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I see a lot of advice on this forum that results in "call your pdoc right now". Can most of you do that? I couldn't. My only access to my pdoc is through her office, and it is VERY hard to express a problem with them. I've called in emergency situations, and more or less got a "we can't move up your appointment" reply.

It never occured to me that this isn't how dealing with a pdoc normally goes until reading this board.

With mine, I only see her when I'm scheduled, I'm quite certain she isn't getting my messages (through her office, I don't have any other way to reach her), and I have yet to be successful in moving an appointment forward, no matter how dire the reasoning.

So, is call your doc "right now" a valid option for most people? Should I be looking for someone new, or maybe I'm not assertive enough (which is likely).

Anyway, input would be appreciated.

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I think it depends on the doc's setting and staff.

I have my psyMD's cell phone for emergencies, emergencies that are bad enough I think it's worth calling her cell phone, and I have used it for that reason exactly once, when I was admitted for a severe drug reaction.

She has a very busy practice in a largish town, and it can take a couple of days to get a callback for a non-urgent call. She just doesn't have time to work through the callbacks, and her callback time is often used for emergency appointments. This is why she sometimes calls back at... 10 pm, when she is getting to the calls. She warned me about this at the first visit.

Her RN, who also runs the front desk, calls back if I have a simple question. She calls back as soon as psyMD gives her the info. I always say (when applicable, which is most of the time) that it's OK if RN calls me when I leave the message, but psyMD calls back much of the time.

If I need an emergency appointment, they put me on the cancellation list for the days I am in town.

My friend works at the community mental health center. They're so swamped that it's amazing anyone ever answers the phone. She can take up to a week to return a call (or delegate it out.) But when you see 18 patients/day, every day, up to 22 with emergency work-ins, that's not surprising.

Have you talked to her about your concerns? She might not know that it's a problem - the front desk's operations are often not well-known to the clinician. Seriously.

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rzettler i feel exactly the same when i read those comments.... i just think no way would i call my pdoc unless it was an absolute utter emergency. and most of the things it's said about i wouldn't call an absolue utter emergency. i always just wait til my scheduled appointment comes up. often i'll call and ask for a sooner appointment and they'll put me on a waiting list, but that's the extent of it. and yeah, i don't think it's ever been moved up either. plus, my pdoc is pretty much always away when something comes up. it's really frustrating!

and also most of the time when i'm freaking out about something i'm too paranoid i'm just being paranoid, and that my pdoc is going to get really pissed of with me bothering her about nothing.

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Yes, I'm one of those people. If I call my pdoc during the day she'll either take my call immediately or respond within a few hours in between patients. After hours there is always someone on emergency duty and that person's cell number is readily available to be used in a crisis. It's also not as though she has a quiet practice - this is just the way she chooses to deal with her patients.

I also have virtually instant access to my tdoc because I have her cellphone # and she's programmed my details into her phone.

I know though that I'm exceptionally lucky with this.

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i was so scared when i first started seeing my p-doc to call out of my schedule time for anything

now u couldn't stop me from calling - i dont call over trivial matters and if it something that doesnt need an urgent reply the girls in his office will normally give him the message and they will call back wit an answer, but if its serious we have set it up so i can get in contact wit him.

talk to your doc about what plans u can have for in between appointments this is VERY important, u need to know what to do in between cause u cant conviently schedule your bad days in time wit appointments. i have a set up wit my doc that if i for some reason cant get in to see him (his out of office, at hospital etc etc) i see a local gp that has mental health training and this only cost no more then $20 and then he can contact my p-doc via letter/phone and i am ensured immediate medical attention wit out going to hospital

your plan will depend on your situation, your doc and what resources are available but u need to be honest and up front with the dr and his/her staff if u want to get help and are in need - they cant guess that when u call sometimes u got to spell it out but afta a few times they will understand when u r in need

many ways docs contact outside of scheduled hours ie phone, email, after hours people.

i feel since i was honest wit my doc and contacted him when i needed him i have a much better dr/patient relationship and i have made more improvements over this time.

good luck wit it

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I've found it really helpful to have a pdoc I can call, and if it's at all possible I really recommend trying to find one. I wouldn't have called any of my pdocs because they didn't offer, and I have a hard time calling people on the phone to begin with.

A lot of times when I tell people to call their pdoc it's because it's the best thing available to do, or because they're having a problem that non-pdocs can't help with. It's true that it's not feasible for everyone, and I wish that in those situations I had advice to give to people that was easier to carry out. But sometimes there's no advice like that to give.

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I regularly email with my pdoc between appointments as per his request. I am also encouraged to call if I need to and have both his direct office line and home number. He goes above and beyond though. He's wonderful and has me as close to stable as I've been yet.

I saw my last pdoc once a month and if I tried to leave a message via his secretary in between it was useless. I had no other method of contact. For side effect issues with drugs HE prescribed, I was told it was unrelated and to see my GP. He didn't come close to stabilizing me in the 6 months I was seeing him. This guy is very well respected and has helped alot of people regardless. He's just not "my type". I need closer care I suppose.

I think pdocs come in all flavours and you have to find what level of attention you require for the severity of your illness.

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rzettler i feel exactly the same when i read those comments.... i just think no way would i call my pdoc unless it was an absolute utter emergency. and most of the things it's said about i wouldn't call an absolue utter emergency.

Bear in mind that sometimes people have asked about very minor side effects that don't seem too bothersome by themselves, but which were major warning signs with their particular medication or condition. Two examples would be Stevens-Johnson Syndrome and temporal-lobe seizures: either one can go from "possible risk" to "medical emergency" with very little advance notice, so the person needs to talk to a doctor familiar with their case as soon as possible.

As unnerving as it is, there have been times I've called to arrange to walk in for a script and the doctor has picked up the phone instead of the staff. A couple of times I have called to ask if I should bother getting an appointment and been told to come in, they'd work me in. Because my doctor keeps late office hours (maybe that works better for his office partner?) he stays busy.

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My pdoc is absolutely horrible at returning phone calls. I discussed this with him and requested his email address. Now I email him and he will always get back to me ( within a day usually). I think its a new generation of docs who are more high tech- he definately checks his email a whole lot more than his voicemail!

(and of course his voicemail says if this is an emergency go to an emergency room.This drives me nuts- yes its might be an emergency but not enough to warrant 8hrs in an ER-next stop GP if necessary- he always gets back to me.)

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My last pdoc was very responsive and I could call when I needed help and he would either calm me down over the phone or move up my appointment.

The pdoc I have now is more like you describe. I leave messages, but he doesn't get back to me. I think part of it is it is hard to express what I'm experiencing to his staff. I did get in for an emergency appointment once (he saw me the day I called) because I was starting to hallucinate again and he adjusted my meds.

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What I can't quite grasp is the fact that many of the people here have pdocs who expect that they should just describe their issues to the pdoc's office staff. Unless one of them is another medical professional who is being kept into the loop with a particular patient's case, I think it's a complete invasion of privacy. My pdoc just has an admin assistant and I wouldn't dream of explaining to her why I'm calling, because it's actually none of her business.

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"Why do I tell people to call their pdoc?"

- First, remember that CrazyBoards is not medical advice. It's just a bunch of loonies hanging out on a park bench commiserating. So when someone has what I consider a significant issue, I refer them to their doctor or the ER.

- Suicidal

- Switching into mania, hypomania, or mixed state (for bipolars)

- Significant med side effect

- For bipolars, one of the major goals in controlling the illness is learning to recognize "prodromes", i.e. signs, of mood switching, and then taking action, medwise, to counter act them. Allowing episodes to develop is bad, because unchecked the episodes escalate and the illness in general gets worse.

Now, there are people who call their pdoc or tdco willy nilly at all times of the day or night and expect to have deep heart to heart conversations. Those people are abusing their doctors and make it more difficult for everyone to get service. On the other hand, delaying 3 months for your next scheduled appointment with the pdoc, when you have been awake for 5 days and on a manic tear is not smart either.

My expectation of how things should go:

- You should discuss with your pdoc/tdoc, what situations they want you to call in.

- What are emergencies and what should you do? (My pdoc doesn't take after hours/weekend calls. If it's an emergency she tells me to go to ER. If it's not bad enough for ER, then it's not an emergency and it can wait till business hours).

- What are the docs policies on Rx refills, lost meds for nights and weekends?

- I expect that when I call, the secretary will take a message from me describing my problem/question

- I expect that the doctor will either call me back, or have the secretary call me and deliver a message from the doc, in a reasonable time perhaps as late as the next day.

- I expect that the doc will have looked at my message, and prioritized it so that if it was an emergency she would call me back quickly, and if I don't hear anything, that should reassure me that my situation probably isn't critical

- If you call and don't get returns, be sure to mention that to the doc at your next appointment. That lets the doc know what is going on with the office processes. Could be the doc forgot, the secretary is dropping message or not making return calls, or maybe the doc will counsel you on appropriateness of your calls

Now, I'm a bit stoic. I don't call her. I don't even call her when she says "Call me next week and let me know how you are doing". I didn't call her during my last manic episode (took lashings for that and learned my lesson). So, I probably have a reputation with her, that if I call between appointments she is going to take me seriously. (Those she has said she doesn't take seriously: patients who call at 9 pm on a Sunday night looking for more benzos). I think she is concientious about returning calls, because I have had her call me several times at 7 pm from her office to check on me. On the other hand, my therapist was a granola crunching Mr. Mom, who gave me his beeper number, told me to call him anytime, and that he would see me any day of the week between appointments.

I've worked in a medical office for five years. Practitioners are different. Some run in a constant state of chaos with jammed waiting rooms, and patients have to lie, cheat or steal to get seen. Yet another one will run an appointment calendar like clockwork and still have plenty of room to work in emergencies and return calls. :shrug:

Bottom line: Call when you need to. Don't abuse the phone. Find out when your doc wants you call, and what your emergency plan should be.

best, a.m.

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I am in the UK and have an NHS pdoc.

I can call and leave a telephone message with the receptionists, but my pdoc is bad at calling back and while I can bring appointments forward, if I have a crisis, I will go to my GP, as I am not successful in bringing appts forward either.

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MiaB,

As admin staff for mental health services, I can reassure you that in the most case, we are trained to be discreet, understanding and we do know a fair bit about mental health. While you may feel your issue ought to go direct to your pdoc, they will likely be in appts or clinics. If people will let admin staff take their full messages, admin can then pass the info on and help pdocs get back quicker in a lot cases. A pdoc will not prioritize a simple call back as high as they would if I came to them and explain so and so called and is having X set of symptoms. Admin staff are held to strict confidentiality and are no more careless with your info than a pdoc is.

Admin staff are not all prejudiced stupid buffoons. To work in a mental health environment, you need to have a certain set of qualities, and I, and my colleagues are not unrepresentative of the concern and care we show for our patients.

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What I can't quite grasp is the expectation that many of the people here have pdocs who expect that they should just describe their issues to the pdoc's office staff. Unless one of them is another medical professional who is being kept into the loop with a particular patient's case, I think it's a complete invasion of privacy. My pdoc just has an admin assistant and I wouldn't dream of explaining to her why I'm calling, because it's actually none of her business.

That is your choice to not disclose anything. However, realize that you may be delaying getting a response to your call and help with your problem.

Consider the doctors priority:

- "Call from Mrs. Jones, severe trembling, do you want to decrease medication?"

- "Call from Mrs. Smith. Won't tell me what is wrong, wants to speak to Pdoc".

Which is going to get an immediate answer? Which is going to sit on the doctor's desk till after appointment hours are done?

The doctors staff is every bit a part of the medical system as the doctor. They are trained to be discrete, and held to the same medical privacy laws. They are not busybodies sitting around waiting to gossip about your personal life. They are going to handle your chart, file the doctors dictation, prepare your medical bills, make your appointments, and order your Rxs to the pharmacy. You are just one of 50 patients they are going to have contact with, and they will handle you in a professional manner. Realize too that the staff develops expertise in assesing the urgency of your situation, and can help get you immediate action, or connect you with the right doctor.

Certainly you won't go into the level of detail with the receptionist that you would with the doctor. Thats not even desired. You should be able to distill your problem to a sentence or two that can be passed to the doctor and readily understood.

- "I'm having severe anxiety attacks for the last 2 days, slept only 3 hours, haven't eaten in 4 days and its getting worse. Does the doctor have a medication recommendation?". NOT, your life history, dreams aspirations and a narrative of the event that gave you PTSD.... You get the idea.

a.m.

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I have trouble calling my doctor, but I do.

THere have been times when people here told me to call my doctor and I'm glad that I did because I wouldn't have otherwise. For the most part he is very responsive and I think that is because I have called with valid concerns, but also because he's a good doctor.

I think that if your doctor isn't returning your calls, this is a BIG problem. You should talk to them about it and find out why- if there is a problem in the office or if there is a problem with the doctor. Either way it should be fixed. Not that your doctor should be at your every beck and call but they should be reasonably accessible when needed.

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I've called in emergency situations, and more or less got a "we can't move up your appointment" reply.
This is ridiculous and unacceptable. If you call a doc's office and tell them you are suicidal and you get a "You can't move your appt up" response, get yourself a new doc. If nothing else the doc's office has a legal obligation to act when you tell them you are suicidal. If you kill yourself, they are liable. I agree with what AM said about reasons to call. If you're calling for other than an emergency, then it can be understandable to wait. But sitting and being miserable because you're self-conscious just compounds the problem and delays feeling better.

My doc will get back to me usually the same business day if I call. If I call and say I'm suicidal, which I did exactly 4 weeks ago, I usually get the next free time he has. I am sure that if I had called when he wasn't in and left a message I would have gotten a call once someone checked it. I have no problem with telling support staff that I'm suicidal, they are used to it. And they abide by the same HIPPAA rules as the doc. At my doc's office, the support staff answers the voicemail, so whatever I think I'm telling my doc goes by them anyway. It is their business to respond to patients in a crisis. If I'm OK I'll blow off the "Call me in a week" thing too. No news is good news. If it is truly an emergency and you can't get in touch with your doc, suck it up and go to the ER. Waiting in a safe place is better than suffering in a potentially dangerous place.

Definitely have a talk with your doc at the next appt and tell him your displeasure at being blown off. You have to take your treatment in your own hands and do what is best for you. Screw however inconvenient your suicidality is to others or how inconvenient you perceive it to be. Get help when you need it.

First, remember that CrazyBoards is not medical advice. It's just a bunch of loonies hanging out on a park bench commiserating.
Yeah, that pretty much sums it up!!
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oh for god's sake, I never SAID admin staff were "prejudiced stupid buffoons" or "busybodies". Maybe it just works differently in South Africa, but none of the pdocs I've seen over the years has ever required me to explain anything to their staff, and quite frankly, I wouldn't be comfortable doing so. I like my pdoc's admin assistant, but the closest I'd come to sharing information would be to say "this is an emergency, and I need Dr X to be informed of that asap". As I stated in my first post, I've never had a problem with my pdoc (who I've now been seeing for nearly 4 years) calling me within more than 2 or 3 hours, and as I also said, I know I'm exceptionally lucky in having this kind of service.

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Maybe it just works differently in South Africa, but none of the pdocs I've seen over the years has ever required me to explain anything to their staff, and quite frankly, I wouldn't be comfortable doing so.

Obviously most things work differently in South Africa, even water in the toilet swirls backwards.

Here, it's that staff you wouldn't want to talk to that arranges referrals, handles insurance claims, deals with the addict in the lobby trying to scam more drugs, photocopies test results, transfers records among the necessary offices, everything except treat the patient ... After liability insurance and facility costs, some doctors make out alright but few can afford more than a minimal number of personnel. So those personnel have to be more responsible than Joe Wageslave temping for minimum wage and benefits, and far more responsible than you give them credit for.

Then again, if you're worrying about maintaining your comfort levels when you call the office, it's not an emergency.

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Actually I was a little embarrassed when I called in during a crisis (at least for me) telling the receptionist that I was calling because sometimes I see and hear things that aren't there and I was having one of those times. She was professional about it and set up an evening appointment for me.

There are things I don't like about my pdoc, but he seems to be good with meds and he listens to my requests for trying different medications. When I was first diagnosed, I wasn't very stable and I needed someone I could get ahold of readily, but I feel like the pros outweigh the cons of seeing him. I bring my husband when I want to bring something to my pdocs attention (like I was having nightly anxiety attacks) because I worry I downplay things.

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