View Full Version : You are NOT the doctor and no, you don't play one on T.V.


sarahsweets
05-16-17, 05:13 AM
This is not directed towards a person and although its ranty its the only way I could think of to express myself today:

Dear Patients:
It's your friendly doctor here...
So, you have done your share of research on Adderall and other stimulants using the internet, and have determined that you should be able to prescribe your own dose? I mean, I do have the medical degree and all that schooling but by all means, do your thing.
No need to ask me why I choose to prescribe you medication a certain way.
No need to honestly tell me what you think would work better before medicating yourself.
No problem taking more than I prescribe you.
Hey, you know your body right? I only know what 8 years of medical school has taught me.

Being this is your first time on stimulants, or you have limited experience with them, I am quite sure you are capable of upping your own dose, running out and then coming to me.
I mean, I am not perfect. I make mistakes. I may even be under-dosing you but I have my license and livlihood to consider. You do not have to deal with the DEA up your butt; second guessing your prescriptions and adding all these codifiers and paperwork. You dont have to answer to anyone (not even me) about what medication you take and if its medically necessary.
No one will threaten to take away your way of earning a living if you take more medication than I prescribe you.
You might get a warning from me or someone else at best- at worst maybe you wont get prescribed these medications anymore from me, but you will still have your career.

You could probably find another doctor willing to prescribe you what you want if you look hard enough. There are bad apples in every profession and mine is no different.
Maybe certain doctors willing to look the other way have a longer career, or have friends in high places. Maybe they have so many patients they cant manage, or maybe they are just missing the point.

If you knew you could lose something by prescribing someone something you spent 8 years studying and learning about, do you think you would do so without serious consideration?

Have you ever tried addressing me plainly? If you do not give me a chance to say "no way jose" you wont know if I am against a dose increase.
If I start at certain doses and you don't feel it's working, try giving me a call or coming back in. Try telling me exactly what you think and at least give me a chance to be an as*hole rather than assuming I will be.
I may surprise you.
I know I make mistakes. I am sure I have quoted medication guidelines wrong, or assumed dosage maximums when their aren't any. These things change often. If you kindly and respectfully bring that to my attention while we are meeting, even if you use your smartphone, I may have the opportunity to explain myself.
Hell, I may still spout B.S. but at least you tried.
You are always free to seek a second opinion.
The reason I have to scrutinize every person the way I do is because of people like you. People that take whatever amount they want of medication that I prescribed because they do not "feel" the effects of the medication the way the internet said they would.
People that say they aren't getting high, yet want to have things like the movie "limitless" happen. Wanting to be superman, the multitasking queen, the perfect mom or employee.
People that cruise reddit looking for ways to potentiate their medication.

No medication will make you perfect.
And you know that therapy I suggested that you blew off? It can really help with meds. It can help most people but adhd people in particular do really well with therapy. Telling me it wont work or you've tried it before is a cop out. Yes you tried it another time, but you did not try it THIS time when I suggested it.
Its ok if we don't agree. Maybe I will have had to draw a line in the sand and you might feel like I am a moron or too stuck in my ways. Its possible, and if that happens I encourage you to find someone that will help you.
But if you take it upon yourself to play doctor without an honest, open discussion with me, do not get upset if I don't jump on your train and ride off into the sunset.
It may boil down to me not knowing my stuff in your mind- and it could get ugly-but thats nothing compared to what happens if word gets out that you took a month's prescription in 2 weeks.
As doctors we have the "do no harm" oath, and I like to think that the second part of that should be "promote well being" or "have goodwill". I know there are plenty in my profession that have egos the size of islands and who think patients are just uneducated money makers. The thing is, when you misuse or abuse your prescription, I cant write a yelp patient review about you however, you can write a review of me. You can rate me and other patients can read those ratings. I am not against reviews or ratings, just pointing out the status quo.

Forgive me if I ever mistreated you, or misdiagnosed you. I can assure you it wasn't on purpose. I want you to tell me what I have done wrong even if I won't like it. It doesn't have to be a confrontation, and you don't even need to hope that I will do something about it, but inside, I want to know these things. There are many ways to break unpleasant news and it all doesn't have to be dramatic or angry.

Underneath all the fuss, I value being a good doctor, even if I lost my way. But that doesn't mean I have to tolerate your misuse or abuse of medication I prescribe. It doesn't mean you get to justify why you do something based what you think the problem AND solution is.
Misusing your medication doesn't mean I will never prescribe anything for you again either. If you try honesty, most times I will work with you.
I treat plenty of drug addicts and alcoholics that have been honest with me and are on stimulants.
I still treat patients that told me once or twice they tried a higher dose. The thing is, they came to me, told me, and were willing to do what I asked while we worked on the problem. They became part of the solution.
Nothing is ever set in stone.
I worked hard in school.
You work harder in life.
Lets meet somwhere in the middle.

Fuzzy12
05-16-17, 06:35 AM
You'd be surprised if you met my psychiatrists...:lol:

In my experience (or maybe just in my region) a good psychiatrist is a luxury and certainly not the norm.

I have never taken more then prescribed and don't recommend doing so and i totally agree that it's important to be honest with your psychiatrist but irrespective of how many years they've studied I definitely don't trust that by default they have the skill or interest to provide me with decent treatment.

I should probably state really strongly that there is a possibility that just my psychiatrists suck and in general it's good to trust your healthcare providers unless they are obvious idiots like mine.

Lunacie
05-16-17, 10:46 AM
You'd be surprised if you met my psychiatrists...:lol:

In my experience (or maybe just in my region) a good psychiatrist is a luxury and certainly not the norm.

I have never taken more then prescribed and don't recommend doing so and i totally agree that it's important to be honest with your psychiatrist but irrespective of how many years they've studied I definitely don't trust that by default they have the skill or interest to provide me with decent treatment.

I should probably state really strongly that there is a possibility that just my psychiatrists suck and in general it's good to trust your healthcare providers unless they are obvious idiots like mine.

That's also been my experience with doctors, and not just psychologists.
I totally understand what Sarah is saying above, and I do give any doctor
a chance to show their true colors before deciding that I know more than
they do.

It's usually when they deny my experiences and tell me that something like
that has never happened to any patient, theirs or anyone else's, that I know
I'm dealing with an arsehole.

The psychiatrist my granddaughter sees is probably one of the better ones,
but 6 years ago when I started seeing the therapist for my anxiety and she
sent me to the psychiatrist, her notes said I probably had bipolar. So that's
what he was going on without asking any of my family history.

Even though I have no family history of bipolar, and tons of family with adhd
and autism, I didn't have adhd. Period. Happy to give me meds for anxiety
and buh-bye for now.


edit ... so pleased with the PA (physician's assistant) I'm seeing now. After
40 years of back pain, none of the doctors or chiropractors ever did an
xray of my lower back. The new PA ordered an xray that shows a small
broken bone that's been there for 40 years! Have to wonder whether some
treatment all those years ago could have saved me years of pain? Too many
doctors think they know everything because they went to school for 8 years
and won't listen to their patients who know absolutely nothing. Ugh.

RextheDog
05-16-17, 12:08 PM
If you talked down to me like that, I'd certainly be finding another doctor. Wouldn't need any help with that.

I'm sure there are people who instantly abuse their meds, but it's wrong to lump everyone into the same category, IMHO. Rant or not.

phlylady
05-16-17, 04:27 PM
I should probably state really strongly that there is a possibility that just my psychiatrists suck and in general it's good to trust your healthcare providers unless they are obvious idiots like mine.

I got lucky with my psychiatrist. My daughter, on the other hand, hoo boy. She has had some awful psychs. My experience with psychiatrists is there is no middle. They're either terrible or fantastic.

sarahsweets
05-17-17, 03:41 AM
Just to note: This is specific to doctors that prescribe stimulants and patients to abuse them, not whether doctors do a good job with other things. I have had more experiences with doctor's invalidating me, or misdiagnosing me then the other way around and thats a separate issue IMO. I probably should have instituted a better filter before hitting send here I just snapped or something. It seems like recently here and IRL I hear so much about people just medicating themselves as they see fit and even though doctor's are no picnic and not Gods, it makes things more difficult for those that need meds when things are done this way.
Like I said, doctors are full of flaws but that doesnt mean we can just do what we want because our experiences havent been the best.

sarahsweets
05-17-17, 03:43 AM
If you talked down to me like that, I'd certainly be finding another doctor. Wouldn't need any help with that.

I'm sure there are people who instantly abuse their meds, but it's wrong to lump everyone into the same category, IMHO. Rant or not.

I wasnt lumping anyone into a category as far as I see it. It was specific to abusing or more like misusing meds based on what someone thinks will be better than what they are prescribed. And it was tongue in cheek. I too would be out the door if I had a doctor talk to me this way. I guess I need to watch the sarcasm.