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mckell13 said:
Now I am wondering… should I be the one directing and assessing the efficacy of my treatment plan??

</div></font></blockquote><font class="post">It depends on what your philosophy is. My primary care physician believes in the team approach--doctor+patient--to medicine. I like that too and so I give input to my doctor on what I want my treatment to be. She may offer options, I tell her what does and doesn't appeal to me, what would not work for my situation, etc., and she takes that into account in our decision making. I may do some independent research and reading in the medical literature. She may veto my suggestions and explain why. Some patients, for example my parents, prefer the "top down" approach and never ask questions of their doctor at all and do not want to be part of any decision making. That's fine too. What approach do you prefer, McKell?

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is it standard procedure for a neurologist to determine medication dosages by simply saying to the patient, “How do you feel, do you want to experiment with increasing your dosage of … Adderall?"

</div></font></blockquote><font class="post">It seems this is fairly standard practice in many areas of medicine. The doctor prescribes a drug and then checks back with the patient to see if the drug has relieved the symptoms. If it hasn't, he may change the dosage or change the drug. That is how my doctors have assessed whether my prescriptions for acne (antibiotics), high blood pressure, and anemia are working. For the anemia prescription, the doctor may ask, "do you feel less tired?" Similarly, for an antidepressant prescription, the doctor might ask, "do you feel less depressed?" or "do you feel better?" The thing is, each of our bodies has a unique biochemistry due to the interaction of our unique genetics with the environment. There is often no way to predict whether a med (or a certain dose) will work for a particular person than to simply try it.

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1) If you were asked if you thought you were receiving the BEST possible care available for your pathology (illness), how would you answer?

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Well, I actually don't believe I have an illness. I approach my mental state from a position of health rather than one of pathology. I believe there is a wide range of what is "normal" in mental health. I don't believe we all need medical treatment to make us fit into one narrow definition of mentally healthy. The mental health care I am receiving is from just one practitioner, my therapist. I do believe I am receiving outstanding care from him because he is getting results and we are making progress. I had a previous therapist and she did not get the results he is, so I have a point of comparison. My PCP has prescribed for me for anxiety, using the team approach, and I was happy with how that went, even though the drugs weren't terribly effective, and when I declined further meds, she didn't badger me into making a choice that was not the best for me. So, yes, overall I am very satisfied.

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2) What criteria do you think are important to consider when judging the quality of your overall mental health care? (pharmacology and psychotherapy) Look deeper than just whether you like or dislike your therapist-- Is just being licensed, nice, and a good listener enough to all it quality care?

</div></font></blockquote><font class="post">For me, an important criterion is if I am making progress. Am I feeling better? Am I coping with life better? Am I making progress on solving my problems? Do I feel more hopeful? Am I learning more about myself? Am I able to apply what I learn from the therapeutic relationship to other relationships in my life? Have I made positive changes in my life? If the answers to these questions are yes, then that is pretty dang good!

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3) Do you have the same quality standards for your personal treatment as you do for others (i.e. your children or other family members)?

</div></font></blockquote><font class="post">Yes. My daughter has a therapist, and I was very careful about choosing her. It is harder to assess the answers to my criteria above though, as she doesn't share much from her therapy with me. So it's harder to answer the question "is therapy working?" when it is not yourself.