Posted by Snowie on June 8, 2000, at 0:28:57
In reply to Re: Anybody been fired by their pdoc?, posted by Adam on June 7, 2000, at 22:00:04
> Snowie,
> If you haven't left out any details, this does sound rather abrubt and confusing.Adam, there's not enough space for every detail, but nothing was left out that would explain it any better. I think my ex-pdoc actually liked me, but he couldn't handle the fact that I can think for myself. I would have loved the benefit of his wisdom, but he rarely shared it with me.
> Did the doctor offer any explanation at all beyond his testyness at your asserting yourself?
At the end? No ... it was just don't come back, but he had been rolling his eyes and making fun of me for quite some time. My feeling is that he thought I should have put all of my faith in him. Also, he didn't seem to want to hear any bad news ... only that everything was going swell and that he was wonderful. That's nice, but it's not the real world. He also wasn't open to technology and new ideas. Maybe he was afraid that I might learn more than he. Was I ever nasty to him? No, that's not my style. I was knowledgeable, persuasive, and persistent, and I believe he resented that.
> Anyway, this is a tough question for me, as I don't know for certain if I have been "fired" or not. But if I have, it has happened at least once, and possibly twice.
> The first time, I had to leave my old physician because I changed jobs and insurance. I was on Welbutrin, but decided on my own to stop it, as it didn't seem to be doing much of anything for me.I've stopped meds more times than I can count. Every time I stopped a med on my own initiative (for legitimate reasons) my ex-pdoc was very displeased.
>After a few months of more depression as usual and no progress in therapy, I sought out a new doc. I laid out from the beginning my history,
the lack of results I had gotten from drugs, X, Y, Z, etc., the side effects I hoped to avoid, and so on. We tried Welbutrin again, but no dice.We decided on Serzone as a possible solution. I started taking Serzone in small doses, saw no improvement, and then began aggressively upping the dose. I started to get, if anything, worse, with a great deal of anxiety accompanying my depression. My doctor had me stay on the drug, and continued to up the dose. After about a month and a half, I came to the conclusion that Serzone just wasn't doing it for me. I was feeling not just depressed, but rather frenzied. It was going from oppressive to mind-numbing. He told me to stay on the Serzone, and augmented with clozapine.Sounds like you were honest with this guy up front. I also have my ground rules ... I won't take anything long-term that will make me fat or decrease my libido. I also tried Serzone ... it just made me terribly dizzy. The combination of clonazopam and Serzone would have made me a zombie.
> No improvement, and really things got even worse. I, after coming very close to killing myself on the highway (deliberately), checked myself into the hospital.
Good for you! At least you wanted to live. Your pdoc should have supported you 100%.
> About a week into the visit, my doctor called. He said that while he did not object to
me as a person in any way, he was dissatisfied with our arrangement, meaning that he preferred to administer both psychopharmacological and psychotherapeutic care to his patients, not just the former. When I reminded him that my insurance company made the arrangement, he just continued, saying that he was glad to hear that I was getting ECT, that he wished me the best of luck in my treatment, and that was it.What? Didn't he even send flowers? The insurance companies yield far too much power over the mental health industry, in my opinion. However, your pdoc certainly should have understood the status quo from the beginning. I guess he got annoyed that you took matters into your own hands, even though you know a drug's effect in your body, and he should have listened to your concerns. However, I personally think that if you had wanted to continue treatment with this pdoc, he should have been advised and consented prior to you receiving the ECT.
> I suppose I could take him at his word, but he knew from the outset what his role as my physician was, and made no mention of changing until after I landed in Mass. General (a move I made on my own, by the way, at the hypothetical recommendation of my psychotherapist, who had originally referred me to the doctor).
Funny you mention your psychotherapist. Right before my ex-pdoc "let me go" I had started seeing a psychologist for therapy. During my last pdoc visit, I casually mentioned my psychologist. I thought my ex-pdoc would be happy that I was getting therapy, but it seem to bother him. This is one reason I want to find a pdoc who also does therapy ... no competing egos to deal with.
> Perhaps he was really not happy all along, and just saw this as an opportune time to bail, I don't know. Something just smacked if disingenuousness. I told the head resident as soon as I saw him next. He was silent for a bit, and then said "we can refer you to someone from here so you can be followed when you leave." Another therapist later on also met the story with a disconcertingly long silence. He ended the pause with "Hmm. Pretty slick."
I guess you'll never really know for sure, but I know exactly what you mean. The last time I saw my ex-pdoc he gave me a hug and enough medicine to last several months. I had been looking for a pdoc on my insurance plan who does med management and therapy, but could find no such person. When I told people what happened with my ex-pdoc, I got some long silences also.
> The next time was with the very physician I had been referred to. After seeing him for a few months, and getting, again, nowhere on a drug combo. (initially Remeron, then Remeron plus a very small dose of Zoloft), we began to talk about Parnate, which had been recommended to me while I was in the hospital, though I was freaked out by what I heard about the drug and opted then not to try it. At this point we were meeting once
per month. Between that visit and the next, I decided to enrol in a clinical trial of the Selegiline transdermal system for depression. It was a study I had heard about earlier, but could not try because I had receive ECT too recently. Now I could qualify, so I went for it. My doctor was not at all happy. My therapist was even less happy. I was a bit shocked, to be honest, at their response. The seemed a bit irritated with
me, and very irritated with the investigators in the trial, and I guess some heated words were exchanged. If I had known my actions were going to create such a stir, I might never have entered the study, which would have been a shame, to but it mildly.I guess I can understand their reactions to that. I never went elsewhere for treatment while I was seeing my ex-pdoc. If I had wanted to join a study I would have attempted to obtain my ex-pdoc's permission in advance.
> Anyway, what followed was a period of six weeks where I was (at their insistance) seeing my old p-doc, the therapist, and the docs in the trial on a weekly basis, which was a big disruption of my life, since all the meetings were on different days, etc. It wrought havoc with my work schedule. After the double-blind portion of the trial I went into the open-label phase, and had a robust, almost hypomanic response within about three days of initiation. I haven't been the same since, thank goodness.
Was that a good or bad experience, and in hindsight, was it worth it?
> Well, I stayed with my old pdoc, who I genuinely liked, for a couple more months, but
we both decided that while the other docs were following me, and while I was doing so well, we could take a breather and reassess when the trial was over. He actually called me towards the end to see how I was doing. I left him a message saying I still wanted to work with him because, even though selegiline was doing for me what I didn't thing was possible from a drug, I still had some nagging anxiety concerns, and since he was an OCD specialist (my other Dx), I wanted to know what he thought of some augmentation strategies I was thinking of. I told him in the message my favorite candidate was inositol, and I
wondered what he thought of the safety of MAOI plus inositol. I said my reasoning was that since it was involved with the 5-HT2C-receptor signalling pathway, which, as I was sure he knew, was implicated in OCD, it might be worth trying, according to an Isreali study, which I was also sure he already knew about.What you just related is very similar to what I might has told my ex-pdoc during a visit. I would tell him that Xanax was definitely helping, but I was occasionally having terrible bounts of anxiety. I would then mention something I had heard that might work for me. However, I suspect the call from your old pdoc was simply a courtesy gesture of goodwill and nothing else.
> He didn't reply to my message, and I never heard from him again.Oh, well ... consider the source. My sister is still seeing my ex-pdoc, so I won't talk with her further about pdocs, meds, and therapy. He'll one day want to know what happened to me, but he doesn't deserve to know.
> The trial ended. I was hoping I could continue with the docs. who ran the trial, but my insurance company wouldn't let me. The doc. who was seeing me in the trial called my old pdoc and asked him about seeing me again. My old doc replied that since he had no expertise with selegiline, he didn't feel comfortable prescribing it. And that was that.Well, at least you got some closure and an explanation, such as it was.
> The head of the trial was quite skeptical about this explanation, but did not elaborate. He
just brushed it aside, saying they would be very happy to refer me to some very good doctors in the outpatient clinic at McLean. It was deja-vu all over again.I'm surprised that you would have gone back to your old pdoc. Mine could get on all fours and I wouldn't be interested. It's almost impossible to go back ... it's much easier to push forward. That's the reason I'm trying to stay optimisic about the future. There's new territory to conquor and new pdocs to annoy!
> This new arrangement is working quite well, I must admit, so I have little cause to complain, I suppose. But, well, the experience of doctors deciding for somewhat mysterious reasons not to see me anymore, has been disconcerting. It has made me wonder on more than one occasion if there is something unlikable about me as a patient. I have never been rebellious, though I do have many of my own ideas, and share them often enough. I never was non-compliant, though I voiced objections or concers if I wasn't comfortable at first.
You sound like me, except I would never have put myself through a trial without my pdoc's consent. That's the only part of your story I see that might have caused some problems between you and your doctors.
> I don't know what to think, really. I have to say, the way the relationships were severed
leaves me little nostalgia for them.I'm trying to get past this. I want to find a pdoc that I can respect, and one who respects me in return. Hopefully, that's not too much to ask for. I hope the same for you as well.
Snowie
poster:Snowie
thread:36199
URL: http://www.dr-bob.org/babble/20000603/msgs/36516.html