![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by PhoenixGirl on March 28, 2001, at 16:37:15
I am really struggling to find a good doctor. The doctor-patient relationship can have a big power imbalance, which I don't like -- I want a doctor and I to work TOGETHER on helping me, I don't want to just do whatever he says. Yesterday I went to a doctor for the first time, and withing 15 minutes he thought he had everything all figured out, and wanted to change me over to Effexor. He said "Depression is treated with serotonin, not norepinepherine", even though I told him that the norepinepherine drugs tend to work better for me than the more serotonergic ones. Right now I take desipramine, levothroid, and Wellbutrin, and I wanted to switch the Wellbutrin to Provigil because Wellbutrin doesn't help my depression. He said "If you want me to help you, I can help you, but I won't fight with you. I'm not going to do what you want me to do. I've been a pharmacologist since before you were born." What the hell is this power struggle crap?! I was very shy and passive during the whole appointment, and I quietly said that I don't want to mess with serotonin drugs again (I've tried 4 without success), and that's the reaction I got! When we were walking out of the office, he told his
receptionist to make an appointment for me with the therapist he works with, even though I never said I wanted a therapist, much less that one. Clearly, he is controlling, egotistical, and thinks he knows it all. I've had depression for 11 years, and a doctor should not make decisions about my treatment within 15 minutes of meeting me. What can I do? I need a doctor who will try new things with me and tailor the treatment to me, since I've tried at least a dozen antidepressants, all with insufficient effectiveness and awful side effects. I live in Atlanta, and need to find a doctor in the area. Psychiatrists shouldn't belittle you and leave you in tears. Please someone help if you can.
Posted by Fred Potter on March 28, 2001, at 17:25:02
In reply to Bad doctors (Dr. Bob, someone, help!), posted by PhoenixGirl on March 28, 2001, at 16:37:15
That could have been me. My pdoc was one of the rudest, most arrogant people I've ever met. Stupidity is one thing, but when combined with bigotry and egotism it's quite intolerable. I'm afraid I really gave it him back. By the way, current views are that Norepinephrine may have more of a connection with depression than Serotonin, although the truth is they're all interelated. A pharmacologist who's rested on his laurels since before you were born may not appreciate this. Find someone else. Yes, it's a joint effort. One psychiatrist I met said that SSRIs can work but no-one knew why. He won my respect simply by saying that.
Fred
Posted by MarkinBoston on March 28, 2001, at 18:06:08
In reply to Bad doctors (Dr. Bob, someone, help!), posted by PhoenixGirl on March 28, 2001, at 16:37:15
Hi!
I've had plenty of Dr.'s with too much ego compared to how little they keep up on literature. The HMO system doesn't give them much time and often the only information source are drug salesmen.
Aside from that, Effexor is perhaps the single most effective AD. It does affect all three neurotransmitters and is on the speedy side. Without rocking your med cocktail too much by taking out one drug that does not seem to help you much, and replacing its DO agonism with Provigil, and NE agonism with Effexor (once you're up to a high enough dose), it seems like a reasonable strategy. Unless you've tried Effexor before and not felt better, I think its worth a try and you should bear with him a little, no matter how lacking his communication skills may be.
His abilities as a doctor don't even matter much here. Effexor has the highest probablity of working, so most anyone treatment-resistant ought to be tried on it first. Excepting contraindications, history is of modest importance even. Today's medical insurance system does not allow him time to scratch the surface of your long history and med combos. It may be even too confusing to gleen much from, so he would want a fresh start.
In the mean time, call around looking for good word of mouth referals of doctors with the style you want.
Posted by KarenB on March 28, 2001, at 18:52:43
In reply to Re: Bad doctors (Dr. Bob, someone, help!) » PhoenixGirl, posted by MarkinBoston on March 28, 2001, at 18:06:08
Dear Phoenix Girl,
I had two ridiculously bad docs before finding the woman I have now, who is excellent. The last guy I called "Mr. Spock," because of his inability to show any emotion whatever. He also thought he knew it all and resented any suggestions or comments I had regarding research I had done on medication. My current doc appreciates my knowledge and willingness to be involved in my own recovery.
Find someone else who has respect for you as their patient. Try a woman this time. For women patients, at least, I think they are better listeners. Just my opinion.
Karen
Posted by Maryanne on March 28, 2001, at 19:45:25
In reply to Bad doctors (Dr. Bob, someone, help!), posted by PhoenixGirl on March 28, 2001, at 16:37:15
I've had the same problem. These doctors must
remember you are paying for their services and if
they want your business make them sit down and
listen to you. I've had 2 great doctors re:
different cases. This latest one Dx me in 15
minutes, but he was correct. His teacher wrote
"The Anxiety Disease" book by David V Sheehan.
Good luck with your search.> I am really struggling to find a good doctor. The doctor-patient relationship can have a big power imbalance, which I don't like -- I want a doctor and I to work TOGETHER on helping me, I don't want to just do whatever he says. Yesterday I went to a doctor for the first time, and withing 15 minutes he thought he had everything all figured out, and wanted to change me over to Effexor. He said "Depression is treated with serotonin, not norepinepherine", even though I told him that the norepinepherine drugs tend to work better for me than the more serotonergic ones. Right now I take desipramine, levothroid, and Wellbutrin, and I wanted to switch the Wellbutrin to Provigil because Wellbutrin doesn't help my depression. He said "If you want me to help you, I can help you, but I won't fight with you. I'm not going to do what you want me to do. I've been a pharmacologist since before you were born." What the hell is this power struggle crap?! I was very shy and passive during the whole appointment, and I quietly said that I don't want to mess with serotonin drugs again (I've tried 4 without success), and that's the reaction I got! When we were walking out of the office, he told his
> receptionist to make an appointment for me with the therapist he works with, even though I never said I wanted a therapist, much less that one. Clearly, he is controlling, egotistical, and thinks he knows it all. I've had depression for 11 years, and a doctor should not make decisions about my treatment within 15 minutes of meeting me. What can I do? I need a doctor who will try new things with me and tailor the treatment to me, since I've tried at least a dozen antidepressants, all with insufficient effectiveness and awful side effects. I live in Atlanta, and need to find a doctor in the area. Psychiatrists shouldn't belittle you and leave you in tears. Please someone help if you can.
Posted by Michele on March 28, 2001, at 20:47:41
In reply to Re: Bad doctors (Dr. Bob, someone, help!), posted by Maryanne on March 28, 2001, at 19:45:25
I had a pretty horrible doctor at first, I can relate. I have a new one now... and he seems to know his s**t.
Just a piece of info he told me:
at 37.5 mg. effexor xr effects serotonin
at 75 it effects serotonin and norepinephrine.
at 150.. effects ser/nore/and dopamine(?)Anyway... that's how it was explained to me.. so that may be a good way for you to go.
Posted by Eric on March 28, 2001, at 21:07:30
In reply to Bad doctors (Dr. Bob, someone, help!), posted by PhoenixGirl on March 28, 2001, at 16:37:15
> I am really struggling to find a good doctor. The doctor-patient relationship can have a big power imbalance, which I don't like -- I want a doctor and I to work TOGETHER on helping me, I don't want to just do whatever he says. Yesterday I went to a doctor for the first time, and withing 15 minutes he thought he had everything all figured out, and wanted to change me over to Effexor. He said "Depression is treated with serotonin, not norepinepherine", even though I told him that the norepinepherine drugs tend to work better for me than the more serotonergic ones. Right now I take desipramine, levothroid, and Wellbutrin, and I wanted to switch the Wellbutrin to Provigil because Wellbutrin doesn't help my depression. He said "If you want me to help you, I can help you, but I won't fight with you. I'm not going to do what you want me to do. I've been a pharmacologist since before you were born." What the hell is this power struggle crap?! I was very shy and passive during the whole appointment, and I quietly said that I don't want to mess with serotonin drugs again (I've tried 4 without success), and that's the reaction I got! When we were walking out of the office, he told his
> receptionist to make an appointment for me with the therapist he works with, even though I never said I wanted a therapist, much less that one. Clearly, he is controlling, egotistical, and thinks he knows it all. I've had depression for 11 years, and a doctor should not make decisions about my treatment within 15 minutes of meeting me. What can I do? I need a doctor who will try new things with me and tailor the treatment to me, since I've tried at least a dozen antidepressants, all with insufficient effectiveness and awful side effects. I live in Atlanta, and need to find a doctor in the area. Psychiatrists shouldn't belittle you and leave you in tears. Please someone help if you can.
Here are my personal rules for dealing with psychiatrists and all other mental health professionals.1) Let them know you are depressed(you have to) but make it clear you are NOT actively suicidal or anything else of that nature. Avoid the self cutting thing that some are into. Thats another thing that can give a Pdoc power over you. If they can see visible cut marks on you that can possibly give them power over you. Psychiatrists in the USA have absolutely no power over you unless they TRULY believe you are actively suicidal or homicidal. Dont give them a reason to think you are actively suicidal, for this can give them legal power over you sometimes. Psychiatrists basically dont have much power over their patients like back in the old days. Thank God.
2) I make it clear to them that I dont take shit from doctors. I have on occasion used mild scare tactics on them and have let them know that I was not happy with some of the services I received in the past from prior doctors. And I give them the impression I am the type of person who will actively seek out a malpractice lawsuit if they treat me poorly. I have on occasion mentioned to my psychiatrists that I have filed complaints against one or two of my doctors with the State Medical Board. That always makes them realize I dont take crap from asshole doctors. Many times the underlying possibility of a Medical Board complaint is more scary to a psychiatrist than the possibility of a malpractice lawsuit.
Of course, telling a Pdoc that kind of stuff will also get you a "paranoid" diagnosis real fast. Oh well. LOL
3) Be polite but firm. Dont be a pushover with your Pdoc, but dont be rude either. I dont talk to my Pdocs in a rude way...but I let them know that I am in control.
4) Psychiatry tends to attract control freaks I have observed. Unfortunately its the nature of the beast. Fight back by being somewhat of a control freak yourself. You can do this by becoming an "educated patient." Some Pdocs will like the fact you are an educated patient. Others however, wont like it and will see it as a threat to their big doctor ego. Learn all you can about the meds, the treatments, the diagnoses themselves. That way the psychiatrist will quickly pick up that you are an educated patient and cant be bullshitted or controlled and mindlessly bossed around.
5) Basically I avoid Pdocs who are excessively dictatorial or jerky acting. If I go to one whom I find is that way, I dont return and I may possibly file a written complaint against them with the Medical Board and tell the Medical Board that the Pdoc has an attitude problem and has poor communications and listening skills. One time I even wrote the board that a certain Pdoc I used needed to be "rehabilitated."
Unfortunately the way psychiatry currently is you have to be like the above if you want to avoid getting jacked around. Its sad so many people have problems with their Pdocs but if you consider how crude, subjective and backwards psychiatry really is its not surprising.
Your psychiatrist's statements about norephinephrine are somewhat unfounded. While its true that serotonin is the biggie neurotransmitter for depression, OCD and anxiety, other neurotransmitters ARE important quite frequently. The strongest modern class antidepressant on the market, Effexor, heavily increases norephinephrine levels in addition to increasing serotonin levels. This effect on norephinephrine is a big part of what gives Effexor its "punch power" and is part of the reason it is so stimulating of an antidepressant. Tell that to your Pdoc next time you talk to him.
Also, there are one or two new meds scheduled to come out which specifically target norephinephrine rather than serotonin. Reboxetine is the most well known. It is an SNRI...Selective Norephinephrine Reuptake Inhibitor. Eli Lilly has another SNRI drug in the pipeline, I cant remember the name of it but its probably coming in a few years.
Basically your Pdoc is a jerk. Find another one. And remember, become an educated patient. Your future Pdoc will quickly pick up on that if you are an educated patient. Become familiar with your State Medical Board as well. Dont overuse it and write a complaint everytime you have a bad Pdoc experience. But be aware that it is there for when shit hits the fan and you feel like you were not treated that well. Save it for when you really need it.
Eric
Posted by grapebubblegum on March 29, 2001, at 7:24:13
In reply to Re: Bad doctors (Dr. Bob, someone, help!), posted by Eric on March 28, 2001, at 21:07:30
I'm sure we all have a "nightmare p-doc" story. I've only found one who is not intimidated by my efforts to learn about my condition and about pharmacology and I've been to a handful of others for "one-visit-stands."
One doc LIED to me by telling me on the phone that he sees his own patients for therapy and does not farm them out to a legion of psychologists and social workers under him (little did I know that is basically the way it is done these days.) When I went in, I found it weird that he talked the whole time and hardly gave me a chance to say anything. He also seemed to think he had me figured out down to a t in five minutes, even asking me about the nature of my panic attacks and before I got five words out, interrupting me to say, "Oh, you're one of THOSE kind..." and then talking nonstop about which meds I could try without even allowing any input from me. It was the only time a p-doc has talked so long and not gotten any input from me. He went on about how he is much smarter than the other doctors (talk about ego) till the session was over. Then when I went in next time, he told me that I would see his social worker from then on. When I confronted him on his lie, he refused to acknowledge his dishonesty but instead turned it around on me by saying, "I think you are very rigid and unwilling to try new things." Well, I did give that jackass a try so that proves him wrong. I went back to my faithful old-fashioned doctor who practices by herself out of her home (a dinosaur in the dying world of traditional psychiatry) who said, "What are they teaching students in medical school these days? That is not the way we were taught to relate to patients" referring to his "you're rigid" barb. Needless to say, I picked up my bill while fighting back tears and never graced his office again.
Posted by Bill L on March 29, 2001, at 8:33:52
In reply to Bad doctors (Dr. Bob, someone, help!), posted by PhoenixGirl on March 28, 2001, at 16:37:15
My advise is to call a teaching hospital and ask for a referral. That should not be any problem in Atlanta. Doesn't Emory have a medical school and hospital? If not, I'm sure there are others. I think that the teaching hospital docs keep up with things and see a high volume of patients which is important. Of course unfortunately there is still no guarantee that the doc will not be obnoxious.
If you want to switch docs, you should call for a referral right away since you might have to wait a couple of weeks for an appointment.
> I am really struggling to find a good doctor. The doctor-patient relationship can have a big power imbalance, which I don't like -- I want a doctor and I to work TOGETHER on helping me, I don't want to just do whatever he says. Yesterday I went to a doctor for the first time, and withing 15 minutes he thought he had everything all figured out, and wanted to change me over to Effexor. He said "Depression is treated with serotonin, not norepinepherine", even though I told him that the norepinepherine drugs tend to work better for me than the more serotonergic ones. Right now I take desipramine, levothroid, and Wellbutrin, and I wanted to switch the Wellbutrin to Provigil because Wellbutrin doesn't help my depression. He said "If you want me to help you, I can help you, but I won't fight with you. I'm not going to do what you want me to do. I've been a pharmacologist since before you were born." What the hell is this power struggle crap?! I was very shy and passive during the whole appointment, and I quietly said that I don't want to mess with serotonin drugs again (I've tried 4 without success), and that's the reaction I got! When we were walking out of the office, he told his
> receptionist to make an appointment for me with the therapist he works with, even though I never said I wanted a therapist, much less that one. Clearly, he is controlling, egotistical, and thinks he knows it all. I've had depression for 11 years, and a doctor should not make decisions about my treatment within 15 minutes of meeting me. What can I do? I need a doctor who will try new things with me and tailor the treatment to me, since I've tried at least a dozen antidepressants, all with insufficient effectiveness and awful side effects. I live in Atlanta, and need to find a doctor in the area. Psychiatrists shouldn't belittle you and leave you in tears. Please someone help if you can.
Posted by Ted on March 29, 2001, at 14:33:38
In reply to Re: Bad doctors (Dr. Bob, someone, help!), posted by Eric on March 28, 2001, at 21:07:30
Eric,
I like, and follow, most of your ideas with my mdocs (internal medicine physician). And, yes, I have had those who were afraid of my knowledge, and others who welcomed it -- saying it was nice to have a patient who knew & cared what was going on. Fortunately I haven't had much trouble with my pdoc, but I consider him only "average". The ones in my insurance plan who are really good are fully booked and not accepting new patients.
Ted
> Here are my personal rules for dealing with psychiatrists and all other mental health professionals.
>
> < details deleted >
>
> Eric
Posted by MarkinBoston on March 29, 2001, at 17:00:38
In reply to Re: Bad doctors (Dr. Bob, someone, help!), posted by Bill L on March 29, 2001, at 8:33:52
I've had little success calling Boston teaching hospitals for referrals of endocrinologists specializing in mens' health. The referral line is often operated by a non-medical person working off a list of specialties, and sometimes doctors will list specific areas of interest. So, I've gotten names and numbers that were useless. The same information I found on the hospital web site and I knew what the subspecialties were about more than the call taker.
If at all possible, getting a name from a senior doctor well tied in to networking with peers is a better bet. You just have to get 1-2 minutes of access to that doc.
Another thing I have done is ask pharmicists. They surely know the bad docs who can't write a script correctly and waste their time, making them call the doc for clarification. They remember the ones that write contraindicated meds based on bad interactions or patient conditions. Pharmicists don't have the attitude and arn't competing for patients, so I like them as a resource. Find a time when they arn't busy and have time to talk.
Hospital nurses know who the good docs are too. Ones in their 30's are best to ask - experienced enough, and not burned out yet.
My experiences with teaching hospital docs is that it takes months to get an appointment, they have the largest egos, and are the least willing to try new things.
> My advise is to call a teaching hospital and ask for a referral. That should not be any problem in Atlanta. Doesn't Emory have a medical school and hospital? If not, I'm sure there are others. I think that the teaching hospital docs keep up with things and see a high volume of patients which is important. Of course unfortunately there is still no guarantee that the doc will not be obnoxious.
>
> If you want to switch docs, you should call for a referral right away since you might have to wait a couple of weeks for an appointment.
Posted by Fred Potter on March 29, 2001, at 19:43:15
In reply to Re: Bad doctors (Dr. Bob, someone, help!), posted by grapebubblegum on March 29, 2001, at 7:24:13
He sounds like the one I saw. He told me to stop Prozac and Xanax abruptly. I said that was dangerous, particularly the Xanax, and he called me incredibly arrogant. He told me I was lucky to get him because all the other psychiatrists were too afraid of litigation to NOT dish out pills. Sounds strange. What did he mean? Spouses litigating for suicide perhaps. He also said the articles I've studied in the major psychiatric journals were all rubbish, written by academics whose survival depended on their publishing. One does see low-quality publications sometimes but I don't *think* the American J of Psych and The Lancet are full of junk
Posted by grapebubblegum on March 30, 2001, at 7:30:03
In reply to Re: Bad doctors (Dr. Bob, someone, help!), posted by Fred Potter on March 29, 2001, at 19:43:15
Heh heh. Just slightly off-topic because this was a lawyer speaking rather than a doctor, but when I told him I had looked up my case online, he said, "You know what? Why doesn't everyone just take the internet and shove it up their a**?!"
It just reinforces the attitudes some professionals have toward their patients being self-educated and informed. I switched to another lawyer who thought looking up my case progress on-line was a smart idea.
Some people are afraid to change doctors or lawyers. I changed obstetricians mid-pregnancy and a friend gasped, "WHAT? You CHANGED doctors?" I do it without a second thought. These kind of professionals are working for you and you should be satisfied. Mutual trust should be there or the relationship should be re-evaluated.
Posted by Bill L on March 30, 2001, at 10:08:46
In reply to Re: Bad doctors (referrals) » Bill L, posted by MarkinBoston on March 29, 2001, at 17:00:38
I agree that pharmacists are usually very helpful. A nurse would be ideal if you know one since she can be candid about who is good or bad. The way that I found the names of senior docs was I went to the web site of a teaching hospital near me and looked at the psychiatry page to get names. Then I went to the AMA find a doctor site and plugged in some of the names from the hospital to see what year they graduated medical school. Then I called a couple of them directly and some were available and others referred me to someone else. All 3 of them that I called returned my call. I got a good idea of how comfortable I felt with each just by chatting for a couple of minutes.
> I've had little success calling Boston teaching hospitals for referrals of endocrinologists specializing in mens' health. The referral line is often operated by a non-medical person working off a list of specialties, and sometimes doctors will list specific areas of interest. So, I've gotten names and numbers that were useless. The same information I found on the hospital web site and I knew what the subspecialties were about more than the call taker.
>
> If at all possible, getting a name from a senior doctor well tied in to networking with peers is a better bet. You just have to get 1-2 minutes of access to that doc.
>
> Another thing I have done is ask pharmicists. They surely know the bad docs who can't write a script correctly and waste their time, making them call the doc for clarification. They remember the ones that write contraindicated meds based on bad interactions or patient conditions. Pharmicists don't have the attitude and arn't competing for patients, so I like them as a resource. Find a time when they arn't busy and have time to talk.
>
> Hospital nurses know who the good docs are too. Ones in their 30's are best to ask - experienced enough, and not burned out yet.
>
> My experiences with teaching hospital docs is that it takes months to get an appointment, they have the largest egos, and are the least willing to try new things.
>
> > My advise is to call a teaching hospital and ask for a referral. That should not be any problem in Atlanta. Doesn't Emory have a medical school and hospital? If not, I'm sure there are others. I think that the teaching hospital docs keep up with things and see a high volume of patients which is important. Of course unfortunately there is still no guarantee that the doc will not be obnoxious.
> >
> > If you want to switch docs, you should call for a referral right away since you might have to wait a couple of weeks for an appointment.
Posted by Eric on March 30, 2001, at 11:29:38
In reply to Re: Bad doctors (Dr. Bob, someone, help!), posted by grapebubblegum on March 30, 2001, at 7:30:03
> Some people are afraid to change doctors or lawyers.
Ive never been afraid to change doctors. I dont understand why others are afraid or apprehensive to do that. One should NEVER be afraid to change doctors, many times it takes a second opinion to get a proper diagnosis and treatment. Sometimes, it even takes a third opinion!My advice to anyone considering changing doctors is to not just change mindlessly. Just dont pick someone out of the yellow pages you know nothing about and make an appointment with them for a second opinion. They could be anybody, you dont have a clue who you are getting when you just pick someone out of a list you got from your insurance or the yellow pages.
Do some research, ask around to those who you know are knowledgeable. Sometimes a good soure of good psychiatrists in your area is a local depression support group. Once youve located one or two possible new doctors call them and see if they take your insurance. If they take your insurance, then go for it and never look back. Screw your old doctor...they have absolutely no power over you unless they truly think you are actively suicidal or homicidal.
Remember, we do live in a free country.
Eric
Posted by Eric on March 30, 2001, at 11:37:53
In reply to Re: Bad doctors (Dr. Bob, someone, help!), posted by Eric on March 30, 2001, at 11:29:38
> > Some people are afraid to change doctors or lawyers.
>
>
Another very simple way to locate a new psychiatrist is to simply ask your family doctor who they think is good. Or if you have a good relationship with another doctor such as a surgeon, ask them if they know anybody who is a good Pdoc. I got an excellent referral for a second psychiatrist from a urologist one time.All in all, I think the best traits for a good psychiatrist is someone who really knows the psych drugs. Believe it or not, not all psychiatrists are as adept at their drug knowledge as you'd think they would be. And also someone who is a good listener. Lots of Pdocs are poor listeners, preferring to be in control at all times. If they dont listen well, forget about them.
Eric
Posted by grapebubblegum on March 30, 2001, at 17:06:51
In reply to Re: Bad doctors (Dr. Bob, someone, help!), posted by Eric on March 30, 2001, at 11:37:53
Yes, Eric, that ridiculous doctor I wrote about was picked from (you guessed it) the yellow pages; his shiny high-rise office building seemed like an endorsement. A few other bad apples I found also worked in posh surroundings or right across the street from the hospital and these were found through strangers reading a list over the phone at my insurance company.
When I finally struck gold it was through my friends' mom, who was a satisfied patient and had learned of this doctor through my friend's stepmom who is also a satisfied longtime patient. Now there are three of us who trust this doctor with our lives, and she seems to be the smartest p-doc in the world (as far as I have seen) and guess where she practices? In her modest, unkempt HOUSE.
Posted by kate9999 on March 31, 2001, at 5:46:24
In reply to Re: Bad doctors (referrals) » Bill L, posted by MarkinBoston on March 29, 2001, at 17:00:38
Yeah I've done the teaching hosp routine here in Boston - WRONG WAY TO GO. I've never met a bigger bunch of shmucks who:
1. Don't return phone calls
2. Don't spend any time in appointments
3. Couldn't care less about my opinion
4. Couldn't care less period.In retrospect (far retrospect) I sympathize with them. I think they're in a vicious rat race, swamped with very sick patients and just plain don't have time to do the job right.
Actually what's worked out best for me is a guy at a local suburban hospital who USED to be at one of the big teaching hospitals.
> I've had little success calling Boston teaching hospitals for referrals of endocrinologists specializing in mens' health. The referral line is often operated by a non-medical person working off a list of specialties, and sometimes doctors will list specific areas of interest. So, I've gotten names and numbers that were useless. The same information I found on the hospital web site and I knew what the subspecialties were about more than the call taker.
>
> If at all possible, getting a name from a senior doctor well tied in to networking with peers is a better bet. You just have to get 1-2 minutes of access to that doc.
>
> Another thing I have done is ask pharmicists. They surely know the bad docs who can't write a script correctly and waste their time, making them call the doc for clarification. They remember the ones that write contraindicated meds based on bad interactions or patient conditions. Pharmicists don't have the attitude and arn't competing for patients, so I like them as a resource. Find a time when they arn't busy and have time to talk.
>
> Hospital nurses know who the good docs are too. Ones in their 30's are best to ask - experienced enough, and not burned out yet.
>
> My experiences with teaching hospital docs is that it takes months to get an appointment, they have the largest egos, and are the least willing to try new things.
>
> > My advise is to call a teaching hospital and ask for a referral. That should not be any problem in Atlanta. Doesn't Emory have a medical school and hospital? If not, I'm sure there are others. I think that the teaching hospital docs keep up with things and see a high volume of patients which is important. Of course unfortunately there is still no guarantee that the doc will not be obnoxious.
> >
> > If you want to switch docs, you should call for a referral right away since you might have to wait a couple of weeks for an appointment.
Posted by Rex Jones on March 31, 2001, at 20:17:36
In reply to Teaching Hospital Docs Re: Bad doctors (referrals) » MarkinBoston, posted by kate9999 on March 31, 2001, at 5:46:24
I have also reached the point where I find it necessary to switch psychiatrists. However, rather than lunging hastily toward another doctor, I think that a time-off period where I either not see a pyschiatrist at all, or at least see one less frequently will be my immediate solution.
Question A: Do any psychiatrists provide prescriptions for Schedule II meds, which by definition cannot be refilled, without a full office visit?
Question B: Does anybody have any advice about where I could find a qualified neuropsychiatrist, that is one with expertise in neurological or movement disorders?
Question C: How can a patient best go about finding a psychiatrist who is more willing to try patient suggested medications, or at the least respond intelligently as to their invalidity while not ignoring the underlying clinical problem?
Regarding Ques. C: I have a movement disorder and perhaps attention deficit disorder, and some other behavioral problem at an annoying, albeit relatively benign degree. My intuitive impression is that my movement disorder [thought to be one affecting the basal ganglia] is related to the attention deficit/depression like symptoms that I might display. I have asked my Dr. to prescribe me Marinol. Smoked marijuana has helped me tremendously with my neurological problem and with my psychiatric complaints. [I found that a low dose not only very salutory in the short-term, but also tends to have positive residual effects for a week. I feel that a resting period is important to not incur memory impairment. While immediately impairing short-term memory rather acutely, and also impairing it somewhat more mildly on a residual basis (@ least for me), I think that it may also play role in memory consolidation]. The problem is that I do not have any contacts whatsoever in my local area and do not want to be associate with shady sub-cultural elements.
My psychiatrist responded to my suggestion by saying: "You want me to prescribe you POT!!!?"
I feel that he overstepped the appropriate limits of power-ego-patient interaction. Why should THC be so shocking? I can say "You hooked me on SPEED!!! You even prescribed me DOWNERS(Mother's Little Helpers)!!!"
In reflecting on my experiences with psychiatrists, I wonder whether the frustration and disappointment with the treatments is not a way to get the patient to get his head out of the clouds and realise that the patient is really not all that ill after all and that most of the remedies tend to be on the deceptively plausible side and are not really all that good.
In the words of Steppenwolf a la Easy Rider. G-d damn the pusher!!! Psychiatrist dependency can be scarier than drug dependency.
Best regards,
Rex
Posted by Sandra on April 2, 2001, at 17:08:14
In reply to Re: Bad doctors (Dr. Bob, someone, help!), posted by grapebubblegum on March 30, 2001, at 17:06:51
I found a good recommendation from going to a web site call Depression Central. The site is...
www.psycom.net/depression.central.psychiatrists.html. In general it is a very good site. Go to the home page and explore it. There, Dr. Ivan Goldberg has a list of the best pdocs for mood disorders in the county. I e-mailed him and asked him how the list was put together and he said that numerous pdocs had compiled the list from names that they felt were people that they would want someone in their own family to go to if they needed to. I asked if they paid to get on the list and he said "No". There were 2 listed for my city - one no longer taking patients - too involved with research. So I went to the other. I was trusting in the fact that I could make a good judgement of him when I met him. I am a non pdoc psychotherapist and I have known so many pdocs that I would not go near! He is in a very modest setting, very helpful staff who spontaneously had really nice things to say about him. He was very good diagnostically and is taking a different medication approach than I have had before ( It didn't work for long in the past ). So far I'm very happy with him. Maybe that list will help you as well.
> Yes, Eric, that ridiculous doctor I wrote about was picked from (you guessed it) the yellow pages; his shiny high-rise office building seemed like an endorsement. A few other bad apples I found also worked in posh surroundings or right across the street from the hospital and these were found through strangers reading a list over the phone at my insurance company.
>
> When I finally struck gold it was through my friends' mom, who was a satisfied patient and had learned of this doctor through my friend's stepmom who is also a satisfied longtime patient. Now there are three of us who trust this doctor with our lives, and she seems to be the smartest p-doc in the world (as far as I have seen) and guess where she practices? In her modest, unkempt HOUSE.
Posted by PhoenixGirl on April 3, 2001, at 15:47:26
In reply to Re: Bad doctors (Dr. Bob, someone, help!), posted by Sandra on April 2, 2001, at 17:08:14
Like was personality a factor?
> I found a good recommendation from going to a web site call Depression Central. The site is...
> www.psycom.net/depression.central.psychiatrists.html. In general it is a very good site. Go to the home page and explore it. There, Dr. Ivan Goldberg has a list of the best pdocs for mood disorders in the county. I e-mailed him and asked him how the list was put together and he said that numerous pdocs had compiled the list from names that they felt were people that they would want someone in their own family to go to if they needed to. I asked if they paid to get on the list and he said "No". There were 2 listed for my city - one no longer taking patients - too involved with research. So I went to the other. I was trusting in the fact that I could make a good judgement of him when I met him. I am a non pdoc psychotherapist and I have known so many pdocs that I would not go near! He is in a very modest setting, very helpful staff who spontaneously had really nice things to say about him. He was very good diagnostically and is taking a different medication approach than I have had before ( It didn't work for long in the past ). So far I'm very happy with him. Maybe that list will help you as well.
>
>
>
>
> > Yes, Eric, that ridiculous doctor I wrote about was picked from (you guessed it) the yellow pages; his shiny high-rise office building seemed like an endorsement. A few other bad apples I found also worked in posh surroundings or right across the street from the hospital and these were found through strangers reading a list over the phone at my insurance company.
> >
> > When I finally struck gold it was through my friends' mom, who was a satisfied patient and had learned of this doctor through my friend's stepmom who is also a satisfied longtime patient. Now there are three of us who trust this doctor with our lives, and she seems to be the smartest p-doc in the world (as far as I have seen) and guess where she practices? In her modest, unkempt HOUSE.
Posted by blackjack on April 4, 2001, at 20:35:35
In reply to Changing Psychiatrists, posted by Rex Jones on March 31, 2001, at 20:17:36
>
> Question A: Do any psychiatrists provide prescriptions for Schedule II meds, which by definition cannot be refilled, without a full office visit?Mine always did, when I was taking dexedrine. I just called him every month and then dropped by the office to pick it up.
Unfortunately, he has totally disappeared now and I've got to find a new doctor too. And my HMO gives me a choice of about 4 within 20 miles...
> Question C: How can a patient best go about finding a psychiatrist who is more willing to try patient suggested medications, or at the least respond intelligently as to their invalidity while not ignoring the underlying clinical problem?Well, what I'm doing right now is talking to docs and telling them up front "Listen, I know what I'm talking about and I pretty much want to run my own treatment. Do you have a problem with that?" If they do, I won't see them.
Posted by Ali on April 8, 2001, at 16:09:58
In reply to Re: Bad doctors (Dr. Bob, someone, help!), posted by grapebubblegum on March 29, 2001, at 7:24:13
I agree with most of what's been said.If you find that your doc is not listening to you and is not receptive to your ideas, find another one.In defence on doctors though, the current HMO/managed care system not only does not reward them for taking extra time and 'going the extra mile', at times they are actually penalized for not sticking to the '15 minute med check'.That said, you have a right to receive the care and respect you deserve so be up front about it.
Posted by Mitch on May 28, 2001, at 16:25:30
In reply to Re: Bad doctors (Dr. Bob, someone, help!), posted by Marissa on May 28, 2001, at 12:58:09
Marissa,
I have had an experience like that once. Just an intuition on my part here: Sometimes I think that some doctors screen their patients by being this way (on purpose!). If he thinks that you are going to have a lot of trouble with meds and you will be wanting to switch them all the time, he may already have made up his mind that he would prefer you just find somebody else-so instead of directly hurting your feelings you get this ego/asshole thing that is intended to get YOU to change doctors. That way all or most of his patients are passive, stable, pay their bills, and create the least headaches for him!
I wouldn't fool around with him if you get an obvious intense first impression like that-just find someone else!good luck
Mitch> > I am really struggling to find a good doctor. The doctor-patient relationship can have a big power imbalance, which I don't like -- I want a doctor and I to work TOGETHER on helping me, I don't want to just do whatever he says. Yesterday I went to a doctor for the first time, and withing 15 minutes he thought he had everything all figured out, and wanted to change me over to Effexor. He said "Depression is treated with serotonin, not norepinepherine", even though I told him that the norepinepherine drugs tend to work better for me than the more serotonergic ones. Right now I take desipramine, levothroid, and Wellbutrin, and I wanted to switch the Wellbutrin to Provigil because Wellbutrin doesn't help my depression. He said "If you want me to help you, I can help you, but I won't fight with you. I'm not going to do what you want me to do. I've been a pharmacologist since before you were born." What the hell is this power struggle crap?! I was very shy and passive during the whole appointment, and I quietly said that I don't want to mess with serotonin drugs again (I've tried 4 without success), and that's the reaction I got! When we were walking out of the office, he told his
> > receptionist to make an appointment for me with the therapist he works with, even though I never said I wanted a therapist, much less that one. Clearly, he is controlling, egotistical, and thinks he knows it all. I've had depression for 11 years, and a doctor should not make decisions about my treatment within 15 minutes of meeting me. What can I do? I need a doctor who will try new things with me and tailor the treatment to me, since I've tried at least a dozen antidepressants, all with insufficient effectiveness and awful side effects. I live in Atlanta, and need to find a doctor in the area. Psychiatrists shouldn't belittle you and leave you in tears. Please someone help if you can.
Posted by Elizabeth on May 29, 2001, at 12:47:30
In reply to Re: Bad doctors (Dr. Bob, someone, help!), posted by Marissa on May 28, 2001, at 12:58:09
> I am really struggling to find a good doctor. The doctor-patient relationship can have a big power imbalance, which I don't like -- I want a doctor and I to work TOGETHER on helping me, I don't want to just do whatever he says. Yesterday I went to a doctor for the first time, and withing 15 minutes he thought he had everything all figured out, and wanted to change me over to Effexor. He said "Depression is treated with serotonin, not norepinepherine", even though I told him that the norepinepherine drugs tend to work better for me than the more serotonergic ones.
Argh! I know I don't have much information, but it really sounds like you just found a bad doctor. A statement like the one you quoted is simply absurd. I *don't* like to make absolute judgments about people (especially with so little information), but after hearing that, I can't imagine anything that would convince me that the doctor you saw is a competent one. I don't think this guy deserves a second chance; I think you should find someone else. That you need for your doctor to treat you with respect (I'm the same way) only makes it worse. This is not a doctor you should be seeing. (If I were in that position, I'd be reluctant even to pay him for the initial "consultation.")
> He said "If you want me to help you, I can help you, but I won't fight with you. I'm not going to do what you want me to do. I've been a pharmacologist since before you were born."
I agree that it's no use for a doctor and patient to be fighting with each other, but it sounds like he's twisted the situation around. He's not willing to accept it if you even *question* him -- not at all the same thing as fighting.
As an aside, I think that it's deceiving for an MD physician to call himself a "pharmacologist," especially one who demonstrates so little understanding of pharmacology! MDs take two semesters of pharmacology in medical school. That's it. A pharmacologist is someone who has a degree (almost always a PhD) in pharmacology. I have more right to call myself a mathematician than he has to call himself a pharmacologist, and I only have a bachelor's degree!
> When we were walking out of the office, he told his receptionist to make an appointment for me with the therapist he works with, even though I never said I wanted a therapist, much less that one.
I hope you cancelled it?
> I've had depression for 11 years, and a doctor should not make decisions about my treatment within 15 minutes of meeting me.
No, he shouldn't. He needs to review his professional ethics -- it sounds like he doesn't understand the concept of "informed consent." A doctor can't force a patient into any type of treatment.
In my experience, the best way to find a good doctor is by word of mouth -- talk to other people who might know a psychiatrist in your area, and see if you can get a few referrals. A good way to do this if you don't know people in the area is to go to a support group for people with mood disorders. (I don't know any pdocs in Atlanta, but I'm sure that NDMDA -- the National Depressive and Manic-Depressive Association, a network of support groups across the country -- has one or more meetings in Atlanta.)
Another strategy: talk to a doctor on the phone before you make an appointment. Make a list of questions to ask him in advance so you can get an idea of what he's like. (One I always ask is, "What are some of the strategies you employ when a depressed patient has not responded to the standard treatments?")
You said that you've tried a lot of ADs with "insufficient" effectiveness. That sounds like you mean they worked some, but not enough. My thought would be that combining two or more partially effective ADs is what you'd need to do in order to get a more complete effect.
I hope that I've been of some help. Don't get discouraged (I know, easier said than done).
-elizabeth
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