Update: I am seeing another provider at primary office tomorrow. I am going over & over in my head what I'm going to say to convince her to prescribe anxiety meds for someone she has never seen before!
Thank you: for the comments/advice on my last post. This is an area of medicine I know nothing about, in terms of logistics. You were right in that 1) primary care does the initial med prescribing for most run-of-the-mill anxiety/depression drugs with psych for ongoing management & complicated cases and 2) it is normal to wait a long time & pay out of pocket for psych. For those asking if my therapist could "Get me in"---the answer is no, I did ask. There is one psychiatrist who sees all the patients for 10+ therapists in the group. ALL the patients coming to him "have an in" with a therapist in the practice. There was a psych NP who helped him out who just left---they are hiring someone new, but until the new person is there, he literally cannot fit another patient in.
Mini-rants about work: I rarely talk about my clinical work but this morning! UGH!
- I had THREE no-shows. Do people not use calendars (I know the answer, but WHY NOT!?) I am a specialist with a long wait-time for new AND follow-up appointments. Ms No-show is likely the same one who will complain about wait-times or call and BEG me to fit them in. When I make an appointment I put it directly on my calendar (currently using Google calendar, but I used to have a physical one)
- Medicine would be so much more efficient if we could find a way to bill for phone consultations. I spent 25 minutes on the phone today, going over (abnormal but not life-threatening or urgent) labs, potential treatment options, risks/benefits of each, follow-up plan for each, send prescriptions and then documenting the whole thing. A follow up visit for me is 20 minutes. I could've billed a level 4-5 follow up in that time period if the patient was physically in my office. I know lots of docs make you come back in to discuss labs but I get that it is hard for people to miss work, etc... and I know they are worried, and our office has a policy that we address phone calls within 48 hours so I can't just NOT CALL and once they get me on the phone it is literally impossible to get off the phone. I wouldn't mind it so much if it "counted" for my productivity and clinical effort.
Goals: 1) No alcohol on weeknights. My wine/cocktail consumption crept up alarmingly again, and I need to reset. I'm on week 2 and its totally fine (of course it is! I don't NEED it, it just became habitual). Seltzer is refreshing in the heat!
2) Meditation. Oh man, I am tired of coming here month after month to tell you how I failed at sticking to it. I keep seeing books/articles/science about the benefits of it, and my new therapist is mindfulness as the best tool for managing anxiety. I need to treat it like medication and JFDI. I can't say "it doesn't work" if I don't try it consistently. I missed yesterday but I'm going to do it today. I AM!!!
3) Shopping ban. I don't need any more clothes so I'm not going to buy any. At least until 2017 but maybe a full year again.
4) Journal. Another habit I keep falling out of---writing down my "3 good things" at the end of each day. It ended the day on a high note, nothing except laziness keeping me from spending 60 seconds on this activity.
I suspect you won't have a problem getting anti-anxiety meds unless the medical stuff in your part of the country is very different from where I normally live or where I went to undergrad.
ReplyDeleteThe fact that this is something you have discussed with your therapist is probably more than enough.
I guarantee my own doctor wouldn't hesitate, but someone who I've never seen before? That's my only concern. Maybe I'm projecting a bit about what I would do in the situation...I often have people wait for their primary provider to return if they have a long relationship and I'm just filling in for emergencies.
DeleteI think that's pretty rare!
DeleteI don't want to minimize the seriousness of obtaining an initial prescription for anti-anxiety/depression medication, but this isn't really an area that requires multiple appointments for a physician to get to know a patient before prescribing.
DeleteAt a minimum, I suggest you bring up that your therapist suggested that you contact a physician to discuss anti-anxiety and anti-depression medication. Of course, be ready to run though all of your symptoms (sleeplessness, anxiety, irritability, lack of focus, etc.)
Stated more simply, many physicians realize that patients are in crisis by the time they seek help for depression/anxiety. It won't benefit the patient, and may even harm them to make them wait.
DeleteGlad I'm not the only provider that gets worried about what to say in my own medical appointments - even for simple things!
DeleteI guess you already had the appointment, and I hope it went well - but one good thing even if you're seeing someone new, hopefully your PCP has documented well what you've discussed! And if you're seeing a therapist (who they could call if they need to) then that's a big help.
yeah, I think mentioning I was already seeing a therapist really swayed the doctor---because that is usually their first recommendation.
DeleteI'm so glad that you are seeing the provider tomorrow, and I hope the other commenters are right about it being easy to get meds.
ReplyDeleteRegarding your goals - it strikes me that you've had these same goals for a long time, and that you generally are not very successful with them (although I think you did stick to the shopping ban for awhile previously). From what I know of you, I feel like you have a strong sense of what you "should" do and set these goals based on that, but you don't actually *want* to do them. I could be totally wrong about this. But I think that setting goals and not sticking to them is not good for one's morale. I also think that for most of these goals, the consequence of not sticking to them isn't really that severe. You're not shopping to the point of being unable to pay bills, meditation and the journal aren't necessary (I HATE meditating, so I'm biased here). The alcohol has the potential to be a problem, but I really don't know. So anyway, I don't want to give you unsolicited advice and be out of line. But I would maybe ask yourself (if you do feel like listening to me): do you want to do these things? Will they make you happy? What will happen if you don't do them? I just worry about you adding more guilt onto your plate unnecessarily.
NPR had an interesting story this morning on why 50% of therapists groups don't take insurance.
ReplyDeleteThanks for sharing. It was pretty interesting: http://www.npr.org/sections/health-shots/2016/07/14/481762357/frustrated-you-can-t-find-a-therapist-they-re-frustrated-too
Deletevery interesting, thanks for sharing. I had a feeling it was something like that, but I didn't realize how hard it was. I see now why independent practitioners rarely take insurance (paperwork/billing hassles that would require hiring someone) and that even in groups they have a quota of insurance patients but need to take some self-pay since reimbursements are so low.
Deletere: the medicine issue - on Gretchen Rubin's widely listened-to podcast, she suggested that her sister follow up via phone with her endo (including reviewing her download) instead of going to an appointment. That sounds great from the patient perspective . . . but I couldn't resist throwing my $0.02 into the comments because hello, our time is worth something too, just like hers!! Agh.
ReplyDeleteYES. YES. (and honestly the majority of what I do isn't as urgent as diabetes so its really really annoying, because it COULD WAIT a few weeks)
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