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Afraid My Doc Will Leave Me

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I'm having a lot of trouble sleeping recently, mostly because I am worrying a lot about my Mom's recent surgery and her breast cancer diagnosis. I need some kind of medical help with the anxiety I'm experiencing, but I'm afraid to tell me primary doc about it. Here's why:

I am prescribed Adderall 60mg a day and Citalopram 20mg. If I go in complaining of anxiety and sleep problems, I'm almost positive she will say that I need to go see a specialist, hand me a referral and tell me that she can't help me anymore. This would be terrible and devastating for me as I work/commute 12 hours a day, don't have a car or license, and very little PTO at my job.

My last doc almost left me when I told him I was having trouble sleeping, and basically wanted me to choose between going to see a specialist or reducing the Adderall dose. Adding something in temporarily for sleep was completely out of the question since it would involve the terrifying prospect of polypharmacy. I'm thinking of just going to see another doc close to my apartment, but is that frowned upon? Will I get in trouble with my primary doc if I don't want to see her for a particular issue? Will the other doc be suspicious that I'm not going to see my primary doc for this issue?

Basically, I need something on a short term basis to deal with this anxiety, which would probably include adding a sedative (benzo or hypnotic) to a stimulant (Adderall). In my experience, this causes the primary doc to push you out the door as soon as possible; that they can only treat one condition, and that multiple psychiatric symptoms require the care of a specialist; that they can't help you now, you have to go somewhere else. This makes sense in a vacuum, but for me is not feasible, for not only the distance but the fact that I have to pay $5000 deductible for specialist care, and that's money I simply do not have.

I'm really sorry for the disorganized post, it isn't very respectful of me to not structure this a little better. I'm just really tired and need some help.

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I have to pay $5000 deductible for specialist care, and that's money I simply do not have.

At least you do not have to pay it all at once. Primary care docs prescribing multiple scheduled psycomeds is indeed unlikely. I hate to say it but I think you need to see a pdoc. You seem to be able to find docs that you seem to have a way of getting to, could you look for a pdoc in your area ? Still I would not second guess your doc, your needs are short term so they may be more likely to prescribe something. Trazadone or Doxapin would be a non-scheduled option.

nf

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Simply explain that you're in a stressful situation and ask if your doc would mind giving you a benzo temporarily. While also making it clear that your current cocktail works and that it's only the added stress that's making you feel this way. Then ask for lunesta/sonata for sleep. (Those two are pretty mild)

Worst case, they say no. I see no reason to kick you out the door with a request like this.

I disapprove of seeing other doctors. However, if you decide to do that anyway, you don't have to tell them that you're seeing someone else. But, again.. I really think you shouldn't.

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My gp explained it very well to me... he said, if you came to me w/ a broken arm... I'd send you to a specialist, I just don't set and cast bones in the office here. Made so much sense. It sounds like you have gained some knowledge about your condition and possible medications. GP's are supposed to think horses when they hear hoofbeats... specialists exists to tease out the zebras. I thought it was a conspiracy for decades. It's not.

Edited to add... I read the book How Doctors Think.... after years of animosity towards the medical community it changed the way I interact with them... they are people, many areas of medicine aren't perfect.... etc. Oh, and docs have egos... if you go in to see a doc and tell him what you have and what you need.... the walls often go up. Be real... be yourself ... just let go and go "fluuuurp" ... "I don't know what to do doc, what would you suggest?" I often write out a 1-3 page summary of the situation before I go because I can be a bit flighty.

Edited by instamattic

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It really sounds like you need a pdoc at this point. Maybe your gp will be comfortable prescribing something for anxiety. But if she isn't, just go see the pdoc. You can find a way to make it work. You won't have to pay the whole deductible at once. If you're able to get time away from work to see your GP, I don't see why you shouldn't be able to manage to see a pdoc.

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Your post was not at all "disorganized". I hope you are able to find a solution soon. I don't know where you live but do you have a trusted friend who would be able to get you to an affordable mental health care facility? We have local mental health clinics here who do sliding fee schedules here.

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I have to pay $5000 deductible for specialist care, and that's money I simply do not have.

It is unlikely you will spend that much in a years pdoc visits. The first visit will be the most expensive and from then on it tends to be 10-15 min. med checks. My doc does not take insurance and I am out about $300 a year. If it were on my insurance the copays would be about $200 a year. Not a big difference for far better care.

nf

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Thanks for the replies everyone. I think I need a pdoc. How would I go about transitioning from my primary doc to a pdoc? I have a list of ones that are in network, but I really don't know which one to pick. Maybe my primary doc will just give me a referral? (although I'm not sure if that particular doc would be in my network). Do you need to have an office visit for a referral? (my insurance doesn't actually require a referral). How do you know which pdoc to go and see? Would the pdoc at least initially continue the meds I'm on?

Thanks again everyone, you all are really saving my life right now.

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This probably sounds dumb, but where do I begin? When I call one of the doc's offices, should I say I want to interview one of their doctors? I'm a pretty shy person by nature, how do they respond to this? I imagine some would with hostility, confusion or an unpleasant mix of the two? I've always kind of tip toed around doctors, careful not to offend them into rejecting me. What's the etiquette on asking about specific drugs? Is there a good resource for starting this whole process? Seems difficult to do when in a crappy mental state.

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Your Citalopram dose is still pretty low. Increasing it could help a lot with the anxiety.

60 mgs of adderall is a lot. How is it divided and when do you take it?

This probably sounds dumb, but where do I begin? When I call one of the doc's offices, should I say I want to interview one of their doctors? I'm a pretty shy person by nature, how do they respond to this? I imagine some would with hostility, confusion or an unpleasant mix of the two? I've always kind of tip toed around doctors, careful not to offend them into rejecting me. What's the etiquette on asking about specific drugs? Is there a good resource for starting this whole process? Seems difficult to do when in a crappy mental state.

The first step is to call your insurance company and find out who is in network. Then call and find who can get you in the soonest. Most people don't have room to be real picky unless they are paying out of pocket.

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Do what sylvan says.

And, I'd disagree with VE, honestly. With insurance (granted, I have cadillac insurance) I was able to get, I think, 4 interviews with pdocs to decide who was best for me. I'd say that's a fair amount of choice, right there.

It's a matter of persistence though..... to get those 4 appts, I probably had to call 20 dr offices, as many were not taking new pts.

Anna

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I've moved around a lot for work so have had to find new pdocs every few years. I've had just as much luck picking someone off the insurance list / out of the yellow pages as I have from referrals. My current pdoc, who is my all time favorite, I found in the yellow pages. I have never tried to interview anyone over the phone, but use the initial visit as my resource for deciding if the doctor and I will click.

I would not go into an initial visit with anything stronger than a suggestion of "I think I might have xyz...". Let the doctor do their job and use their training and experience to come up with a treatment plan and possible diagnosis. I think you you are making a mistake to consider polypharmacy terrifying. Since you're already taking two meds, you're currently experiencing polypharmcy, or am I missing something? Polypharmacy is wonderful on the right combo of meds.

The main question I have when calling around is 'Are they taking new patients?' If the answer is yes, then the next question is when they can see me. If it's more than a couple of weeks, I keep calling. Since you have time enough to see your GP, then you should be able to find time to see a pdoc as well. No one but you needs to know that's what you're doing, you don't have to explain yourself, other than to say you have a medical appointment.

If I were you, I would quit thinking about it so much and just make the call and get it over with. It will be much less stressful to take action instead of constantly mulling it over.

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you must tell your new doctor the same thing you told us.... and he will give you the benzos. you have a reason to take them and you don't even have to tell him about the adderall

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you must tell your new doctor the same thing you told us.... and he will give you the benzos. you have a reason to take them and you don't even have to tell him about the adderall

Uh... that would be bad.

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I'm trying to provide immediat releave. Not bad at all on my opinion. Just showing a way to take advantage of your technical capabilities.

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I'm trying to provide immediat releave. Not bad at all on my opinion. Just showing a way to take advantage of your technical capabilities.

You have a right to your opinion, but we do not condone non-compliance/lying to your pdoc here. To suggest that another member do so is inappropriate.

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I'm trying to provide immediat releave. Not bad at all on my opinion. Just showing a way to take advantage of your technical capabilities.

It's really quite dangerous not to tell a doctor who's going to be prescribing medication for you everything you're currently taking. Please do not repeat this advice here in the future.

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I contacted my primary care doc, and she seems pretty open to treatment. I told her about my sleeping problems as of late and she prescribed zolpidem 10mg every other night ( a pretty conservative approach, not that there's anything wrong with that). She said she's open to other meds too (benzos) but she wants to see how this goes. She reacted a lot better than I thought. I think as long as its temporary (i.e. not a lifelong treatment regimen) primary docs are usually okay with it.

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