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First a guide to what those letters stand for if you're not familiar (I didn't feel like writing it out). I'm a writer so be patient as I tell my story that has no traceable personal info.

PA: Physician's Assistant

MD: Medical Doctor. In psychiatry, he or she is the psychiatrist.

NP: Nurse Practitioner.

I guess I should mention that I have depression, general anxiety, and some OCD.

I am not an expert, but I believe NPs and PAs (I know this for certain) work under the supervision of a psychiatrist. I have had a variety of both and some are better than others, no matter what their training. I saw an MD who is ranked as being the best in the field locally but I only saw him every four months and he rescheduled constantly. I felt like I barely knew him. 

 

When I wasn't seeing him I saw his PA and loved her. She was a little brash and completely different from her boss. I could talk to her more easily and felt like she was helping me. So when she left I followed her.

 

The thing is she isn't perfect. I still got good treatment and she was able to talk to me more. Her "style" is extremely interesting. She doesn't ask me twenty questions straight off the bat such as "How much sleep do you get?" or "Any thoughts of suicide recently" which made squirm. Instead she would ask me about school, how my family, and if I was getting out enough. It sounded like counselling session, but she would suddenly pull out her pad close near the end and describe what she wanted put me on. I realized I was answering all the same questions but in a narrative form. I liked her but I had a bad feeling that she may be be "leaving" soon and made an appointment with a "brilliant" psychiatrists recommended by my therapist. Sure enough, I got a call saying she had left the practice not long afterwards.

 

I like the guy I am with now more than the last MD as I can get in to see him regularly and him and only him. He's not as personal which I didn't mind because I trusted him and he is very nice. I get to talk about what is going on my life but not as in depth. He is more methodical and describes how each med. works typically. And I was excited because he didn't think I sounded depressed.

 

I don't think he has helped me at all. Nothing has changed. He put me on clomipramene and that knocked me out for three days during the week I had three papers due. My therapist talked me into staying with him, but I don't trust him. I have had some family problems recently and it is difficult to weed out what will go away and what needs to be treated. He has me on Paxil and I have no idea whether it is helping me because it takes six weeks to go through and I am four weeks in.

 

I got so frustrated after this past week of lack of productivity in school I decided to pull out the cell phone number for the PA. I had no idea what to say in voice mail so I rambled, but she picked up the minute I hung up. She told me she was thinking about me recently. I found out she wasn't working anywhere which made me want to cry. I told her what was up and when I mentioned I was Paxil she got angry. She explained how it took her a year to get a patient off the drug as the process is extremely slow. That was something the MD never told me even after he upped the dose. She told me to call her whenever. This is what I loved about her. She may not be perfect but she has an understanding of drugs that I have never found in any of the people I have seen.

 

So what do I do? The logical answer is to continue with this guy because who is top-ranked and I am running out of people to see in the area. But the bottom line is, I don't like him. He goes with stats and makes me nervous because I don't trust my own judgement when he gives me options based on what I have taken before. I need to get better fast and I know it is not always an option with drugs. I can't focus and I want to feel like the person I was last semester who got things done and didn't have to begging for excuses. A teacher emailed me today about whether I was giving up on the course. It's online and I don't like her that much, but I am not a quitter. 

 

I see my therapist this week and I'll be asking her for advice. I just wanted to get some perspective here.

 

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To be honest, if you don't like or trust your doctor, it doesn't really matter what their "reputation" is - I think it's just as much a matter of goodness of fit as it is of reputation, especially when his suggestions have not been particularly successful for you. If I were you, I'd try to get another doctor, or at least get a second opinion.

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You would go see a pdoc that  you don't like when there are other options?  That wouldn't be the choice I would make.  Reputation is one thing.  Finding someone you can partner with is completely different.  I've found that I've got to have a good relationship with my health care providers, no matter which type.  If we don't click then there is no point.  I need someone I can trust and respect.  If that is missing then I don't bother.  

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