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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 35 to 59 of 97. Go back in thread:
Posted by Squiggles on April 9, 2006, at 15:03:08
In reply to Re: Blind Faith In A P Doc » Squiggles, posted by linkadge on April 9, 2006, at 14:58:36
> What I mean is this. Suppose 10% of the American population is on SSRI's. Then in a company the size of Lilly, you would expect to see approximately the same proportion of people taking SSRI's. This is not the case.
>
> If forget the exact percentage, but it was very disproportionate to the to the population at large.
>
> LinkadgeIs it possible they screen people for mental
illness? I know my friend lost a high-paying
corporate job because of the physical test -
showing psychiatric drugs. They were at first
very impressed with an exceptional record and
very high IQ and almost showed him the office,
but after the test, he did not
get the job. Hmmm.Squiggles
Posted by Caedmon on April 9, 2006, at 15:43:28
In reply to Re: Blind Faith In A P Doc » linkadge, posted by Squiggles on April 9, 2006, at 15:03:08
I've always had good luck with pdocs, they generally go along with my ideas, unless they are too far in left field.
The only time I've really been 'put in my place' re: meds, and complied despite my own inclinations, was in taking Risperdal for an acute mixed mania episode. Which, thinking back, I'm glad I did. That was a time when he was right to tell me what's what, and I was smart to go along.
I've known of some pdocs who are very liberal with their Rx pad and will write just about whatever someone asks, so long as it's not a controlled substance. "Doc I'd like Cymbalta and Remeron and Geodon and Neurontin and a touch of Wellbutrin" winds up being okay. Go figure.
In general I think that the better self-educated you are wrt psych meds, the better you'll be able to help your pdoc make decisions. Unfortunatley as some have mentioned, getting only 5 minutes of consult every 2 months often means you had better just have a good game plan and execute quickly.
Wish everyone could have a pdoc who was inexpensive and gave them at least an hour every two weeks, if they wanted it. That would be great. It's sad, but very often my favorite days, the days I look forward to the most, are days when I get to see my shrink.
- C
Posted by Squiggles on April 9, 2006, at 15:53:06
In reply to Re: Blind Faith In A P Doc, posted by Caedmon on April 9, 2006, at 15:43:28
Yeah, you're right. Pdoc is an American
category of doctor i think; Well, things
could be much worse. I read at WHO of
a village that has one psychiatrist dealing
with 400 people, and they have gone through
traumatic experiences that are only the
worse nightmares in this country.I use the net a lot for extra help - i
probably use it *too* much.Squiggles
Posted by john berk on April 9, 2006, at 16:11:05
In reply to Re: Blind Faith In A P Doc » Caedmon, posted by Squiggles on April 9, 2006, at 15:53:06
I have a good friend whose mother is a respected psychologist who has had major depression for 20 years and refuses to take medication, [my friend says she has her reasons] i often wonder what she knows that i am not privy to, or maybe she is just stubborn, but it does worry me at times...john
Posted by Caedmon on April 9, 2006, at 16:17:33
In reply to Re: Blind Faith In A P Doc, posted by john berk on April 9, 2006, at 16:11:05
> I have a good friend whose mother is a respected psychologist who has had major depression for 20 years and refuses to take medication, [my friend says she has her reasons] i often wonder what she knows that i am not privy to, or maybe she is just stubborn, but it does worry me at times...john
Perhaps she is able to cope with psychological techniques? In which case, good on her.
Or it could be that classic antagonism sometimes existing between therapists and doctors for psych problems. I suppose that if you're a psychotherapist, you are so because you believe that you can help people with interpersonal and behavioral things.
- C
Posted by john berk on April 9, 2006, at 16:27:23
In reply to Re: Blind Faith In A P Doc » john berk, posted by Caedmon on April 9, 2006, at 16:17:33
that's a good point "c", i worried that her family may say her symptoms more obectively and wondered if she had some "insiders" info on meds, but i think there definetly is antagonism between therapists and psych docs on the healing process.that is maybe until therapists get prescribing privleges, [i here that is in the works] then we may see less antagonism, lol. but she may have good coping mechanisms, your right, therapy is much underrated these days..john
Posted by ed_uk on April 9, 2006, at 17:38:15
In reply to Re: Blind Faith In A P Doc » Phillipa, posted by linkadge on April 9, 2006, at 11:38:11
>Doctors often just say things becuase they think that (in the medical community) this is what is acceptable, and expected of them.
A wise statement Link. Doctors also like to prescribe whatever med is currently considered to be most 'acceptable', regardless of whether it is actually the most appropriate choice eg. starting a depressed patient on Celexa after all the other SSRIs have failed, rather that trying a different type of antidepressant eg. nortriptyline.
Ed
Posted by Phillipa on April 9, 2006, at 17:41:38
In reply to Re: Blind Faith In A P Doc » Phillipa, posted by gardenergirl on April 9, 2006, at 13:14:03
GG that's one of the problems he won't listen. Only his nurse talks to the patients. A month after his own pscy testing he didn't even know the results and that was two docs in his own office so where is the team? Obviously not there. Love Phillipa ps you're lucky you have a good pdoc with the communication you do.
Posted by ed_uk on April 9, 2006, at 17:45:02
In reply to Re: Blind Faith In A P Doc, posted by linkadge on April 9, 2006, at 14:27:03
>Even if a doctor didn't believe that medications were safe, they wouldn't really have the option to tell that to the patient would they? They are expected to hand out pills.
I work in a pharmacy Link. I am *expected* to 'reassure' patients that their symptoms are not side effects and that they should continue taking their medication as prescribed. This is what is expected of me. I am not expected to warm patients of side effects, since this may reduce 'compliance'. Under NO circumstances am I expected to challenge a doctor's prescribing or advice.
Eddy
Posted by Phillipa on April 9, 2006, at 17:56:00
In reply to Re: Blind Faith In A P Doc » linkadge, posted by ed_uk on April 9, 2006, at 17:45:02
Another scenario. When I met my husband his Mother had shorness of breath and weakness . She saw a pdoc and he said the reason was anxiety and depression. He prescribed paxil which she couldn't take due to the side effect. Two weeks later they had a consult at Duke University Hospital and it was not anxiety or depression it was Lou Gerhigs Disease. She went into respiratory depression declined a ventilator and died a week later. Misdiagnosed. She knew something was wrong with her but the pdoc wouldn't listen but there was no internet then. So she died. Love Phillipa
Posted by linkadge on April 9, 2006, at 18:07:34
In reply to Re: Blind Faith In A P Doc » linkadge, posted by Squiggles on April 9, 2006, at 15:03:08
Lilly..screen for SSRI's ?!!
Well then that too would say something! "Here at Lilly, we stand behind our product, as being safe and effective, our only policy is that if you work for us you cannot actually consume our product, and our reasoning behind that is confidential. Any questions ?"
Linkadge
Posted by Squiggles on April 9, 2006, at 18:11:45
In reply to Re: Blind Faith In A P Doc » Squiggles, posted by linkadge on April 9, 2006, at 18:07:34
> Lilly..screen for SSRI's ?!!
>
> Well then that too would say something! "Here at Lilly, we stand behind our product, as being safe and effective, our only policy is that if you work for us you cannot actually consume our product, and our reasoning behind that is confidential. Any questions ?"
>
> Linkadge
Heh :-) Funny - hope this is not against
the posting rules; frankly i don't know
about Lilly, but the incident with the
Big Corp is authentic - again they may have
just changed their mind in not hiring the
whiz kid.Squiggles
Posted by linkadge on April 9, 2006, at 18:21:40
In reply to Re: Blind Faith In A P Doc » linkadge, posted by ed_uk on April 9, 2006, at 17:45:02
>I am not expected to warm patients of side >effects, since this may reduce 'compliance'. >Under NO circumstances am I expected to >challenge a doctor's prescribing or advice.
The funny thing was that (on my own) I added some lithium to an MAOI one time, (now I know some people have got away with it), but it was BAD news, I felt like I was going to have a seizure.
I've also had serotonin syndrome on an SSRI + lithium, which a doctor said was not possible, but I didn't care at this point for his opinion, he told me it was just my nerves.
Its not that I don't think the doctors are smart, as they are, but I do think I know my own body better.
Linkadge
Posted by linkadge on April 9, 2006, at 18:23:58
In reply to Re: Blind Faith In A P Doc, posted by Phillipa on April 9, 2006, at 17:56:00
Thats a very good example. Doctors don't know everything. They will try to chalk everything up to your nerves.
Linkadge
Posted by LegWarmers on April 9, 2006, at 18:43:02
In reply to Re: Blind Faith In A P Doc » Phillipa, posted by linkadge on April 9, 2006, at 18:23:58
> Thats a very good example. Doctors don't know everything. They will try to chalk everything up to your nerves.
>Its true that they don't know everything, and in some cases when they have reason to believe that someone is suffering from anxiety or depression assume thats the casue... but... they did go through a lot of years of medical school so that they can help people. Some of those years in med school must have rubbed of on them ; ). And a lot of symptoms of depression and anxiety truely do mimic other health issues. But it IS thier job to look into all possibilties. I have had some terrible experiences with doctors, but I'd say the majority of doctors are good. Its that when we have experiences clsoe to us we tend to generalize out... and people are more likely to complain about something then they are to praise it so its normal to hear more about unhappy peoples experience then happy ones. If people are unhappy with their doctors, they shouldn't stay with them. And as patients, we have the right to get second, and third opinions and that really is what we should be doing, if someone doesn't trust thier doctor, they shouldn't stick around. Its our life and our health. this site is great for education about meds as long as we remember that each body reacts differnetly.
i do agree though, that blind faith in anyone is probably not the best way to think... and yes, a lot of people do that with doctors.
Posted by Racer on April 9, 2006, at 18:58:24
In reply to Re: Blind Faith In A P Doc, posted by Phillipa on April 9, 2006, at 17:56:00
> Another scenario. When I met my husband his Mother had shorness of breath and weakness . She saw a pdoc and he said the reason was anxiety and depression.
That's a terrible story, Phillipa, but I'd like to clarify something: was this a pdoc? Or did you mean she saw a doctor?
If this really was a pdoc, then I'm not surprised her condition was missed. A pdoc is going to look for the psychiatric issue underlying physical symptoms such as shortness of breath, right? Because that's what a pdoc will usually see.
If she saw a GP, it's still pretty egregious that he didn't run some tests, but you know what? ALS is not a common disease, and I'd bet a lot of doctors would miss it. It's unfortunate, but it's true.
Posted by ed_uk on April 9, 2006, at 19:13:15
In reply to Re: Blind Faith In A P Doc, posted by Racer on April 9, 2006, at 18:58:24
I get the impression that there are more bad psychiatrists than there are bad gastroenterologists, bad surgeons, bad radiologists, bad anesthesiologists, bad pediatricians.......
I have seen some nice pdocs. Nice: yes. Good: no.
Ed
Posted by cecilia on April 9, 2006, at 19:20:19
In reply to Re: Blind Faith In A P Doc, posted by Racer on April 9, 2006, at 18:58:24
Medicine changes rapidly, so it's not reasonable to expect a pdoc to be up to date on all physical problems (which begs the question, why are they expected to go to medical school in the 1st place), BUT a pdoc should make sure a patient has had a recent physical before dismissing their problems as depression and anxiety. Few do, though, and well Lou Gehrigs disease is rare, many pdocs don't even check for common problems like thyroid. And vise versa. of course, regular docs often dismiss anything a patient with depression or anxiety says. Cecilia
Posted by Phillipa on April 9, 2006, at 20:14:21
In reply to Re: Blind Faith In A P Doc, posted by Racer on April 9, 2006, at 18:58:24
Racer both. First an internist with a large practice and when he got tired of her not being able to breathe or go up and down stairs he sent her to a pdoc to get her out of his hair. And now me. First an internist after a trip to the Er for Shortness of breath. The Er doc referred me to a neurologist who did Mri's of brain, neck, and cervical spine. And then another trip to the Er waiting for my appointment with the neurolosist this time atypical chest pain. Percocet so I could sleep without pain and then the neurologist got the reports saw me and now a neurosurgeon tomorrow as the spinal canal is being compressed by discs and a herniated disc in another area. And he's afraid of paralysis if a car accident and he said yes that may be why you lost your taste and smell, can't feel the urge to void, or defecate. So You have to advocated for yourself and not believe one person cause they have been to medical school. Oh another instance is my husband's brother was having horrible headaches the internist said take aspirin. Miraculously his parents took him to a neurologist who did an MRI and low and behold he had a large brain tumor. Surgery could only remove a portion of it. That was way before I met him. And his brother was a teenager at the time and today is like a stroke victum. So if any of you wonder why I dont't have blind faith in a pdoc or other doctor I can give you a lot of other examples. One other a lady in the hospital had lice and there is a med you rub all over the body and 30minutes later wash it off. Well the doctor didn't write to wash it off and a week later the lady started having seizures never had them before. I started my shift and was asked to help move her and her belongings to another floor. I found the tube of the medicine. She wasn't my patient we always worked togehter . I said what is this. A bunch of shocked people said OMG. Well needless to say it had caused the seizures but the doc wrote the order wrong and no one picked up on it unfortunately. She did live. But no one was allowed to tell the family or talk about what happened it would have meant a law suit. Should I go on or is this enough? Love Phillipa
Posted by Squiggles on April 9, 2006, at 20:23:53
In reply to Re: Blind Faith In A P Doc » Racer, posted by Phillipa on April 9, 2006, at 20:14:21
and I was wrong.
He had told me long ago that these
were panic attacks (don't ask me how
they work with w/d, etc.) and I didn't
believe it. The ER dr. said they were
panic attacks and I didn't believe it.
My husband said it was anxiety and
I didn't believe it.And they all said take a XANAX.
Dang - had I taken the Xanax from the beginning
I would have had neither scepticism and
fear of horror scenarios, nor dyspnea that
mimicked cardiac problems.SYMPTOMS and SIGNS folks - need a dr.
for that.Squiggles
Posted by WeeWilly on April 9, 2006, at 20:30:22
In reply to Re: I get frightened when I read this sort of thing, posted by linkadge on April 9, 2006, at 11:31:36
> I don't think its a matter of being "smarter" than your doctor. When you're dealing with something like a mental health issue, its not always about right and wrong, it can be a matter of what works better and what works worse.
>
> Sure, it can set your mind at ease to think that all of the doctors decisions take place on a wavelength two steps above the average patient, but most of it is trial and error.
>
> My doctor told me it was ok to take lithium and parnate together. When the pharmacy called him back questioning the decision, he recanted !
>
> Thinking you're better than your doctor probably won't get you very far, but as far as do I "trust" my doctor, the answer would have to be: How could anybody fully trust their doctor? Many of these sorts of medical decisions always cary a degree of uncertainty and risk.
>
> You've got to think for yourself. I think it is foolishly to blindly trust every decision a doctor makes for you, under the guise of "oh they know what they're doing"
>
>
> LinkadgeLinkadge,
I can't understand why your doctor recanted on the use of Lithium with Parnate. Lithium is the first line of augmentation when Parnate is not sufficient on its own. Is there something in your individual case that makes it prohibitive?
Thanks. Best wishes
Posted by Squiggles on April 9, 2006, at 20:48:05
In reply to Parnate is often augmented with Lithium » linkadge, posted by WeeWilly on April 9, 2006, at 20:30:22
Have you tried checking a drug interaction
chart? Or perhaps going to Dr. Preskorn's
site of drug compatibilities or incompatibilities,
or Dr. Steven Stah's "Basic Psychopharmacology"?That might supplement your knowledge;
Squiggles
Posted by Caedmon on April 9, 2006, at 20:48:47
In reply to Parnate is often augmented with Lithium » linkadge, posted by WeeWilly on April 9, 2006, at 20:30:22
I'm curious to know too. Stephen Stahl's "Essential Pharmacology" lists Lithium as an augmenter for Parnate. I know because I'm looking at the page right now.
All I can think of is that they might synergistically lower the seizure threshold in people who are susceptible. <shrug> What is contraindicated about Li?
- C
Posted by SLS on April 9, 2006, at 21:01:50
In reply to Re: Parnate is often augmented with Lithium, posted by Caedmon on April 9, 2006, at 20:48:47
I always thought that Parnate + lithium was a particularly good combination.
What's the problem? Serotonin syndrome?
There have been reports of serotonin syndrome occuring with combinations of lithium and SRIs. It seems to be relatively rare, though.
- Scott
Posted by gardenergirl on April 9, 2006, at 21:25:45
In reply to Re: Please be civil » gardenergirl, posted by Squiggles on April 9, 2006, at 14:01:49
> I only said that because Dr. Bob
> kept kicking him out when he posted
> racist remarks here.Squiggles,
I've read some of the archives, so I'm aware of what you refer to. That said, civility guidelines here do not leave room for characterizing another's posts in a way that could lead others to feel accused. I asked you to be civil before, so now I am blocking you for a week. Dr. Bob has oversight over deputy decisions, and he may view this differently.Follow-ups regarding these issues, as well as replies to the above post, should be posted to Admin. and should of course themselves be civil.
Regards,
gg acting as deputy for Dr. Bob
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