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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by cybercafe on April 2, 2003, at 0:49:05
my doc tells me i should just put up with my depression
he wants me to wait before taking an antidepressant, but i'm thinking he has no clue how bad i feel, i should stop wasting my time and get my family doc to give me an AD
would this be a really outrageous thing to do? like would my doc say "i don't want to deal with you ever again.... don't come back"
thanks
Posted by Dinah on April 2, 2003, at 6:55:34
In reply to what do docs do if you disobey them?, posted by cybercafe on April 2, 2003, at 0:49:05
A good number of pdocs will terminate you if you go behind their backs and get your own meds. However, from what you say about your pdoc, that might not be such a bad thing. An even better thing would be for you to get a second opinion from a respected pharmacologist in your area, perhaps one affiliated with a university program. And if your pdoc meets those criteria, I still say find another one and get a second opinion. Do you have any particular reason for sticking with this one?
Posted by japonica on April 2, 2003, at 10:16:01
In reply to what do docs do if you disobey them?, posted by cybercafe on April 2, 2003, at 0:49:05
I doubt your doctor would expect you to just put up with your high blood pressure or your diabetes, both serious medical conditions just as depression is.
Is sounds to me like your doctor is at best uninformed or at worst dangerous. I'd dump this one like a hot rock. But first I'd give him a copy of "The Beast" by Tracy Thompson. It's the true true account of this Washington Post reporter's lifelong battle with depression.Good luck!
japonica
Posted by Dave1 on April 2, 2003, at 10:55:40
In reply to what do docs do if you disobey them?, posted by cybercafe on April 2, 2003, at 0:49:05
Hi,
Several times I've found stuff on the internet that I want try and my pdoc initially resists. After I bother him over a few sessions, he gives in and gives me what I want, just so I'll stop bothering him. I wanted to try clomipramine + lithium, but my pdoc said no because the TCAs are out of date and dangerous to your heart. I persisted and he gave it to me and it helped (for awhile).
Luck,
Dave
Posted by Bill L on April 2, 2003, at 15:17:27
In reply to what do docs do if you disobey them?, posted by cybercafe on April 2, 2003, at 0:49:05
It sounds like the doc you are referring to is a pdoc. Is that true? If the pdoc will not give you an AD, I think you should ask your family doc. Family docs (such as internists, pediatricians, and OBGYN's) prescribe about 70% of antidepressants.
Posted by stjames on April 2, 2003, at 15:23:01
In reply to Re: what do docs do if you disobey them?, posted by Bill L on April 2, 2003, at 15:17:27
Family docs (such as internists, pediatricians, and OBGYN's) prescribe about 70% of antidepressants.
What is your source for this ?
Posted by cybercafe on April 2, 2003, at 20:22:13
In reply to Re: what do docs do if you disobey them?, posted by stjames on April 2, 2003, at 15:23:01
i guess i won't risk things just yet
damn i wish i had the motivation to leave my house
Posted by fachad on April 3, 2003, at 0:14:40
In reply to what do docs do if you disobey them?, posted by cybercafe on April 2, 2003, at 0:49:05
When you are seeing a pdoc, you are basically outsourcing to a mental health consultant. You are paying for professional services.
Think about how you would react if you hired a carpet cleaner and when he got to your house he told you that your rug did not look very dirty to him; he did not feel that it merited his lugging in the shampooer, and then he suggested you just lower your expectations for cleanliness?
After you caught your breath from laughing you would fire his butt and take out the yellow pages to find someone else who is willing to perform the services you are seeking.
And there is your answer.
> my doc tells me i should just put up with my depression
>
> he wants me to wait before taking an antidepressant, but i'm thinking he has no clue how bad i feel, i should stop wasting my time and get my family doc to give me an AD
>
> would this be a really outrageous thing to do? like would my doc say "i don't want to deal with you ever again.... don't come back"
>
> thanks
Posted by Viridis on April 3, 2003, at 0:43:09
In reply to Procuring Professional Services » cybercafe, posted by fachad on April 3, 2003, at 0:14:40
That's a very good point: you're paying for a service, and if the service isn't adequate, you should have some recourse (and be able to seek a better service provider).
In any profession, the majority of "professionals" aren't great, and some are actually incompetent. This has certainly been my experience with mechanics, repair-people, general practitioners, and pdocs; I think it's just a consequence of human nature. When you're dealing with your mental health, it's crucial that you find someone you can trust and work with. And, the fact is, they're working for you, so if they don't do their job, you should move on.
I'm not suggesting that people be rude or overly demanding of their doctors, but it's a mistake to be intimidated by them either. They're there to serve you, and if they don't do so adequately, then move on. This is especially hard when you're depressed, anxious, etc., but if your condition isn't being treated appropriately, there are options. So many people here seem to feel trapped and subject to their doctors' whims, and this is just wrong.
Doctors (including psychiatrists) are paid for their services, and if they aren't doing their jobs, there are usually others who would be delighted to have you as a client, and would serve you much better.
Posted by cybercafe on April 3, 2003, at 0:50:54
In reply to Procuring Professional Services » cybercafe, posted by fachad on April 3, 2003, at 0:14:40
actually i'm in canada, so i don't pay
and there's a big wait to see new docs -- this guy is really good though.. just busy i guess
> When you are seeing a pdoc, you are basically outsourcing to a mental health consultant. You are paying for professional services.
>
> Think about how you would react if you hired a carpet cleaner and when he got to your house he told you that your rug did not look very dirty to him; he did not feel that it merited his lugging in the shampooer, and then he suggested you just lower your expectations for cleanliness?
>
> After you caught your breath from laughing you would fire his butt and take out the yellow pages to find someone else who is willing to perform the services you are seeking.
>
> And there is your answer.
>
>
> > my doc tells me i should just put up with my depression
> >
> > he wants me to wait before taking an antidepressant, but i'm thinking he has no clue how bad i feel, i should stop wasting my time and get my family doc to give me an AD
> >
> > would this be a really outrageous thing to do? like would my doc say "i don't want to deal with you ever again.... don't come back"
> >
> > thanks
>
>
Posted by Viridis on April 3, 2003, at 1:49:22
In reply to Re: Procuring Professional Services, posted by cybercafe on April 3, 2003, at 0:50:54
I'm Canadian too, but have lived in the US for a long time. Regardless, you have to insist on proper treatment, period. You can get it in Canada, with persistence. Don't settle for anything less, and don't see inferior pdocs. Canada has great medical care (free) but a high proportion of incompetent doctors, and you have to sort through them to find the best.
Posted by Bill L on April 3, 2003, at 11:09:38
In reply to Re: what do docs do if you disobey them?, posted by stjames on April 2, 2003, at 15:23:01
> Family docs (such as internists, pediatricians, and OBGYN's) prescribe about 70% of antidepressants.
>
>
> What is your source for this ?
>That's what a pdoc told me last year.
Posted by Bill L on April 3, 2003, at 11:17:57
In reply to Re: what do docs do if you disobey them?, posted by stjames on April 2, 2003, at 15:23:01
I did a quick search, but it did not give a specific percentage.
http://www.mcmanweb.com/article-121.htm
This is not a minor problem. In 1998, more than 130 million prescriptions for antidepressants were written in the US, the vast majority by primary care physicians, very few who refer their patients to more specialized treatment or counseling.
Posted by HelenInCalif on April 3, 2003, at 12:45:21
In reply to what do docs do if you disobey them?, posted by cybercafe on April 2, 2003, at 0:49:05
Years ago when I first suspected I had ADD I was already depressed due to poor performance at work (it was my 1st full time job out of college: I'd always been able to somewhat compensate but not for 8 hours a day).
The 1st pdoc the HMO gave me told me that 'you can't take antidepressants and ADD meds at the same time': Wrong! He wanted me to wait 2 months before starting on the ADD- I would have been out of a job by then. He also was condescending and discounted my research (at the med library, not just any old articles).
This was not acceptable. I found a sympathetic nurse in the HMO's occupational health division who pointed me to a pdoc with real experience with ADD. He immediately started me on Ritalin- such a wonderful change. I could work efficiently, and the depression went away quickly because I solved the root cause.
All to say that doctors can be wrong or inexperienced, and you have no reason to accept his or her statements without solid evidence on their part. I'd find another opinion and doctor.
Posted by Viridis on April 3, 2003, at 21:25:35
In reply to Re: Procuring Professional Services » cybercafe, posted by Viridis on April 3, 2003, at 1:49:22
No one's taken me to task on this (yet), but in a post above I suggested that Canada has a high proportion of incompetent doctors. What I intended to say was that like everywhere else, Canada has a high proportion of incompetent doctors (i.e., I didn't mean to imply that medical care in Canada is inferior, just that wherever you are, it can take a lot of trial and error to find a doctor who's a good fit for you).
Just thought I'd clarify that before I offend any fellow Canadians. Canada's health care system is (in my opinion) much saner and fairer than that in the U.S., in many respects.
Posted by wendy b. on April 3, 2003, at 22:21:04
In reply to Re: Procuring Professional Services, posted by cybercafe on April 3, 2003, at 0:50:54
hey mr cybercafe,
> actually i'm in canada, so i don't pay
i have read your posts with interest for quite a while, and am pondering this particular comment... of course you pay! doesn't a huge proportion of your income go to income taxes in order to support more humane and fair social programs, like your health-care system? even if you are out on disability (not sure), whatever you or your parents already paid into the system was a lot! your money goes to paying this guy's salary - he shouldn't be seen as doing you some kind of favor! if he can't listen to your needs, he isn't as good as his reputation (or his busy calendar) indicates...
just my (unasked-for) two cents,
wendy
Posted by jane d on April 3, 2003, at 22:54:14
In reply to Re: Procuring Professional Services, posted by cybercafe on April 3, 2003, at 0:50:54
cybercafe,
What I wanted when I first saw a psychiatrist was an opinion about whether I should take meds - not just a prescription. Unfortunately many doctors feel either that everyone should take meds or that nobody should. Does your doctor have a bias against antidepressants? Does he think that everything can be solved with counseling? If he does you may want to find someone else unless you agree with him. If he prescribes antidepressants for other people, however, you may want to ask how your case is different. And how long he wants you to wait. And then see whether the answers convince you.
Also, is it possible that your doctor really doesn't know how bad you feel? I still often understate how I feel. I can't seem to help it. And I get out clean clothes and comb my hair for appointments so that I don't look like I'm falling totally apart, even if it's the only time I do that all month long.
Jane
Posted by stjames on April 4, 2003, at 17:35:58
In reply to Re: what do docs do if you disobey them?, posted by stjames on April 2, 2003, at 15:23:01
> Family docs (such as internists, pediatricians, and OBGYN's) prescribe about 70% of antidepressants.
And they do a poor job:
Do you rely on a family physician to diagnose and treat your depression? Perhaps you should reconsider. In January 2001, three studies came to light that strongly suggest primary care physicians are better off poking and prodding our bodies than getting inside our heads.The first, an Indiana Community Cancer Care-Aetna US Healthcare-Pfizer study of the records of 100 patients who were prescribed antidepressants in primary care, found that 90 charts contained documentation of just three or fewer symptoms of major depression, sixty revealed one or more criteria, and 40 contained no documentation of any criteria. The required five or more symptoms were to be found in only seven charts. Use of screening tools was documented in only four charts. Only 57 of the charts revealed a depression-focused follow-up visit, while just five charts indicated an educational intervention.
In other words, these doctors were indiscriminately handing out meds.
Not surprisingly, only 37 percent of the patients improved. Sixteen percent were referred to specialists. There were two suicide attempts. The article cited other studies suggesting that primary care physicians misdiagnose depression in as many as two out of three cases, and when the correct diagnoses is made, patients are often treated with subtherapeutic doses prescribed over periods of time too short to produce a benefit. The article also noted that 50 percent of patients quit their antidepressants after less than 30 days, but if a follow-up visit was scheduled, 86 percent of patients complied.
According to the authors of the study: "These survey results may add credibility to concerns ... that antidepressants are being used too frequently and without proper consideration and justification."
This is not a minor problem. In 1998, more than 130 million prescriptions for antidepressants were written in the US, the vast majority by primary care physicians, very few who refer their patients to more specialized treatment or counseling.
In the second study, UCLA-Rand researchers found that only 19 percent of a sample of depressed or anxious people they surveyed received appropriate treatment from their primary care physician.
By contrast, 90 percent of those who saw a psychiatrist got proper care.
The study surveyed 1,635 people, more than 80 percent who had seen a health care provider in the past year. On average, only 30 percent received proper treatment.
Those least likely to have benefited were African Americans, men, people with less than a high school education, and those younger than 30 or older than 59.
Posted by jemma on April 6, 2003, at 16:07:10
In reply to thanks guys, posted by cybercafe on April 2, 2003, at 20:22:13
> damn i wish i had the motivation to leave my houseI know this sounds flip, but have you considered getting a dog? They get you out there, even when you're in the depths!
- jemma
This is the end of the thread.
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