I have a major axe to grind. That's right, "I'm mad as heck and I'm not gonna' take it anymore!" Well, not to worry, I'm not gonna' flip out. But somehow I aim to do something about it. Maybe you can help. Okay, okay...here's what fried my bacon. And, no, that isn't me in the pic.
I got paged late this morning to assess a patient who's been having a tough time with anxiety and panic. So I get there and begin to work with this very nice 29-year-old woman who'd been an anxiety sufferer since she was 13. And, of course, depression had made an appearance, as well.
Not really part of my point here, but I always find meds interesting. She'd been treated over the years with a number of antidepressants and benzodiazepines. She's currently prescribed alprazolam (Xanax), .25mg PRN TID (as needed, 3x/day). She told me she typically takes two tablets per day. And for the past month she's been taking 20mg/day of paroxetine (Paxil). Her meds are prescribed by her primary care physician (PCP).
Okay, now for what really chaps my fanny. The woman had an appointment earlier this morning with her PCP in an effort to secure a paroxetine refill. See, the doc had only prescribed 30 days worth and she'd run out. And if you've experienced selective serotonin reuptake inhibitor (SSRI) withdrawal, especially from paroxetine, you'll know why she wanted a refill. Not to mention her anxiety and panic had been nasty as of late.
So does the doc take care of his patient by giving her a refill? By the way, whether or not you or I think paroxetine is good medicine is irrelevant here. Nope...he tells her to report as a walk-in to the behavioral health intake department at the hospital just across the street (where I assessed her), telling her she could receive counseling and meds services there. Oh, and before I forget...God forbid the doc give her a prescription for maybe ten days worth of paroxetine while she finds another source.
Sadly, when I looked at the referral, the doc had written a department/program that hadn't existed in years. Worse yet, though an assessment could certainly be provided free of charge, the facility doesn't even provide the kind of care the doc promised. And that meant I was going to have to refer her elsewhere. Two places, in fact...one for counseling and one for meds. Just what an acutely anxious person needs, isn't it?
And just for the record, the woman told me when she presented, acutely anxious, to the doc's office a month or so ago, she had to wait three hours before seeing him. And she knew at one point he was in the back eating lunch.
Is this an outrage, or what? I guarantee this doc had no interest in retaining this woman as a patient. And I'll double guarantee his disinterest was fueled by the fact that he couldn't deal with the complexity of an anxiety case and the reality that the woman's health care coverage was through Medicaid.
So he "streeted" her, even giving her a carelessly considered and written referral.
Why does your story not surprise me??? My son goes to a county-funded mental health clinic because of his disabilities and I can't tell you how many psychiatrists he's had there who don't give a rat's ass. He's developmentally disabled and one of them, on his first (and last) visit told him he should get his dad to do something by threatening to kill himself! He also talked to him about colleges. What??? I contacted his supervisor and ended up getting a written apology - kind of a lame one, but better than nothing. Another one that just left there would see him for 10 minutes, maybe; we asked about getting my son off Abilify and he said, "Sure, try it." So he did it cold turkey and in a few days, had to go back on it. At his last appointment, he told him not to come back for six months; after three months, I got a notice that he didn't have an appointment scheduled - so, okay, I called to schedule one and they told me he was leaving the clinic that week. Hooray. Got him in with another doctor and on the day of THAT appointment, the doc called in sick and they couldn't reschedule for two more months. My husband complained to the clinic because by now, my son hadn't been seen for almost six months, so they managed to squeeze him in with somebody the following week. This new guy seems decent, but I'm very wary. None of them seem to stay there long. I guess my point is, I don't understand psychiatrists who act like they'd rather be somewhere else, don't bother to read charts and really, just make no effort to act interested in the person. They collect a salary whether they do a good job or not.
In the scenario you're talking about, I think it's appalling that her PCP would not give her a new prescription to get her through. I think this kind of thing happens more often, though, when people go to a GP instead of a psychiatrist for their medications - they aren't that up-to-date on mental health stuff and just want to give you a pill to shut you up. The only time I would tell somebody to try their GP is if things were so bad they just couldn't wait to get in to see a psychiatrist. Then, there's the fantasy (usually) of, if you just take some medication, everything will be fine, when what they need to do is look at what in their life is not working.
Sorry for going on so long but you pushed a button for me! Thanks for sharing your story; I'm sure others can identify, too.
Boy, Judy, did you hit the nail on the head or what? Unfortunately, what you've detailed doesn't surprise me one bit. I see tons of unfunded and Medicaid psych patients in the E.R. who have to rely upon non-profits and county agencies for help. And it's like a meat market. And the psychiatrists who contract with them seem to simply take the money and run. I'm sorry I pushed a hot button, but then again I'm not because it gave you an opp to blow some steam.
Yes, and thank you for that!
Hi, I'm afraid your well documented post didnt suprise me one bit. Infact it could have been from one of my Diaries. When I had to stop work, after some time I entered what they call the 'public arena' or 'Welfare health system' over here. So, waiting for up to 3 or 4hours is nothing new for me. Having suffered Anxiety/Depression/phobias for most of my life and been prescribed Benzodiazepines very early in adolescence, I became dependent on same. I can tell you first hand having been on Paxil [seroxat here in Europe, Im from Ireland] that being short acting, if you miss even one dose, you start to get horrible withdrawals, I was on Paxil for maybe 20years. ~ In the public system, I have had similar things happen with doctors, infact, I have even said 'Do you not want to treat me anymore?' the pschiatric profession is a shambles here and being public [or poor] I get a princely 10mins. Now how a Doctor can access ones state of mind, Mood etc in that time is beyond me. ~ I have 2 friends in similar circumstances, Due to bungling with GPs that dont care they have received insufficent supplies of Lithium [both friends are what Id describe as Bad Bipolar 1 sufferers] and also Xyrexa for both as they suffer delusions during Mania. Ive had to go into pharmacies and demand some lithium until the bungling [for both friends] could be sorted. My own story is similar. A new Psychiatrist decided to take me off Benzo s Cold turkey, he was young, inexperienced and hadnt read my Notes. Having withdrawn cold turkey some years ago, I waited for the 4th or 5th day, i went into really heavy withdrawals, only being older, Ive high Bp, Have had a TIA etc., So in desparation, i used my knowledge of latin [RX] and wrote myself a script for the Sleeping tablets and Valium he had taken me off Cold turkey. Yes folks, I broke the law !! I then complained to the medical Board, it turned out the young Doc hadnt read my notes at all. Thought i was taking them to 'chill out and feel good' if only !!
Our Mental health system here is two tier, if youve lost your job or become ill as in my case, and are forced to use the Free medical service, you can expect this sort of thing. Im sorry, this isnt what you want to hear. But being in the EU hasnt changed it one bit. Sorry for going on, i had to vent my spleen. Ps ~Over a year ago a new, and young psychiatrist [they change every few months when youre public] saw me for about 10mins and decided, because he couldnt/wouldnt believe something I was telling him [2 conviluted to go into here] he said 'Im going to write you a script for Xyprexa, as youve become psycotic'. I wasnt psycotic, I had been speaking to the receptionists outside in the Hospital during my 3hr wait. I was relating a story that I had backed up [I had been on radio] Luckily i turned on my Mobile unbeknowns to this Shrink [a consultant]and the conversaton was recorded. He insisted i was having delusions. This is SO dangerous, Again, I had to go to the Medical Ethics, Mental health Advocacy board, they pass the buck but this guy was dangerous. To make a snap diagnosis on the premise of a single conversation.. I eventually got an apology and he was moved. thats what we do here with our Clergy and Bad doctors when they 'misbehave'
What an incredible story. Sadly, it's written all too often. I just resonded to a similar comment on the same post over on the anxiety connection. Don't know what to tell you other than I empathize with you and wish I could wave a magic wand and fix it all. Bottom-line is basic human compassion and respect doesn't exist much anymore. And it's the same here in the good 'ole USofA. Thanks for responding to my post and I'm glad you could at least blow some steam!
Hi chipur, Yes it was longwinded !! Things arent all bad, in somuch as at least we now have Boards where you can go and complain, mind you, theyre staffed and 'policed' by psychiatrists themselves. But at least they are there and My complaint, makes it easier for the next unfortunatel. Psyciatrists used to be Gods in this Country, much like Clergy were. Things are changing and I think knowledge and education are empowering. We have lay people who run Advocacy Groups and have abit of clout legally speaking if anyones treated badly in hospital, though, at the end of the day, if you suffer Anxiety/Depression and even worse for those unfortunate enough to be deemed psycotic, its hard for the patient to be believed.