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How to go about firing a pdoc


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Okay, so I have been mostly stable for the past month. A couple of mild hypos (lasting for a few days) and one day of mild depression. For me this is fantastic, I feel better than I have felt for the past few years. I'm in control and able to deal with most of the little bumps life sends my way. I'm not screaming at everyone in sight, no SI, and I'm finally losing the weight I put on with Paxil (a year ago!!). I can actually think, remember, and perform well in a fast paced environment (vet clinic).

My pdoc seems to totally disregard any of these convincing arguments for leaving my cocktail alone, I think solely because he was not the one who prescribed it. The emergency consult at the ER resulted in me getting lamictal and coming off of remeron, these have both contributed to my stability. My pdoc seems to be convinced that I need to come off of the clonazepam and I have no problem with that, I don't really want to be on something that is addictive to begin with. However, he seems to feel that reducing the lamictal and upping the valproic acid is a good plan. Why? I don't know, I'm stable as is.

He also feels the need to add an AD for the mild depression I experienced. We're talking actual mild, I feel crappy, no energy, negative thought depression that goes away in a few days. Not my typical depression where I cannot function and contemplate suicide. So, he's prescribed ZOLOFT! I flipped out on prozac, and paxil turned me in to a panicky mess. I don't think SSRIs and I play well together.

He's also totally disregarding the fact that I cannot handle putting on weight. I've talked to him about my food restricting, bingeing, and purging. I have these disordered thoughts under control now and am losing weight in a sane manner through proper eating and exercise. If I put on a ton of weight on meds it's going to send me in to a seriously negative place where I will likely head straight back to never-diagnosed anorexia land. This doesn't seem to factor in to his decision making at all. He's prescribed zyprexa for my mild anxiety and sleeplessness.

All I really wanted out of this appointment was a med refill and something to stop the trembling in my hands so that I could do lab work again. Instead, I got a complete overhaul of my meds that make me stable.

I'm really not a difficult patient, I'm extremely med compliant and usually follow directions quite well. I fully acknowledge that I have not trained to deal with mental health issues and do not know the complexities of treating them. However, I really feel that if the meds are working and I feel comfortable we shouldn't mess around with it. I really enjoy being able to function.

What are the best ways to fire my pdoc? I'm going to cancel my next appointment, I cannot deal with a doctor that doesn't listen to me. He asked me how my new job is going, I've been at my job for 3 years!! He was going to prescribe risperdal for me again, I had to remind him that it made me lactate. It's all in my file which he can't be bothered to read.

When I call the other pdocs listed in the phone book do I tell them that I am switching pdocs? Do I just keep quiet about it? My gdoc isn't comfortable dealing with bp so talking to him is out of the question, but he's a fantastic doctor so I might try explaining things to him again. Do I just say screw it b/c I'm moving in a few months and keep getting med refills from the walk in clinic?

Sorry for the long rant, but I feel worse than I have in weeks. I feel ignored, and diminished by his total disregard for my opinion. I really want to cry, binge, and maybe SI. However, I'm not going to do anything except cry and clean the house because I'm actually on meds that help. Dammit.

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Heya Alissha,

1. If you're not comfortable with your psychiatrist, and you've tried to discuss this with him and he's nonresponsive, hey, get another one.

1b. However. Coming off clonazepam is a good plan, as you say. But, I can tell you're uncomfortable decreasing the Lamictal. And yeah, Lamictal is my favourite drug b/c I'm not depressed since I started it. What's your psych's rationale for that move?

1c. That said, are you underweight right now? B/c a common strategy for docs dealing with a patient who has comorbid mood and eating disorders is to Rx a mood med that stimulates appetite. Be straight with yourself about this. And ask your psych about it.

At any rate, if you really want to switch docs.

2. If you can, chat with your family doc about it. He/she might have an idea about who/where you can call for a referral.

3. If your (like my brilliant and caring but inexperienced) family doc isn't sure, is there a way you can find out who saw you in emerg? That doc or someone he/she works with might be available to see you.

4. If you start calling psychs -- well, you'll get all different kinds of approaches around here. Personally I would think that the first phone conversation should only involve .does the doc take new patients .what's the wait time .does the doc have experience with your disorder(s) .can you make an appointment please.

4b. I made the (bonehead rookie OMG-I-can't-believe-I-did-that-and-here-I-am-a-doctor-fercrissakes) mistake of being *too* open on the phone with a potential new therapist and ended up with a whole new diagnosis and a treatment plan over the phone.

5. At your first visit with a new doc it's a good idea to disclose your previous docs. At some point your new doc is going to chat with you about why you left the previous one, which is okay. Trust me, we (docs) see red flags all over the place when a patient doesn't want to tell us about previous docs.

6. Hey, if you're actually feeling stable, are moving soon, and have a family doc who can at least monitor how you're doing ... Not a bad plan (assuming you know where you're moving to) to start looking *now* for a family doc and a psychiatrist.

Bleh, making a lot of lists today. I should try the house-cleaning thing. Seems popular today for some reason.

--ncc--

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I got a referal from my therapist and just stopped going to my old P-doc. I asked my new p-doc if I should write a letter or anything and she said she'd let her know when she requested my records.

Tommy

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ncc said it all brilliantly. I've had reason to leave 2 pdocs in the past and though I felt bad about it (I just do; I'm a people-pleaser type), I also just went the route of cancelling the appointments and moving on. I've wound up with a great doc who believes in patient rights and actually listens to what I say.

You don't owe your current pdoc a thing if you're uncomfortable with your treatment and don't feel heard. Don't wait too long on this though - it sounds as though your moods are starting to wobble off course.

take care,

Skittle

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Well, I've definitely calmed down since the last post. I'm really uncomfortable with this pdoc, and if I'm honest I've never felt comfortable. It feels like he's pushing me out the door before I've even opened my mouth.

I'm at a healthy weight right now, well within normal range (5'4, 120 lbs). I would like to be more fit than I am and maybe have a bit less jiggle:) . I'm trying my best to eat lots of fruits and veggies, whole grains, and good quality protein. I've been tracking everything on fitday with realistic goals set for my intake of protein, fats, carbs, and calories. I've been very focused on meeting my nutritional requirements.

I'm going to make an appointment with my family doctor and see if he has any recommendations. He's a wonderful doctor and person who has never made me feel uncomfortable or ignored. He knows who I am, what I'm interested in, and what my life is like. One of the things I'm going to miss most about this city is my regular doctor.

I just can't handle med changes on top of the financial difficulties I'm having right now. I'm working so hard on being healthy and I feel like this pdoc isn't going to be helpful. I found at least two other pdocs listed in the phone book, hopefully one of them is taking new patients.

I'm usually not the type to rant about doctors, I know so many who work really hard and do everything they can for their patients. I've never had anything but amazing family doctors, so maybe my standards are a bit high. I just want someone who is going to let me take an active role in my treatment, not someone who tells me knowing too much about potential treatments/meds might be a bad thing. I'm a biologist by training, I research everything obsessively.

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