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Listen before you prescribe!

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I had my "first" appointment with a psychiatrist about a month ago. And by first I mean the first that I wasn't forced into.

Anyway, we talked for about five minutes...she basically just went through a list of questions and prescribed Lamictal,Ativan and Ambien for me. There was so much about my screwed up way of thinking/acting that I didn't even get a chance to tell her. She prescribed the lamictal starter kit for me, Ativan (that doesn't do anything except make me tired) for when I'm feel manic and Ambien because I can't sleep because I'm "always" manic. ;)

First of all, I was thinking, shouldn't I get more than five minutes to talk? (And it really was only five minutes, I kept watching the clock)

I feel manic about 60% of the time, suicidal most of the time, hallucinate when I'm stressing out extra, have a eating disorder, and PTSD.

So especially for the first appointment, shouldn't I get more time?

Should I maybe make a list of things I think she should know and bring it with me next time?

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It seems a lot of P-docs are doing more quick "med-checks" these days (as opposed med-checks and therapy), due to the amount of money they are being re-imbursed by insurance companies for patient care (in the U.S. anyway). It's truly unfortunate.

Is this really your problem, though? No.

I'd inquire at this P-doc's office (diplomatically) if what you experienced is normal "procedure" with all new patients. Because all P-docs don't run their practice that way, and you don't have to put up with it.

Some patients like it, others don't.

My doctor didn't give me a diagnosis for 3 weeks (after I'd seen him 3 times, for an hour each time. Although he did prescribe an anti-depressant.) Five minutes certainly sounds "rushed" to me.

I don't know all of the circumstances, but still. Five minutes? For a brand new patient? Hmmm. This does not smack of a doctor treating you as particulary valuable; more like a commodity, IMO (and I wouldn't particularly care what the "justifiable" reason for it might be.)

Part of my fears in going to a P-doc include being mis-diagnosed (I've been diagnostically mis-labelled as having a few psychiatric illnesses that I definitely do not have) Unfortunately, it took several years to discover this. I told my currrent doctor about this -and I found that he did listen.

Just how is this type of P-doc behavior that you described, supposed to foster doctor-patient bonding? First impressions count. This kind of assembly-line "patient processing" does not bode well for establishing further doctor-patient trust.

Is it your job to have to hit the P-doc over the head w/a hammer (so to speak), to make them realize this? Not really. You can "just leave". You really can. When I discovered this, it was very liberating.

I am big on having a P-doc who truly listens to me. Mine does therapy, as well as prescribing meds (my P-doc is also my therapist.) At the end of our 2nd appointment, my current (very competent) P-doc asked me: "Do you think we can work together, as a team?" How charming of him to ask.

If it didn't seem like that was happening (or ever would), and it's what you want, then I suggest you seek a different P-doc who will do that. It took me awhile to find mine, but ask around for referrals (check at colleges; schools of social work, med schools, friends who might know someone, etc.)

Then check w/the offices of these new potential resources - call to ask (either the office manager, or the P-doc, or both) how they "process new patients". If they act like you're weird for asking how long a P-doc normally sees a new patient, don't let that put you off - you have a right to know. They're asking for your money, after all.

When you find some that sound promising, see which ones accept your type of insurance, or will do "sliding scale" as far as fees (low fees, acc. to your income, if that's what you need). Then make your choice, and give a new one a try. That's what I did.

Still, this was a first appointment, and there really are P-docs out there who really do "know their stuff" as far as being very, very experienced w/meds. Maybe it's worth it to stay w/this one - despite the bad first impression - I don't know all of the details, of "how it all went down". (But still - five minutes?..first impressions count. Trust your gut intuition. You do need to be able to "work w/your P-doc".)

If what you are feeling right now is un-bearable, due to your meds, and you just cannot stand it - then call your P-doc now.

If "talk therapy" is what you were originally seeking, as well as meds - seek out a P-doc who can give that to you.

If after 4-6 weeks, your meds aren't working all that well, and this P-doc gives you no new alternatives, or reasonable explanation re: Why your med regimen cannot change - then you can bet, if it was me, I'd definitely leave and seek a new doctor.

**However, if you really, really feel totally weird on these meds, so much so that you consider it to be an "emergency", I'd not hesitate to call their office (or an emergency phone number for that P-doc) right away.

Have you tried most of these meds before? (and if so, were you feeling then like you are feeling now, when you tried them?)

If so, what did the P-doc say when you told them that?

If they wanted you to try them again, what was the explanation? Did you get one? Did you ask for one?

If not at all, I'd say that's poor "customer service." Time to find someone who can listen.

If this is true for you, you can call their office and voice your opinion on all of this, if you want, before you opt out of there, and give them another chance (if they want one).

It amuses me sometimes, how truly bad doctors think their "work" warrants auto-respect.

Well, not if it sucks, it doesn't. I know med school is probably tough, I really do respect how many grinding hours of study it took, etc. - and I do know some good P-docs (my current one is very good).

But I also know some truly bad ones.

It's a consumer-driven economy. Patients are consumers. Wake up bad P-docs!

Hang in there. And welcome to crazyboards!

- Susan

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I agree. I wrote little pages about how I was feeling, (generally, and in response to my meds) for my first 6 appointments, and just gave it to my current P-doc to read. Sometimes, I still do it.

It was nice for him to have, and I could tell he appreciated me doing that - because he could refer back to it, before I saw him for the next appointment, too (he didn't say that, but it's partly why I did it. He definitely used these pages I wrote for him. By that time, he was starting to "grow on me" as a P-doc, and I decided to stay on with him, as a patient.)

- Susan

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