View Full Version : How would you handle this?

08-26-07, 12:27 AM
Hey all! I'm looking for insight on a probelm with my psychopharmacologist. You know, I'm so weak from my current fibromyalgia flare, I literally just cut and pasted this excerpt from my post on the Adderall board where I was asking about a Provigil/Adderall combo:

Overall I had a very unpleasant experience today. I am in the midst of a very bad fibromyalgia flare. I believe this has rendered my Adderall all but ineffective.

I went to the doctor and I can honestly say it's a partial blur. I don't remember chunks of our conversation.

Brief background: The psychiatrist who prescribes my Adderall (and now Provigil) has only known me for about 2 months. He diagnosed my ADD at first visit, but my fibro and cfs were diagnosed by my team of other doctors who referred me to the psych because he can prescribe the meds I need without having to cut through a bunch of ins co red tape.

Anyway, today was my 4th visit with him and basically I check in for about 10 minutes each time and get a new prescription. (and, yes, he bills my ins co for a full hour)

Today he asked me how the Adderall was working and I told him. Works okay on focus. Not too well with energy. I'm still incredibly fatigued. I'm in the midst of a flare so fatigue is much worse right now. Having trouble sleeping, but I don't think this is Adderall, at least not 100%, because I seem to have trouble sleeping every few weeks. My symptoms are ever present but seem to get worse in cycles.

Bear in mind I am in a flare or something right now, and when this happens I have more trouble than usual putting words and thoughts together.

Apparently I was not clear and apparently I frustrated the doctor to the point where he snapped at me. I don't remember what I was even saying. I was trying to explain to him how I guess I am better energy-wise because I don't fall asleep during the day at the drop of a pin, but I really don't have any energy and am still way more fatigued than a normal person.

I guess this came out all wrong. I can see that, considering. If asked, maybe I could have tried to clarify a little. But he accused me of saying one thing and then another and contradicting myself, etc, etc. I immediately felt like he didn't trust me. I welled up a tiny bit (exhaustion exacerbates emotion, I guess) and apologized and explained that it's very frustrating for me to not be able to communicate.

This is the most frustrating thing I deal with and the worst part is how it makes me feel stupid.

I will grant that I was probably confusing as heck. I told him I wanted to start taking the Adderall twice a day instead of three times to see if I would sleep better, and I guess I wasn't clear about that either, so he lowered my dosage by just knocking off the last dose of the day. And I'm sure I may have been a little hard to follow. My brain was literally in neutral. I couldn't come up with words, I would take long pauses when talking because I'd stop to gather my thoughts and my brain would just stall out for like 30 seconds before I remembered I was talking.

I'm no stranger to confusing people to the point of frustration. But, that said, I thought that was why I was seeing him, and I thought he knew that.

Apparently my ADD combined with serious fibro fog just irritated him.

So to cut this long story short HE brought up Provigil, and by that point I was afraid anything I said might make me look stupid or whatever. (I don't think he thought I was being 'funny' about getting more meds, but you never know.)

So out of fear I kept quiet and didn't ask about the 7-day free trial. Bummer.

Then he told me to take just the Provigil alone to see what I like about it, what I like about Adderall, and then when I go back in a month we can see if we should combine.

Problem: Well, I don't want to go back. I now feel like I have to defend everything I say to him. But now that I'm on meds, if I start switching docs it will look suspect.
Problem #2: He didn't tell me how long to just take the Provigil alone. I can't fill the prescription for about a week or maybe two weeks because it requires some pre-authorization forms for the ins co. So I'm still on Adderall till then. And then I guess I will have to stop the Adderall and take just Provigil for almost a month. So if the Provigil doesn't work, I'm back to square one and will spend a month feeling like I did pre-diagnosis (i.e. like a big old mess).

And now I have an awkward situation and feel unable to communicate effectively with him. I wish I could give him back both prescriptions and start from scratch with a new doc, but it took me almost four years to get the diagnosis and get any meds to begin with.

Oh, he also refused my request to be referred for a sleep study. He said he did not see that it was necessary, and I got the distinct impression he felt my confusion and inability to communicate well today was due to my just being dumb and annoying as opposed to being a side effect of severe fatigue. Basically he made me feel guilty for having symptoms that can't be entirely explained, and he called fibromyalgia "just a label" which made me realize he either one, doesn't know much about it or two, doesn't think it's real.

Yes, I know I should just tell him I now feel untrusted and uncomfortable, but, you know, I don't want to argue with doctors. I just want to get treated.

I really don't know what how to handle this. I'm afraid I'm going to be worried now that everything I say to him is going to be misconstrued somehow.