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How much input do the pdocs let you have on meds?


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I am going to the pdoc tomorrow and I have a laundry list of meds that I want. Not meds that I wanna try but meds that I've done tons of research on and refuse to leave the office without a prescription for. lol

I have a feeling I'm going to be brutally rebuffed. they may change 1, if even, and tell me to "wait and see how that works." BLA BLA!

So how much input does your pdoc give you in consideration of meds? or are they like mine and figure I'm too "crazy" to figure I know what's best for ME?

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hmm, well. It not that you or I are too crazy to know, its that we don't have 8 years of education, and an MD degree!

Going in asking for particular meds is a bad way to approach your doc. really. It puts them on the defensive, and in those with lesser will power can even tick them off. Remember that your pdoc has rx'd the very best medication he knows of based on his education, training and experience. If we arbitrarily reject them without giving them a fair trial, we are thereby default to the second best med based on his judgement.

Now, what should you do?

- Tell your doctor what psych symptoms and problems you are having

- Tell him what medication side effects are troubling

- Tell him what concerns you may have about your particular meds

- Let your doctor respond with any comments, dosage or med changes.

If you still have questions

- Ask your doctor "are there any medications that might do better for me, or that you are considering changing to?"

- Ask, "How would drug X be different for me?

good luck. a.m.

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My pdoc sent me out the door last winter with a note for my family doc that said "Please let Castor adjust his own meds as needed" (within reason) then he retired into the sunset. Good for him, he was a good man, but I digress.

I had the "I need this" arguments with him for years before we finally found a cocktail that works for me. It still needs seasonal tweeking and every once in a while we throw something new into the rotation.

He was always willing to listen to my concerns, and he was always quite frank when talking about the meds. He only ever said "no" outright a few times and each time he backed it up.

AM is right...he has the training, but you will know what works for you. At some point we all reach compromise.

Good Luck

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The last time I let my psychiatric ARNP suggest something new (Abilify), I went into a month long mania that cost me thousands and thousands of dollars (I am SO pissed off at myself). I am back on the tried and true cocktail that I've been on for years. We both learned our lesson, I think. I have free rein to adjust my Seroquel as I see fit, based on how I feel, but the Lamictal and Effexor are hers to manage. BTW, we've been together for 4 years, and, up until the Abilify debacle, I've had no issues with her decisions.

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My pdoc is always very willing to hear my concerns about my meds (almost insists on it, in fact), but I can't imagine pitching up in her office and saying "I want xyz". I believe the pdoc-patient relationship should take a team approach, ie involve having a dialogue with each other, but never turn into a situation in which one person (patient or doctor) throws a list of demands at the other. So I completely agree with AM in saying that approaching your pdoc like this is an extremely bad idea.

Also, no matter how much research you've done, you really have no idea of how the meds you want to switch to are going to affect you. Your doctor, however, has years of experience, both in training and in treating other patients. This is why we're not all running around with doctor's degrees we bought on the internet and prescribing meds for ourselves. Research is useful and I'm all for educating ourselves, but you're essentially wanting to head down the road of self medication according to what you've been reading up on. So, share your thoughts and feelings about your current cocktail and by all means indicate you've been reading up on some meds on the net, but really -- don't sit down with the attitude that you're not going to listen to him/her because you believe you know best.

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All that I know is that if I don't get any input with a new pdoc or nurse, I'm going to give up on seeing doctors at all. I had no input while in the hospital at all, and they screwed me up. They always screw up really badly when they don't listen to me, so if they don't, it's the end of doctors and either the end of everything or the beginning of illegal online prescription buying.

Yay.

I never would have guessed that you know more than the entire battery of nurses and pdocs that have seen you. I find your attitude galling, impulsive, and childish.

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I find the way they've treated me the same way. Just randomly throwing about meds and making me sick. And not listening when I get sick. Doing everything possible to make me completely nonfunctional, oh, and not listening when things are not working and continuing to stick with them despite lovely things like EPS side effects. "Oh, Cogentin will fix you right up if it happens again".

I don't think there's one competent doctor within a 100 mile radius and I am not going to just trust them with my health because they have screwed me over one too many times. I guess it's nice being able to be sure your doctor's not going to hurt you.

Asshole.

Life shall be a cat o' nine tails to thine backside dearie.

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All right. 'Nuffa that.

My feeling is that a dialogue with ALL your healthcare providers is necessary. Recently I went to urgent care, and even there I was treated with respect in regards to the whole diabetes/bipolar/alcoholism/smoking thing. (the smoking is important, I was there for bronchitis...)

If someone is getting screwed over because no one is listening...I don't find a problem with that "attitude".

Let's not call names.

And if one feels a need to straight-out insult because someone got pissy at a pissy post, then maybe some warns will be in order. I'm an asshole and I don't play well with pissy people so don't, like, push me.

Anyways. Business aside. I talk to my doc every appointment, almost, and if a med change is in order we discuss what and why. He knows I research my meds and, *because* I'm diabetic, that adds a certain extra dimension to what I can/should/shouldn't take. For instance, all AAPs are black boxed for blood sugar issues--turns out abilify was OK, but zyprexa could kill me. Dialogue is good. My next appointment, we'll have to discuss risperdal's effects, also risp+topamax and the horrid drymouth the two combined cause, which leads me to think some sort of switch may be in order.

BUT do you think I would say "oh let's try trileptal or tegretol next?" No, I will leave that to him, as I'm sure that's what he'll say. The key is--lead him to it. If at all possible. If you don't want on something else he may suggest (for me, depakote) know why and have your arguments ready. Make them logical and non-whiny. Be prepared to bite the bullet and take what you don't want; worst case, you suffer for a couple months and go back and say "dude, this is shit, get me off it!" Better case, it works, and without icky side effects. Ya never know.

You're the boss. BUT that doesn't mean be bossy. The doc's there to help you, but he can only do so if you let him.

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I'm actually seeing a psychiatric nurse who has no true Rx power, just a nod. I went to APS (basically urgent care for loonies) and they wouldn't change anything on my med list but threw me 5 trazodone for sleep. Thanks. The pdoc did say MY pdoc is a ninny for putting me on Zyprexa when I'm already morbidly obese and for sending me to APS for something like sleep problems in the first place!

That's why I don't really trust my pdoc. I had a GREAT pdoc but she moved away and I got stuck with her boss... who knows less than her. The funny thing is that I work in health information and I am not completely blind and dumb when it comes to psych meds. Well, that, and I've been on all of em. LOL!

But seriously, I guess I'll go in and say "give me something that doesn't cause weight gain or tiredness" and let's see what they come up with. Something tells me it's gonna be what I want... Wellbutrin/Topamax/Geodon.

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It depends on the pdoc. I've had Nazi pdocs and I've had pdocs that practically handed me their prescription pads. Either end of the spectrum wasn't good for me. I've got one now that is very good and right in the middle. One that listens to me but also debates what I suggest if it isn't in my best interests. It's also my pdoc that was able to get my GP to get me referred out to my awesome endocrinologist so that maybe now I can get a handle on my hypothyroidism.

That's having your "docs" all in a row.

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Really? You really said "docs in a row"? Shame on you!

Anyway, my pdoc is a push over. I flat out tell her what I think I should take, and suddenly I have a script for it. I thought this was great, until I realized that there is a reason I don't self medicate.

I'm looking for a new pdoc right now.

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Usually when I self medicate or adjust my meds, they ask me why I've done that (ok Zyprexa made me homicidial, 5mg Risperdal makes me slur my speech and sound totally out of it so varied it to 4mg which I can tolerate etc) and I also discussed going on Lamictal at length with the pdoc (she didn't like the idea), yet that was given me that option vs Tegretol when I was in hospital recently (I chose the Lamictal).

They do seem to listen most of the time. I ask for some Diazepam, I get it etc. They seem to respect patients that do their research... just take it gently with them and explain why you want it... and how much you know about it and side effects etc and they seem to listen.

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