Posted by Elizabeth on April 21, 2002, at 12:39:28
In reply to Re: help! (rant; advice?) » Elizabeth, posted by JohnX2 on April 19, 2002, at 2:48:29
Hi everyone. I was gratified to see such an overwhelmingly positive response from so many of you. Thanks guys! You have all been very supportive (as Dr. Bob might say ;-) ). I'm seriously thinking of printing out your posts and showing them to my pdoc so she can get an idea of how bad her behavior is. I'm too chicken to do that, of course. I'm often afraid to assert my rights with people who have some sort of power over me, for fear of being punished.
I've been so angry and anxious about this stuff that I just haven't wanted to think about it, and that's why I haven't posted a followup until now. But anyway....
Firing my pdoc really wouldn't be practical, mainly for reasons Shelli mentioned: getting somebody to prescribe Buprenex isn't trivial. I'm not in or near Boston, or New York, or L.A., or any large city. There is a med school here, but I've checked out the doctors there and they're *awful*: a private psychiatrist would be my best bet, but it could be months before I could see one, and even after that they might still refuse to prescribe the buprenorphine.
I have called some private pdocs to try to get a feel for their attitudes. It's hard enough even to get them to talk to me on the phone. Even if I can, I can't get a pdoc who doesn't know me to promise that they'll keep prescribing the stuff I'm already on, or even give me a general idea of their attitudes. Just making an appointment with somebody at random isn't likely to yield results, except for wasting a lot of money that I don't have. And I don't know anybody who I can trust to give me a referal to somebody who'll be sympathetic.
There are two private pdocs in town who know me. One of them is the guy I saw when I was in high school, over a period of two years. He was actually willing to talk to me on the phone for a couple minutes (this shouldn't be a marvel, but it is). He had space in his schedule when I talked to him. The other is someone I saw briefly during a few months last year. I couldn't get her secretary to ask her to call me, and her schedule is full anyway. In neither case is it certain that they'd prescribe buprenorphine, but there's a better chance than there is with someone I don't know. If the woman I'm seeing now actually refuses to prescribe things I need or something (to date, she's just been saying offensive things), I'll seriously think about talking to them. There is a money issue -- my current pdoc is seeing me at a reduced fee, but neither of the other two does does that -- and that that's why I'm hesitant to switch unless I really need to.
Some directed responses:
John:
What are the "non-standard approaches with unknown risk" that you take towards dealing with pain and insomnia? What is "the right story," in your experience? (I've always been able to get away with being honest.) And when were you a bastard? :-)Re finding another doc for the controlled drugs: buprenorphine is *hard* to get; few pdocs will agree to it without a great deal of convincing. I was actually amazed that this woman did. I think she just didn't want to make any changes. Also, the Ambien and Xanax doses are quite high. A lot of doctors seem to have trouble with the idea of prescribing 20 mg/night of Ambien, in particular. (A while back, the company that makes Ambien sent out a letter saying that, statistically, 20 mg didn't work significantly better than 10 mg but had more side effects. So I'm an outlying data point -- a concept that a lot of people, even educated people such as doctors and pharmacists, don't seem to get.)
Bekka:
I was "seeing" my previous (out-of-town) pdoc over the phone for quite a while. He's not comfortable doing it long-term. He didn't know me very long anyway (just a few months), but I did tell my current pdoc that she can call the guy I was seeing in Boston if she doesn't believe me (not the exact phrasing). Calling him myself and asking him to call her might be a good idea -- he's a really nice guy, and I saw him for several years, for talk therapy as well as meds (so it was a weekly-or-more thing, and he really got to know me). I've taken Klonopin in the past, and I'd prefer it if I were taking a benzo around-the-clock. For my purposes, Xanax is better because it starts working rapidly.fachad:
That was a particularly great post. But I beg you, don't believe that I "love" the DSM! (Sure, I cite it often, but that's just because there's no real alternative. There is the ICD, but that's not really much different.) I do think that, although DSM-IV gets the general idea of "addiction" right, it does include some criteria (like the one you mentioned) that just shouldn't be there. (The one about legal problems is also disturbing.)I think that a lot of the BS that we get from doctors regarding CSs is a result of the government's insistence on meddling in what ought to be strictly medical matters: is drug abuse a mental disorder, or a crime? And are doctors supposed to diagnose it, or find patients guilty of it? Can politicians (or their apointees) decree that certain behaviors indicate mental pathology? It's all very disturbing.
The idea about talking to my former pharmacist is an interesting one. I did go to one pharmacy pretty much all the time when I was in Boston (the only one there that took my insurance). There were only two pharmacists there, one of whom I chatted with often. I often got prescribed 20 mg/night of Ambien, and I would think the pharmacy still has the records. I don't think that a pharmacy is such a great way to prove "compliance," though, because one could always be using another pharmacy or something.
I'm not convinced that "most pdocs are rational."
Mitch (or is it Ritch?):
A lot of the problem is that she just didn't prescribe enough Xanax: she prescribed 1-2 mg p.r.n. but only gave me 20 mg each month. Most months that's okay; every now and then I need more. So as a result, one of those incidents that tend to fuel mistrust (in this case, my running out of Xanax) happened when I'd only been seeing her for a little while. I think part of it is she doesn't get that I really need to take 2 mg a lot of the time. I don't think she's going to try to force me to go off the controlled drugs, because she's started having me see her less often (next appt in 2 months instead of 1), which indicates to me that she doesn't expect me to need to make many changes in meds at this point.Kate:
I know what you mean about feeling "disgusted at myself for wimping out." I've been feeling a lot of that in the last few days! (BTW, 400 mg/day of Ativan might not be so very excessive if you're on an IV drip; I'm told that I was on 120 mg for a while when I was in the hospital in Feb 2001!) It really is weird having a pdoc question your responsibility after every pdoc you've seen before trusted you and didn't have a problem if you needed to tweak something a little on your own. Alas, I'm a terrible liar, and I don't think I could pretend to be afraid of benzo addiction and still keep a straight face.rainbowlight:
Yeah, Boston was full of psychiatrists too (there are 3 or 4 medical schools in the Boston area). What part of CA are you in? I saw a great pdoc when I was in Santa Barbara.Shelli:
I felt really validated after reading the first couple lines of your post. Thanks!You hit the nail on the head about why I can't just go find somebody else. Plus, as I mentioned, pdocs around here are such jerks about letting you interview them before making an appointment! (I think it's not really fair to demand a promise to prescribe something before they've examined you, but it'd be nice at least to get an idea of where they stand on the relevant issues.) I've actually known some very experienced pdocs who were still very petty, as well as very young pdocs who were very open-minded (is that enough verys for you?). I think it has a lot to do with the culture of the locale and of the place where they did their residency.
Seeing a pain specialist might work out. The problem, of course, is that I don't really have very severe pain! (The back pain is, well, a pain, but it's not like it prevents me from being able to function or anything. It does give me some trouble sleeping, but most docs don't take insomnia seriously enough.) I should ask my internist to prescribe something for the back pain. (He wanted me to try ketoprofen, even though I've already tried NSAIDs galore.)
BTW, trazodone and Atarax aren't controlled drugs; I wouldn't expect any pdoc (or even GP) to hassle you about those.
Bob:
I wish that anger over injustice helped relieve my anxiety! Instead, it just makes it worse. I think threatening to sue my pdoc would probably backfire. :-) But I do want to try and be upfront and assertive with her. This last time I just wasn't expecting any of this stuff -- I was speechless, as well as intimidated. Maybe I'll bring notes, like a list of points I want to make, to the next appt. (No, I'm not in the New York area; if I was, this wouldn't be happening!)Alan:
The pdoc who I saw in Boston is a psychoanalyst, and he's very concerned with confidentiality. So he took minimial notes and didn't keep a "treatment summary" or anything similar that I could hold in my hands. (Basically he makes a diagnosis and notes the times of therapy and what meds are being used. He only uses very broad diagnoses, too, and doesn't use DSM except for insurance purposes.) I'm going to call him and explain the problem, though. He's helped me a lot in the past with various things, and I think he might be able to do something here.I think one of the problems here is that this pdoc doesn't seem to believe that I know myself, how I feel, and what works for me, better than she does. :-P I'm going to try to figure out a way to convey that to her beyond all doubt. I've been looking inward and trying to understand what's wrong with me for more than ten years, and the assumptions and speculations she keeps making just seem infantile. I don't think my situation here is as extreme as the ones you described, though. She's got some dumb ideas, but she's still prescribing the stuff I need, which is the important thing; so I'm holding off on firing her for now. If she starts making real trouble, though, I'm outta there!
poster:Elizabeth
thread:103496
URL: http://www.dr-bob.org/babble/20020416/msgs/103713.html