Wednesday, January 28, 2009

How to Drive ME Crazy


The last post was stolen from another blog and was meant as a joke.
Here's my personal list, it's not a joke.

1. Don't show up for an appointment. Don't call. Don't answer your cell phone. Don't return my concerned calls.
2. Don't show up for an initial appointment where I've blocked out two hours for you. Don't answer your cell phone, never contact me again. Ignore the fact that I made a point of requesting a call if the appointment wasn't going to be kept.
3. Insist that Xanax is the only medication that works for you and refuse to try anything else, even once, even if you've never tried it before.
4. Insist that a 90 day supply of a very expensive medicine must be written because that's the only way you can afford it through the insurance, and two weeks later announce that it suddenly no longer works.
5. Present in a crisis, sit through a session where we develop a plan, then return having done none of it.
6. Decide that the medication that was the only thing that worked for you after years of trying to find something, anything, that would work suddenly is something you don't want to take, even though you've been on it, stable, and doing well for a few years with no side effects. When your psychiatrist reminds you how awful your last 7 episodes of illness were, how hard it was to get you better, and that statistically the chances are extremely high that you might get sick again and it might be hard to get you well again, say, "I'm not going to get sick again."
7. Attribute your flagrant mania to "real emotion" and insist your psychiatrist can't understand because they aren't Italian/Irish/whatever. (Oh, this doesn't really bother me.)
8. Spend the session discussing just how suicidal you're feeling and how badly things are going, and at the end of the session announce that you need to decrease the frequency of the sessions.
9. Promise to call between sessions when your shrink is very worried, then don't. Rest assured, shrink will remember you didn't call at 3 AM.
10. Ask your shrink very intrusive personal questions. I'll spare you the examples.
11. Cancel ten minutes before a session. Tell shrink you suddenly remembered a conflicting appointment that was scheduled a month ago.
12. Leave treatment without a word after years of therapy and leave shrink to wonder how you are and how all the details of your life turned out.

I could probably go on for a while. I liked some of the ones people put in the comment section of the last post.

15 comments:

rvitelli said...

13. Spend the treatment session being totally non-compliant and then tell everyone how useless your therapist is.

Return Of Saturn said...

Ugh...After reading this, I feel like a complete idiot. =)

I was seeing a psychiatrist for about a year and a half (only med management, not tx--do docs in CA even do therapy anymore?). During that time, I think I missed one appointment. I'm ridiculously disorganized. =( Anyway, I felt really badly about it and I'm glad he billed me for it because his time is valuable. Then, I missed another appointment and kept putting off rescheduling.

Four years went by...and here we are. It's funny that you happened to post this today. I decided I really needed to get back in to see someone, and even though it took me two months and several incidents of hanging up when I got his voicemail, I finally made the appointment.

Since speaking with his receptionist, I have not been able to stop perseverating on my past transgressions, what will happen at the appointment, etc. Sigh. I guess this is why I'm going to see him...

Therapy Patient said...

It drives my psychiatrist "crazy" when patients don't pay for their last month of sessions. He hand delivers a bill in the last session of the month, then is paid (theoretically) the first session of the next month for the previous month. Apparently a lot of his clients not only disappear without calling, they also disappear without paying.

I have done #9, and not called between sessions when my shrink is really worried. I hadn't promised to call however. I have felt like a burden at those times which is why I did not call.

mindful said...

I would love to hear about some of the personally intrusive questions that you have been asked.

Anonymous said...

Dinah,

I understand your concerns about Xanax but it seems to me that Seqoquel, which you prefer (correct me if I am wrong) has a side effect profile that is alot worse even at lower doses. Frankly, if a gun was held to my head as to having to chose between Zanax and Seroquel, I would take Zanax in a heartbeat.

I am also confused because as you know, finding the right med for someone can be very hard. Why would you want to mess with something that is working as long as the patient and you are taking the proper precautions?

Also, regarding withdrawal symptoms, getting off other meds can be just as horrific.

Again, I do understand your concern and am glad you realize the dangers of Xanax unlike other psychiatrists. But it seems in a way, you are simply trading the fire for the fire pan.

AA

mysadalterego said...

Someone else beat me to saying it, but I also sometimes don't call between appointments when I should because I feel like it's annoying or a burden. I don't want to press on his time. Maybe you should say something like that when you ask people to call - that you will worry and it isn't a bother.

Anonymous said...

Dinah,

More thoughts since my previous post this morning.

One theme I am noticing is this big disconnect between psychiatrists like yourself and patients. I think it is interesting that No and I turned the situation around and wrote of ways psychiatrists annoy patients. Then you write an updating blog entry getting specific about your situation and using similar language that I used in post such as saying "whatever". It might have been totally unintentional on your part but I did notice what was happening.

You did that instead of specifically commenting on what we wrote. It was like you were annoyed with us for writing what we did.

But getting more specific, you commented about being irked with the patient who wants to go off meds in spite of not having side effects. That seemed to be in response to what I said about psychiatrists being so sure that patients would relapse who were going off of meds. Again this total disconnect.

Has it ever occurred to you that that your view of the patient not having side effects might be disputed by the patient? Many doctors, not just psychiatrist, deny that drugs have side effects when patients have found evidence that is not the case.

For example, my psychiatrist disagrees that Remeron caused my hearing loss. But hearing loss is listed as a side effect and the hearing loss occurred after I started taking the Remeron. I know, causation doesn't equal correlation but when I made the mistake in dosage during my withdrawal and took more than I should have. my hearing worsened. I think that is a pretty good sign I am right.

Also, while I don't think my hearing is back to normal, it has definitely improved now that I am off of Remeron.

Additionally, I felt when I was on my full complement of meds, that they were doing weird things but I couldn't articulate very well what the problem was. So of course, my psychiatrist thought I wasn't having side effects.

It was only when I started tapering off of them, did I realize what was going on such as the meds causing severe apathy.

When I say I am not going to relapse, I am not saying that because I lack insight as you seem to be inferring about patients who say that. I have actively worked on coping techniques on my own that have worked great in spite of dealing with a death in the family and job instability.

I realized that I had to find a way or I would be back on the meds I want to stay off of.

I just think you need to give patients alot more credit than you do. Maybe the patients you have aren't capable of going med free but many patients are and I think it is criminal for psychiatrists not to realize that.

Anyway, maybe a better thread would be how can psychiatrists and patients start really communicating with each other?

AA

Rach said...

Lately, I've also forgotten to call between appointments too, although I'm the first one to admit that I'll pick up the phone and be like HELP ME! I DON"T KNOW WHAT TO DO, because I think that drives my shrink equally nuts.

There's a fine line, I'm sure. I haven't figured out how to toe it gracefully.

Roy said...

@AA:
I assume that any drug can cause any side effect, but I present the frequency of reports (eg, you're the first, 5 reports, 10%, most). For example, I've never seen (heard?) Remeron cause hearing loss. But, presented with the evidence of a possibility, my approach would be "Ok, assuming it is, what are the options of what to do next?". Lots of us (psychiatrists) actually include the patient in the decision process, presenting the info needed to make a decision, and ask the patient to make the tough calls (eg, would I rather take either a 20% chance of weight gain or a 5% chance of hair loss).

Hmm, I should do one on how *I* drive Dinah crazy. Let's see...
1. don't return emails for a week
2. don't return emails about The Book for 6 hours
3. change jobs
4. call her a "private practice psychiatrist" on the podcast
5. call her on Skype and pretend to be Dr Phil, then record the prank for all to hear
6. stop doing podcasts for 7 months

Mind Mechanic said...

Amen to the post!

I'm not sure some of my more difficult patients actually get that I worry when they aren't doing well and chose to 'go incommunicado' or no show...right after they bring up suicidal urges - or agree to a plan of action that we worked very hard together to construct then do none of it.

I used to work very hard to look at what I as their psychiatrist might do better in terms of catching cues or be more meticulous to collaborate in goal setting, etc. I'm starting to move on from that stance, though.

I'm coming to the realization (slowly) that it's a common part of living for many of those I serve, and I'm try to find some compassion for the need to cut themselves off from help and stonewall progress - right when they need it most. I guess that's part of why we are working together in the first place.

Unfortunately the dawning realization isn't helping me sleep better.

spotsy said...

Hey Anonymous! Not everything is about you. Try laughing a little more dude. i thought your list was great, and i thought Dinahs list was great too. Can you see yourself at all in her list and still laugh at it? we're all just humans trying to get sane.

Ladyk73 said...

I find this all interesting...the shrink vs. patient. Having a mental illness and learning to be a clinical social worker is just weird.

I was a patient in group therapy, and 90% my mind was on the process..and helping the other people in the group.

I still have mixed feelings of whether I should be on a moodstabizer. As I have never been manic, I wonder if it just make me apathetic.

Anyways, as someone who has been both a mental health worker and a mental health patient....

I think it all related back to the individual characteristics of people. I have known a few professionals who were very very bad (as seen from both a coworker and a patient's point of view).

I have also worked with some very difficult clients.

Sarebear said...

a way to drive ME crazy: keep rambling on about Pristiq (a "newer" form of Effexor XR kind of, for those who don't know, that cuts one of the two substances (venflafaxine / desvenlafaxine, one being part of breaking down Effexor XR in your body, but they both do the same thing, really) out of the picture, when I've been telling you for a year that I think the anti-depressent isn't working . . . . . Effexor XR, btw . .

I swear, he's driving me crazy. I point blank asked him this last time, um, if the XR isn't working for me, then what good would Pristiq do . . .. and he answered, "none, then . . ." or something like that, and moved on. Lol.

Bout time I got some courage up, lol. But he still didn't change the anti depressant, which . . . I'm slowly having to titrate myself down on, because holy cow sent hubby to the pharmacy and my mood stabilizer is apparently 600 freaking dollars. That we don't have. And that's just one of my meds.

Next day was payday and got two weeks worth (crosses fingers rent doesn't bounce, eats some ramen).

Sarebear said...

I have called between sessions for a couple of reasons, and I'm referring to my psychologist (my iatrist, well if i leave a msg. I think it might be 4 days before he gets it lol).

One was especially when I was going in for surgery, and a couple days after I called him to let him know I was ok; no details, but just I did say that what they found was a big shock for me, and more extensive than expected, but that i came out of surgery alright.

Oh, and then again on the day they thought I had a blood clot in my leg and we ran up to LDS hospital for an ultrasound, I called to let him know that was negative - I was a bit freaked out about the possibility so i had called him earlier in the day to help face all the well i'm not good in new situations and there was alot of new and terrifying going on there . . . .

that was a week after surgery. And a day before scheduled session w/him. The ultrasound tech looked JUST like Hillary Swank when she was in Karate Kid III (except older) but with the hair and everything . . .. !!!

There's been a few others . . . . some occasions where i've made REALLY BIG SCREWUPS and I was frantic . . . .. or, a mother's worst nightmare, an occasion when I had a reason to believe that someone's child might have been flashed by a man, and I called him up for his advice on how to handle it, how to approach the situation, cause I had no clue . . . . . the situation was handled, in the end, and things turned out, but for awhile I had feelings of knowing what it must feel like to wonder what if MY child . . . . if their child could be . . . . and it was so sickening.

I have, on rare occasion, called between sessions to report something really good, since such things are so exceptionally rare . . . . figure it might give him a smile too . . .esp if it's mid-between appt's. Or if I've done something that I've promised to report back on, or something.

but really, I can go months without any between appt. calls, then sometimes it could be couple weeks in a row w/ a call a week, just depends.

Part of the problem is I am so isolated in my life . . . . and I have so few people I can trust . . . . I start to trust someone an they just burn me, over and over.
Anyway, if I'm feeling like I've GOT to cut or burn, and sense says well why don'tcha call someone who'll understand first, I MAYBE call him, if my "oh don't bother him" thing doesn't kick in.

I've even made a couple good friends in the last year . . .but then . . . they move away. Hurts somethin fierce.

Anyway, sorry to go on. Hate being so isolated, with little in the way of a support system. Little to none. In-laws are a f'in joke, and I don't use that term lightly, AT ALL, but they are, as far as emotional trust or other kinds of trust goes, I've been burned over and over.

So, I'm alone, to try to handle it. Um, sorry I've rambled on, never mind . . . . . back to my recent, uh, embarrassing neopets obssession . . .ws checking it ouot for dd but not so happy bout all the games of chance. for kids her age. nonsequitur that's me. pathatic, labeling, burns, yep.

Anonymous said...

I want to know what Child Psychiatrist would ask you what kind of med's to put you child on next if the one they are on stops working?