second onpinon. He brushed me off, said he had eliminated all the other medical illnesses,didn't explain, and that I could go get a second opinon but the 'world expert' would just say the same thing and suggest the same thing he did, (saying this defensively by the way).
He continued to think my manic times where my good times. That I was chronically clinically depressed. The final straw was he recommended estrogen, again. I had gone through a trial, of over 6 smonths of different kinds and ways and it helped with hot flashes but not with mood.I got enough courage to say, you did that before, and he said, try it again. The appointment was over, I got up, left and made an appointment with a pdoc 2 hours away that had really helped a friend. And I got the second opinion from the 'world expert'. My new doc encourages me to get as many opinions as I want so we can triangulate the problem.
When I was looking in town, I got in touch with manic depression/depression group and the opinions I collected said I was lucky I wasn't dead. Things I overheard in the waiting room (nurses do gossip loudly) was he was having a lot of problems, divorce and clinic relationships.
My new doctor calls me right away, he takes everything I say seriously, though he does have a sense of humor. And, he does not give up.
It is hard to evaluate the care being received when you are depressed or manic. I am trying to train my spouse to be my advocate and be another set of eyes and ears while I try to figure this out. I have heard NAMI is also a good source for who to go see.
> Thanks for the feedback. Although my doc is in his middle 50's, he does seem to be more "cutting edge" in his med use. For instance, I had never heard of Wellbutrin for depression (and how it interacts with dopamine and the GABA receptors)and he does explain his rationale. It's more like because I only see him every 4 months for med refills (he's not a Freudian therapist, and I have had limited success with that type of treatment...it works for a while, then the therapist is just telling me what I already have figured out). My main gripe is that I recently had a really blue week or two that I think was a situationally-related experience, and his "solution" was to put me on 200mg SR Wellbutrin x 2 (after he first told me to take 300mg SR x 2...and it casued bad chest pains) and to add Depakote, which is hardly an innocuous med, to help me sleep. I stopped both, and went back to my 150mg SR x 2 (and Tranzene, which he wants to take me off of) and I have been "back to normal" since then. I have been on this particular med combination for two +/- years with fairly static mood, and I have been OK, except for the aforementioned blue weeks. Why is he so quick to chuck out what has been working as opposed to perhaps just listening to what I had told him about my symptoms? I have been considering asking my GP if he will prescribe me the meds I have been taking, and boot the Pdoc (especially since he provides no therapy). I am currently seeing a Christian counselor to help me with some family problems, and he has been helpful. Is this a unique situation, or do others of you have similar experiences?
Posted by paxvox on August 3, 2001, at 11:51:11
In reply to Re: When do you switch Pdocs?, posted by susan C on August 3, 2001, at 11:05:16
Thanks for the post, Susan, good stuff. We only have 3 Pdocs here in town, though I am within 2 hours of several larger urban areas. I feel too, that these docs go with what works "the most" as to what works "the best" for an individual. As I have been ranting this week, we are not all vanilla, and we react very differently to meds as indiviuals. I guess it's the cookie-cutter mentality that bothers me the most. Also, these Docs need to realize, we aren't stupid people. Statistically speaking, most chemically imbalanced people are of above average intelligence. Some of history's so-called genius cutting-edge intellectuals were clearly out of balance. I know as much about a med before I go into the Doc's office as he does. I can read a PDR, and understand the basic biochemisrty of the brain, its receptors, how enzyemes affect metabolizations and the like. Strangely, it's not the "rocket science" I once thought it to be, but more a skill of detective work and postulative exrtapolation.
This is the end of the thread.
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