Posted by dalukens on February 17, 2001, at 2:33:54
In reply to Re: Your idea of a good psychiatrist+does he/she exist, posted by Cece on February 16, 2001, at 1:57:15
---O.K., I've got to add my own 2¢ worth to this discussion. I've been "doctor shopping" many times in my history (I'm 40 now, and have been one or another form of bi-polar all my life), and I've had some real losers in my time, but I'd rather not get into that now (it'd just depress me, and God knows I don't need that). At present, I have _finally_ found a pdoc I can honestly say is good (maybe not great, but a lot better than average). Some salient facts:
---He _listens_ to me. He doesn't have a one-size-fits-all treatment that he uses on everyone, he tries to tailor treatment to the patient's needs (what a concept!). I react strangely to many medications; previous pdocs I've had simply wouldn't believe what I reported as my reactions to a new med. If something is making me feel worse, he doesn't try to talk me into taking it longer. (When I reported adverse reactions to a drug a previous doctor had put me on, so severe that I felt I had to refuse to take it any more for fear of my life/sanity, he simply terminated the relationship, and refused to see me again. Just as well.) In contrast, my present pdoc has me taking 12.5mg. of Lamictal a day; a microscopic dose, but he believes me when I say that I'm hypersensitive to it. He suggested today that I might try going up to 25mg. in a week or two, but it's up to me.
---He's reasonably easy to reach. Although he's spread out over 2 hospitals and 3 clinics, he's given me the number for his answering service, and they're polite about having him paged. And he's apparently always wearing his pager. When we first started therapy (I was a mess), I made emergency calls at least weekly; I don't recall ever having to wait even overnight for him to call back.
---He understands about financial limitations. Not only was he very helpful when I applied for Medicaid, but while we were waiting for me to be approved, he would frequently give me samples of drugs he'd gotten from the manufacturer's representative, rather than writing a prescription I'd have to fill and pay for. He maintained me on Zoloft (which is rather pricy at the pharmacy) for months that way, giving me entire cases of sample bottles (7 pills in a bottle). I don't know how he talked the Pfizer rep into parting with that much.
---He doesn't take personally things I might say in a moment of mania-induced rage. I know, no health professional should do this, but some of them do. I once swore at him and said that I was going to sue him for malpractice; when I later apologized, he laughed it off: he knew it was just the mania talking. I've lost more friends (and one job) that way...
---He's willing to discuss treatment, and listen to my suggestions. My father was a pharmacist, and owned his own store; I often say that I "grew up in a drugstore." My brother is a caseworker in a mental health clinic. I know quite a bit about drugs, from reading about them, from discussing them with my father and brother, and from seeing customers who were taking various of them. My current pdoc will usually present more than one alternative as to what to try next, and let me choose.
---He knows his stuff, and he believes in continuing education. In spite of what I've learned about drugs, I've never caught him in a mistake, and I've never suggested something that he'd never heard of. On the other hand, as it's been awhile since I've been in a drugstore as anything but a customer, my knowledge is slightly out-of-date; he has routinely suggested things that I'd never heard of before. He's not stuck in a rut, making diagnoses and suggesting treatments that were in vogue twenty years ago.
---And last, but most important, HE KNOWS WHAT CONFIDENTIAL MEANS! When I was in junior high, I made the mistake of telling my then therapist that I was depressed to the point of being suicidal. The next day at school, all the teachers were looking at me funny. I was an assistant in the science lab (yeah, I was a geek; still am, really); the teacher took me aside and gave me a lecture about how someone could hurt themselves if they were to deliberately pour acid on their hands, and said "now you wouldn't do that... would you?" My guidance counsellor actually took my hands, turned them over, and inspected my wrists for slash marks (and then made a joke about it, about as funny as a dead baby in a punch bowl). Sure enough, when I confronted my therapist, he admitted it: he'd broken confidentiality. For the rest of our abbreviated relationship, I didn't tell him anything that I wouldn't feel comfortable shouting out loud in a crowded room. Naturally, this meant we made no further progress.
---I don't mean to imply that he's perfect. He's a bit shy about prescribing opiates (but then again, I'm not quite shy enough about taking them, so perhaps we balance out). He can be a bit abrupt during our sessions, particularly if he's running behind. (I've found it helps to make a list of what I want to discuss during our sessions; I don't forget anything that way, and as long as I'm still visibly checking items off my list, he doesn't try to end the session.) These are minor quibbles, however. I finally feel I've found a pdoc with whom I can make some real progress. First, we're going to have to try to undo what all the other doctors have done to me.
DaL
P.S.: D***, this is long! I hadn't realized I felt this strongly about this 'til I sat down and wrote it out. Maybe I should print out a copy and show it to my doc. Maybe I'm just hypomanic tonight. Whatever... :)
poster:dalukens
thread:49203
URL: http://www.dr-bob.org/babble/20010212/msgs/54216.html