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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by thinkingitover on July 29, 2008, at 13:32:36
Hello,
I am considering firing my PDOC and would like as many responses to get a variety of opinions.
My PDOC is nice, but I guess the best way describe him is unavailable and overextended. He is an HMO doc, so he does the best with the resources that he has... but as a result of his lack of time and availability, things are a mess, physically, side effect wise , etc...
For example, he only wants me to come in every 6 months, I am welcome to come in sooner, but really, there is nothing else to do. Appointments are rushed (about 10 minutes) and I am starting to become an annoyance to the office (in my opinion) as I have resorted to FAXING lists of my side effects to him to keep my records updated. I feel like I am "my own doctor", (and I am not qualified obviously). Another thing is side effects, I came into his office 5 years ago with OCD/anxiety, and depression. I weighed in at 150lbs, now after the treatments we've tried, I am a stocky 195 lbs. My blood sugar is high too. On the "bright" side, he told me I wear my weight "well." My brother (who is also seen by him) got fed up by all of this and went off the meds, except for Valium. He lost all the weight. This isn't an option for me. I have panic attacks that really flare up under stress.
I ahve to believe that there is a happy balance in workign with a PDOC and appropriate care to balance out everything. I feel really alone in all of this.
I take Zoloft, topamax (for the nightmares from the da*n Zoloft), and Valium. Where should I look for a good doctor? should I get a physical? Shouldn;t PDOCS work in teams with other docs? What should I look for in a good pdoc so I can keep an even keel, and also have good physical health?
Posted by dbc on July 29, 2008, at 14:46:11
In reply to thinking of firing my PDOC- scared, posted by thinkingitover on July 29, 2008, at 13:32:36
Get a psychiatric nurse practitioner. They can and will deal with seeing you on a weekly basis and tend to return your calls the day you leave them a message. I love mine compared to the PDOCs i've had experience with.
Posted by Phillipa on July 29, 2008, at 17:05:33
In reply to Re: thinking of firing my PDOC- scared, posted by dbc on July 29, 2008, at 14:46:11
Yes I'd get a physical and I use valium for panic attacks as ad's don't work for that with me. No weight gain on valium. I wish we had NP's that delt in psych none here just the hospitals and maternity. Phillipa
Posted by Justherself54 on July 29, 2008, at 19:00:59
In reply to thinking of firing my PDOC- scared, posted by thinkingitover on July 29, 2008, at 13:32:36
Every six months is not enough IMO. I see mine once a month and he always returns my phone calls the same day I leave a message. I too have gained a lot of weight from AD's and I now have high BP..but as I'm treatment resistant, I know his main focus is continuing drug trials hoping to find something with longevity..
If you are feeling rushed through appointments and aren't given the care you need...I would look for someone else. I wish I had words of wisdom about the weight gain...it sucks...and it's awful on the self-esteem too..
Posted by thinkingitover on July 29, 2008, at 19:15:52
In reply to Re: thinking of firing my PDOC- scared, posted by Justherself54 on July 29, 2008, at 19:00:59
Thanks for the responses so far...
indeed this is frustrating.
They can't be miracle workers, and I accept it, but how much should one tolerate before they say "enough!" and try someone else. I am not treatment resistant, I am jsut a guy with panic attacks and OCD... if left untreated I get depressed because I don't do well in a rather fast paced world... I need that boost to keep myself afloat. When I am treated correctly, I thrive, work productively, and love life.
But at what cost? High blood pressure, prediabetic or type II diabetes blood sugar, and at one point 70 extra pounds? So, I should be "fat and happy?" That's not a quality of life either... It's almost as if I'm afraid I'll be perceived as selfish for saying "I want to be happy, but I also want to be able to have some semblence of control over the side effects and my body."
I'm a single guy... I want to feel attractive, have control over my body, be healthy, and not feel hopeless when I jump on the treadmill, watch my eating habits, or lift weights. I don't want to feel as though everything I do is in vain because of a little pill.I think my biggest frustration with him is with not being able to work with me to find the right "cocktail" and dose so to speak that can minimize side effects. A little of this or that is fine. It's just that the HMO downsized the staff over the past year as it is, so he is in such a hurry all the time, and I feel like treatment should be peripheral... it should involve the whole body. When things are out of whack... the whoel treatment plan defeats itself.
Posted by Chris O on July 29, 2008, at 20:10:34
In reply to Am I being selfish?, posted by thinkingitover on July 29, 2008, at 19:15:52
God, I totally identify with you. Doesn't mental illness suck so big time? I am also a guy with GAD, panic, and depression who doesn't do well in this fast paced world. I also need the "boost" of antidepressants to stay afloat. And I also ask myself the "at what cost?" questions over and over. I am 6' 1" and weighed a skinny 170 pounds before taking ADs. Now, my weight is always hovering around 200 pounds and I can't seem to get the weight off. My blood sugar also runs high, despite my healthy diet and good exercise schedule. And it's all due to these stupid pills. (Thanks, mom! A little inside dig.) Anyway, and the getting the right cocktail thing, it's like, so frustrating. It takes so much effort on the part of you and the psychiatrist. I often feel like I need a Spock-like mind-mend healer, someone who can tap into my specific symptoms and provide the perfect cure. But I guess that isn't going to happen anytime soon.
Anyway, it doesn't sound like your p-doc is helping you as much as he could. If you have the time and your insurance covers it, it is worth experimenting with different doctors, just to see if you can find one who more empathetic to your situation. That's what I would do if I were in your shoes. Hope you can find a better p-doc!
Chris
Posted by BGB on July 29, 2008, at 20:30:46
In reply to thinking of firing my PDOC- scared, posted by thinkingitover on July 29, 2008, at 13:32:36
Good luck! I am firing mine too, and just found a replacement! =) Doctor of the year, my *ss!
I would just like to chime in with my experience with a CNS (Certified Nurse Specialist) in a psychiatric practice. She was utterly clueless. A very, very, kind woman but a useless clinician. I normally prefer to see nurse practitioners and physician's assistants when I visit a doctor's office, but I'm careful when it's in a psychiatric setting. I find that they are best for refills and for treating problems that are already pretty much under control. For tough problems, you might want to consider an MD.
P.S. I don't have anything against psychiatric nurse practitioners, nor do I say that anyone shouldn't see one, I'm just explaining my experience with one particular nurse. Just like doctors, I'm sure there are great nurses and there are terrible ones.
Posted by bleauberry on July 29, 2008, at 21:26:42
In reply to thinking of firing my PDOC- scared, posted by thinkingitover on July 29, 2008, at 13:32:36
> I feel like I am "my own doctor", (and I am >not qualified obviously).
Just my opinion, but I disagree with the above statement. No one knows you better than you do. No one knows how you respond to certain meds better than you do. No one knows your side effects better than you. And assuming good research on your part, no one knows the best options to choose from better than you do. In the end, it is an ultimate guessing game. You can pay someone $200 for the guess, or you can make it yourself for free. With good research, you will probably know things better than the pdoc does.
Nurse Practioners who have a psychiatric license paid some serious dues to get there. Residency time in hospital psych wards and such, just like pdocs. I had one who was great. Easy to reach, fast appointments, $45 an hour for her versus $200 15 minutes for pdoc, willing to try anything I wanted. She frankly knew a lot more than any of the half dozen pdocs I had.
It takes work to search for a new doc. Call every place you can think of, including the yellow pages listings. Have some screening questions to find exactly what you want. Most will not fit the bill. But you will get some referalls and stumble onto some good names, names you would never have found any other way. If you know someone who is being successfully treated, ask them who their doctor is. Just some ideas to find a new doc. My best pdoc was found when I was calling pdocs in the yellow pages with screening questions. A couple times they brought up the name of someone else. I wrote that name down. It wasn't in the phone book. That's because he worked out of a hospital and not an office. Once I discovered that, I got in contact, and he was the best. Then he retired, damn. But, he was referred by other pdocs, and I never would have found such a good one without going through the work.
And yeah, you do need a new doc. Either an MD who does psychiatry routinely, or a pdoc, or a specialized nurse practioner. You need someone you can see as often as once a week, or at least once a month, during the times you are starting new meds.
Posted by thinkingitover on July 29, 2008, at 21:33:58
In reply to Re: thinking of firing my PDOC- scared, posted by bleauberry on July 29, 2008, at 21:26:42
Hi, Thanks for the advice.
In terms of screening... what types of questions should I ask them? Is there anything I should look for in particular? I am not sure how to articualte with them my needs. Do you ask to speak to the PDOC directly, or will you end up speaking to a receptionist/nurse?
Case in point, I take a low dose of valium daily (10 mgs, exactly as perscribed). Some pdocs are benzophobes, whereas others appreciate the medication's effects. It's all of these little details that make me nervous, and I'm not sure what qualities to look for. Also, I like doctors who will listen when I tell them how I am feeling, and not say "no big deal"... alot to consider.> > I feel like I am "my own doctor", (and I am >not qualified obviously).
>
> Just my opinion, but I disagree with the above statement. No one knows you better than you do. No one knows how you respond to certain meds better than you do. No one knows your side effects better than you. And assuming good research on your part, no one knows the best options to choose from better than you do. In the end, it is an ultimate guessing game. You can pay someone $200 for the guess, or you can make it yourself for free. With good research, you will probably know things better than the pdoc does.
>
> Nurse Practioners who have a psychiatric license paid some serious dues to get there. Residency time in hospital psych wards and such, just like pdocs. I had one who was great. Easy to reach, fast appointments, $45 an hour for her versus $200 15 minutes for pdoc, willing to try anything I wanted. She frankly knew a lot more than any of the half dozen pdocs I had.
>
> It takes work to search for a new doc. Call every place you can think of, including the yellow pages listings. Have some screening questions to find exactly what you want. Most will not fit the bill. But you will get some referalls and stumble onto some good names, names you would never have found any other way. If you know someone who is being successfully treated, ask them who their doctor is. Just some ideas to find a new doc. My best pdoc was found when I was calling pdocs in the yellow pages with screening questions. A couple times they brought up the name of someone else. I wrote that name down. It wasn't in the phone book. That's because he worked out of a hospital and not an office. Once I discovered that, I got in contact, and he was the best. Then he retired, damn. But, he was referred by other pdocs, and I never would have found such a good one without going through the work.
>
> And yeah, you do need a new doc. Either an MD who does psychiatry routinely, or a pdoc, or a specialized nurse practioner. You need someone you can see as often as once a week, or at least once a month, during the times you are starting new meds.
>
>
Posted by bleauberry on July 30, 2008, at 20:08:43
In reply to Re: thinking of firing my PDOC- scared » bleauberry, posted by thinkingitover on July 29, 2008, at 21:33:58
For screening questions, they should be specific to what concerns you. For example, does the doctor routinely prescribe benzos? If not, or if at a minimum, you don't want that doc, right? Can you get an appointment squeezed in on a moment's notice if you're having a lot of trouble with your new med? That's important. If the doc is too booked up, that's not good for you. Is the doctor easy to reach? Does he return calls the same day? Does the doctor have experience with treatment resistant patients? Does the doctor follow common psychiatric guidelines, or does he also engage in off-label experimentation? The last thing you need is someone who follows a rigid boxed in strategy without any creativity. Can you please recommend a pdoc who you refer your most difficult patients to? That's a real good one. The answer to that will give you a clue as to whether they can handle the difficult ones or not, and if not, who can. Could also ask for a name of someone who is especially gifted a psychopharmacology.
It might be a good idea to just think about it deeply as often as you can and figure out for yourself, what is your ultimate perfect pdoc? Then design questions to determine if the one your are screening is that person or not.
You will probably get a receptionist. If they are unwilling or unable to get you hooked up to the actual pdoc in a few days, well, that doesn't speak very well of that doc, does it? Probably don't want that one. Too busy. Too uncaring. Not a good businessperson. Too unorganized. Something.
Expect a lot of dead ends. That's ok. Those are the duds you just saved yourself from getting involved with. But somewhere along the line, someone will impress you. Someone will refer a name. Something will happen. But without forward determined strategic motion, nothing will happen other than drifting in the wind and landing in some docs office you know very little about.
Your mental health is way too important to take lightly. We are our own best doctor, by taking the steps to find our own very best doctor within a field of me-toos and duds.
Posted by bleauberry on July 30, 2008, at 20:26:20
In reply to Re: thinking of firing my PDOC- scared » thinkingitover, posted by bleauberry on July 30, 2008, at 20:08:43
While the questions in the previous post were just general suggestions that may or may not apply to you, they are just to give you a rough idea of things to think about.
But in addition to them, here is a powerful screening question to ask...
Do you have experience in prescribing Nardil or Parnate? Do you have any patients on them right now?
Run-of-the-mill pdocs will likely say no, or say those meds are old fashioned and not used much anymore, or those meds have too many side effects, or they are too dangerous, or something like that. The good docs will be comfortable with those meds and have experience with them. Regardless of whether you would ever be on those meds or not, that doesn't matter, the point is you want a doc with that kind of calibre.You could also ask an outfront question by asking the doc if he could give you a rough estimate of what percentage of his patients recover remarkably well. If he kind of beats around the bush, well, you gotta kinda wonder. A good doc will be comfortable in saying 50%, 60%, 80%, whatever. Honesty, integrity, accountability, humbleness, and talent...all of those are revealed in the answer to this one question.
Posted by rvanson on August 4, 2008, at 0:05:11
In reply to Am I being selfish?, posted by thinkingitover on July 29, 2008, at 19:15:52
> Thanks for the responses so far...
> indeed this is frustrating.
> They can't be miracle workers, and I accept it, but how much should one tolerate before they say "enough!" and try someone else. I am not treatment resistant, I am jsut a guy with panic attacks and OCD... if left untreated I get depressed because I don't do well in a rather fast paced world... I need that boost to keep myself afloat. When I am treated correctly, I thrive, work productively, and love life.
> But at what cost? High blood pressure, prediabetic or type II diabetes blood sugar, and at one point 70 extra pounds? So, I should be "fat and happy?" That's not a quality of life either... It's almost as if I'm afraid I'll be perceived as selfish for saying "I want to be happy, but I also want to be able to have some semblence of control over the side effects and my body."
> I'm a single guy... I want to feel attractive, have control over my body, be healthy, and not feel hopeless when I jump on the treadmill, watch my eating habits, or lift weights. I don't want to feel as though everything I do is in vain because of a little pill.
>
> I think my biggest frustration with him is with not being able to work with me to find the right "cocktail" and dose so to speak that can minimize side effects. A little of this or that is fine. It's just that the HMO downsized the staff over the past year as it is, so he is in such a hurry all the time, and I feel like treatment should be peripheral... it should involve the whole body. When things are out of whack... the whoel treatment plan defeats itself.The whole system of healthcare in the US is a mess, in part because so many are left out of it, and do not pay into it.
Now, with cost-cutting in every profession and business, it has become even worse then it was a few years ago. It wont get better if it is allowed to be controlled by private enterprises with no oversight, IMO.
As far as your Pdoc goes I would have dumped him a long time ago. If you can find a Pdoc that will work with you and you feel comfortable with, that would be different but this man is obviously not doing that for you.
My take? Give him the broom and don't look back!
This is the end of the thread.
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