Posted by Adam on June 7, 2000, at 22:00:04
In reply to Anybody been fired by their pdoc?, posted by Snowie on June 5, 2000, at 21:03:43
Snowie,
If you haven't left out any details, this does sound rather abrubt and confusing.
Did the doctor offer any explanation at all beyond his testyness at your asserting
yourself?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. 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. 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.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.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). 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."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.
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.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.He didn't reply to my message, and I never heard from him again.
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.
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.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.
I don't know what to think, really. I have to say, the way the relationships were severed
leaves me little nostalgia for them.
> After 5 years, the receptionist in my pdoc's office told me today that my pdoc would be discontinuing his services to me. In a word, I was shocked, and after I hung up the telephone I began to cry, probably from the fear of abandonment more than anything else. Actually, I should have fired him years ago, but I didn't because of our long association. It's strange, but I never felt like he really understood me nor cared ... obviously, I know now that he didn't. I've heard of people firing their pdocs, but I've never heard of a pdoc firing a patient. I know this too shall pass and he probably was doing me a favor, but I'm feeling extremely vulnerable right now. Was the fact that I research the internet really so imtimidating? He was so nasty toward the end, and every question of mine was followed by some sarcastic "ask your internet friends" type response. Paul, I certainly understand what you went through now. I guess surviving and doing well is the best revenge, but first I have to find a replacement. It's also a little awkward since my sister still uses him, and I don't want to jeopardize her relationship with him. At the same time, I don't want him to know anything further about me, and I don't want to know anything further about him. Anybody experience anything like this before?
>
> Snowie
poster:Adam
thread:36199
URL: http://www.dr-bob.org/babble/20000603/msgs/36500.html