[*Beth*]

I've been seeing my pdoc for 2 years. Most of the time she goes the extra mile for me. She's moody, however; when her mood is bad it's very hard to be around her.

At my appointment 2 days ago I told her that I had slightly changed my Abilify dose. She flipped out and gave me a stern lecture on why I shouldn't change my dose without contacting her (including that she's responsible if I change my dose and have a negative result).

But here's the thing: she works only Tuesday through Friday. The clinic I go to is free. There is absolutely no back-up for the 3 days my pdoc is not in the office.

I'm feeling terrible hurt about her lecture, and am obsessing about it. I'm in a special program for "severely mentally ill" so I'll see her again today (I see her frequently).

Any ideas? What should I say to her about her reaming me? I am so angry. Or should I just cancel today's appointment until I speak with my therapist on Monday (she and my pdoc work together)?


Give me some ideas. Thanks!

[sarahsweets]

I say be honest. Say it from the heart.
"My feelings were hurt when last met and discussed my medication. I completely understand where you are coming from but I was feeling hurt and ashamed by your reaction and tone. If you need to discuss something like that with me again can you just be sensitive to my emotional state?"
Or something along those lines.

[fern46]

Are you frustrated with the essence of the message, or the way she delivered it? Perhaps she could have expressed her displeasure in a more calm way. Do you think you would have accepted the message then?

I can see her being upset. She has the very difficult job of trying to balance your meds to theraputic levels. That often takes a lot of time and trial and error. It must be frustrating when a patient decides to tinker with the levels on their own. I'm glad you were honest though.

I'm not sure what she means about being responsible if you have a negative result. People experience negative results on meds all the time and I've never known a pdoc to be reprimanded for it or held accountable in any other way than perhaps feeling bad about it. She may hold herself personally responsible, but she shouldn't put that on you. I feel the issue is more that getting your meds right is like executing a complex chemistry experiment. The scientist works hard to control all of the variables to give them the best chance at achieving the expected result. You dorked with the variables without her consent and now she has to rework the plan.

I do think in the future you could consider running changes like this by her. Waiting a few days is not a huge deal unless you're in an emergency in which case you should see an emergency doctor for that. I would keep the appointment and explain why you wanted to change your meds so she can know clearly what kind of effect you were going for. Then she can decide if your change was correct or if another alteration is warranted. Don't worry too much about her slapping your wrist. Just go get the help you need now and maybe consider changing docs if she continues to treat you poorly. An apology might go a long way toward clearing the air, but it is obviously not required. It is your body and ultimately your decision how to treat it.

Hi BethRags. I understand the discomfort of having mental health providers clearly showing bad moods/stress. I've experienced that with a few in the past. Even my long-time psychiatrist can come across as grumpy on occasion. Or even yell. He can also be a wet blanket. If it is a constant, that can be good reason to change a doctor/therapist, but if it is a temporary thing, perhaps if it affects you negatively, it's good to tell them. They are human with problems in life, too. However, if there is ever a doctor or other service provider that should try extra extra hard to regulate such emotions at work, it is a psychiatrist and therapist. Us psych patients are often very easily triggered.

I have received the same exact lecture you received from my psychiatrist a few times. The last time he delivered it in a very appropriate and calm way. To that, I took it well and the lecture achieved what it was supposed to. The other times, it was in response to me not just adjusting my own medications, but even quitting one (or more). That sparked a much angrier reaction, which I now feel was also justified. Plus, I think it was more stemming from caring. Yes, some docs need not (or should not) respond angrily, but sometimes it can be a "jolt" of sorts. What I'm willing to take from my current long-time psychiatrist may not be what I'd take from another. And it goes the other way, too.

Please do talk to your doctor about how you feel. I wouldn't cancel the appointment. Talking, not running away, is something we must all do to help ourselves and others. It could help your psychiatrist.

[winter4me]

Originally Posted by BethRags

I've been seeing my pdoc for 2 years. Most of the time she goes the extra mile for me. She's moody, however; when her mood is bad it's very hard to be around her.

At my appointment 2 days ago I told her that I had slightly changed my Abilify dose. She flipped out and gave me a stern lecture on why I shouldn't change my dose without contacting her (including that she's responsible if I change my dose and have a negative result).

But here's the thing: she works only Tuesday through Friday. The clinic I go to is free. There is absolutely no back-up for the 3 days my pdoc is not in the office.

I'm feeling terrible hurt about her lecture, and am obsessing about it. I'm in a special program for "severely mentally ill" so I'll see her again today (I see her frequently).

Any ideas? What should I say to her about her reaming me? I am so angry. Or should I just cancel today's appointment until I speak with my therapist on Monday (she and my pdoc work together)?


Give me some ideas. Thanks!

I think your anger is valid, and whether you talk with her today or after talking with your T. is up to you. She is not responsible for your decisions, she is responsible for her own actions. Given she is 'moody', I wonder if she obsesses over reaming you out...hope so. No one needs a dress-down lecture in a "therapeutic" relationship. Your body and your decisions do still belong to you.

[bpcyclist]

Of course, I don't know your pdoc, but I have had many (like lots of us) over the years. Like @BirdDancer, I have actually d/c'd meds without telling my pdoc until the next scheduled visit. The response has varied. My current and best-ever by far pdoc just nods his head and listens. He knows me now after several years and he trusts that I would not do something like stop a major med for zero reason. But I have also been dressed down. I suspect that all the energy you were experiencing as she spoke to you was more about her than you. I'm sure she worried that, had you had an adverse reaction to your med change while she was totally unaware of what was happening with you, that something bad could happen. So it was probably a stress reaction in her. Just my two cents.

[*Beth*]

Originally Posted by sarahsweets

I say be honest. Say it from the heart.
"My feelings were hurt when last met and discussed my medication. I completely understand where you are coming from but I was feeling hurt and ashamed by your reaction and tone. If you need to discuss something like that with me again can you just be sensitive to my emotional state?"
Or something along those lines.

Excellent way to communicate with her, Sarah. Ashamed is exactly the feeling I had - I didn't even realize it, so thank you for giving me clarification for my own feelings. In my mind, I was being completely truthful with her and received zero validation. In addition, I don't think she was really hearing how awful I felt on the higher dose (Abilify).

Thank you, so much

[*Beth*]

Originally Posted by fern46

Are you frustrated with the essence of the message, or the way she delivered it? Perhaps she could have expressed her displeasure in a more calm way. Do you think you would have accepted the message then?

The way she delivered it. I was honest with her, yet she didn't hear (or believe) how badly the Abilify dose affected me. Since it was a week-end, I opted to drop the dose, rather than to feel sick and spend my week-end in bed, unable to do anything - not even safely drive.

I can see her being upset. She has the very difficult job of trying to balance your meds to theraputic levels. That often takes a lot of time and trial and error. It must be frustrating when a patient decides to tinker with the levels on their own. I'm glad you were honest though.

I agree - her job is immensely difficult...I can't even imagine. It was her delivery and shaming that shook me up so badly. She was 100% judgment/zero validation. I feel embarrassed to even see her today. Part of me just wants to cancel - and part of me is so angry, I want to let her know how badly she hurt me.

I'm not sure what she means about being responsible if you have a negative result. People experience negative results on meds all the time and I've never known a pdoc to be reprimanded for it or held accountable in any other way than perhaps feeling bad about it. She may hold herself personally responsible, but she shouldn't put that on you.

It was a weird statement, for sure. I recognize that perhaps something had happened already that day...a patient od'ing, or whop knows what. But you are correct: whatever happened, or her feeling "responsible" is not on me.

I feel the issue is more that getting your meds right is like executing a complex chemistry experiment. The scientist works hard to control all of the variables to give them the best chance at achieving the expected result. You dorked with the variables without her consent and now she has to rework the plan.

That's about exactly what she said. What she has not provided is a plan for what to do if I have a bad med reaction (and that one was) on a week-end, when there is no back-up (another pdoc to check with). That's 3 days of...??? Waiting until she is back in the office. Say I have to drive somewhere and cause an accident because I'm so checked out on a med. Well, that's on me, not on her.


I do think in the future you could consider running changes like this by her. Waiting a few days is not a huge deal unless you're in an emergency in which case you should see an emergency doctor for that. I would keep the appointment and explain why you wanted to change your meds so she can know clearly what kind of effect you were going for. Then she can decide if your change was correct or if another alteration is warranted. Don't worry too much about her slapping your wrist. Just go get the help you need now and maybe consider changing docs if she continues to treat you poorly. An apology might go a long way toward clearing the air, but it is obviously not required. It is your body and ultimately your decision how to treat it.

Wise words, and thank you. I'm all obsessed over her behavior...thinking about the actual issue at hand (the medication) has taken a back seat. I'm feeling like a puppy who has been smacked on the nose. The behavior is forgotten; all I know is that my nose is sore and I'm ashamed.

I also struggle with being treated as if I don't know my own body. I do. I've lived with me for 56 years. I wish she'd validate my own experience.

~~~~~~~~~~~~~~~~

[*Beth*]

Originally Posted by BirdDancer

Hi BethRags. I understand the discomfort of having mental health providers clearly showing bad moods/stress. I've experienced that with a few in the past. Even my long-time psychiatrist can come across as grumpy on occasion. Or even yell. He can also be a wet blanket. If it is a constant, that can be good reason to change a doctor/therapist, but if it is a temporary thing, perhaps if it affects you negatively, it's good to tell them. They are human with problems in life, too. However, if there is ever a doctor or other service provider that should try extra extra hard to regulate such emotions at work, it is a psychiatrist and therapist. Us psych patients are often very easily triggered.

Thank you for sharing your experience. And yes - I agree. As psych patients, we can easily be pushed over the edge. Honestly, all I could think of was that my pdoc was thinking only of herself, not hearing me - just like my mom always did. It hurt. A lot.

I have received the same exact lecture you received from my psychiatrist a few times. The last time he delivered it in a very appropriate and calm way. To that, I took it well and the lecture achieved what it was supposed to. The other times, it was in response to me not just adjusting my own medications, but even quitting one (or more). That sparked a much angrier reaction, which I now feel was also justified. Plus, I think it was more stemming from caring. Yes, some docs need not (or should not) respond angrily, but sometimes it can be a "jolt" of sorts. What I'm willing to take from my current long-time psychiatrist may not be what I'd take from another. And it goes the other way, too.

Interesting point.


Please do talk to your doctor about how you feel. I wouldn't cancel the appointment. Talking, not running away, is something we must all do to help ourselves and others. It could help your psychiatrist.

Sticking with this and dialoging with her seems to be what all of you who have so kindly replied to me think I should do. I'm really nervous. I guess the worst that can happen is that I tell her I'll need to work on this with my therapist on Monday.

~~~~~~~~~~~~~~~~~~~~

[*Beth*]

Originally Posted by winter4me

I think your anger is valid, and whether you talk with her today or after talking with your T. is up to you. She is not responsible for your decisions, she is responsible for her own actions. Given she is 'moody', I wonder if she obsesses over reaming you out...hope so. No one needs a dress-down lecture in a "therapeutic" relationship. Your body and your decisions do still belong to you.

Thank you so much, winter. You reply gives me courage because it validates how I feel. She often talks down to me, which really, really bothers me. I'm always honest with her, I'm good with knowing my own body and mind. Her unpredictable moods have been a recurring issue. Feels like I need to call in advance and ask her nurse, "So what kind of mood should I expect today?"

~~~~~~~~~~~~~~~~~~~~~~~~

[*Beth*]

Originally Posted by bpcyclist

Of course, I don't know your pdoc, but I have had many (like lots of us) over the years. Like @BirdDancer, I have actually d/c'd meds without telling my pdoc until the next scheduled visit. The response has varied. My current and best-ever by far pdoc just nods his head and listens. He knows me now after several years and he trusts that I would not do something like stop a major med for zero reason. But I have also been dressed down. I suspect that all the energy you were experiencing as she spoke to you was more about her than you. I'm sure she worried that, had you had an adverse reaction to your med change while she was totally unaware of what was happening with you, that something bad could happen. So it was probably a stress reaction in her. Just my two cents.

Good observation! She did seem extremely stressed out that day. And maybe what I'm thinking of as her "moodiness" is actually her reaction to stress. I do believe that she cares but, geez, lady...work on your delivery

It is confusing, when we've had more pdocs than we can count, whether this one or that one is okay with us making slight med changes. I've had some that tell me they trust me to make an adjustment if I feel the need.In fact, they seemed to rely on me to do so.

I despise being talked at as if I were a naughty child.

~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~

[*Beth*]

I want to thank each of you for your outstanding input. I now feel much more courageous about bringing this up with her.

I will post later, after my appointment with her.

[fern46]

Originally Posted by BethRags

~~~~~~~~~~~~~~~~

I hear you. It stinks she reacted so strongly and that she didn't bother to understand why you made the change. I think it is completely fair to ask her for a plan of action when her office is closed to you. You definitely cannot carry on with her plan if it is unsafe.

Sometimes teammates treat us badly, but they are still teammates. Hopefully you can find a way to be comfortable with her again. I'm wishing you all the best today!

[*Beth*]

Originally Posted by fern46

I hear you. It stinks she reacted so strongly and that she didn't bother to understand why you made the change. I think it is completely fair to ask her for a plan of action when her office is closed to you. You definitely cannot carry on with her plan if it is unsafe.

Sometimes teammates treat us badly, but they are still teammates. Hopefully you can find a way to be comfortable with her again. I'm wishing you all the best today!

Thank you so much, fern. And maybe this is, in a way, a good thing. She and I have never discussed what I should do if I have a psych issue during the 3 days when there is no one to contact. It's beyond time that we had some kind of plan.

[Moose72]

Originally Posted by BethRags

Thank you so much, fern. And maybe this is, in a way, a good thing. She and I have never discussed what I should do if I have a psych issue during the 3 days when there is no one to contact. It's beyond time that we had some kind of plan.

Is there a psych ER near you? They shoud see you no matter what.

[yellow_fleurs]

I am sorry you experienced a reaction from your pdoc that made you feel shamed. Listening to why you stopped a medication is important so they can figure out what barriers exist and help you work out a plan that will work for you. I can understand why a pdoc would be concerned about a patient stopping medication without talking to them, because they could have a reaction to stopping the medication of some sort, but doesn't sound like they handled it in a way that worked for you. As others have said, maybe talking to them about how that interaction made you feel would be useful. Also perhaps coming up with an agreement about how you will handle wanting/needing to stop meds in the future?

On a related noted, one time due to a reaction I talked to my pdoc on the phone and we decided to stop the med, but he forgot by the next appointment and thought we agreed to only lower it. So then when I told him at the next appointment I had stopped it he seemed taken aback and asked me a little accusingly why? I explained that we had talked about it and then he was like oh, right we did. Haha. I guess it was a bit of a knee jerk reaction from him.

[*Beth*]

Originally Posted by Moose72

Is there a psych ER near you? They shoud see you no matter what.

No, unfortunately not. There is a small hospital with a tiny psych ward. I was forced to go there last year and it was awful.

[Pookyl]

I’ve got a pdoc who is only available Mon-Thurs.
We have an action plan in place for any eventuality that might occur Fri-Sun. That being said there is only very rarely something that can’t wait. If I have an episode beginning on the days she is not available I’m allowed to manage it by tweaking my meds.

[*Beth*]

Originally Posted by yellow_fleurs

I am sorry you experienced a reaction from your pdoc that made you feel shamed. Listening to why you stopped a medication is important so they can figure out what barriers exist and help you work out a plan that will work for you.

Thank you, and exactly. I'm not a "case study" - I'm a human being with a real life.

I can understand why a pdoc would be concerned about a patient stopping medication without talking to them, because they could have a reaction to stopping the medication of some sort, but doesn't sound like they handled it in a way that worked for you. As others have said, maybe talking to them about how that interaction made you feel would be useful. Also perhaps coming up with an agreement about how you will handle wanting/needing to stop meds in the future?

Yep!

On a related noted, one time due to a reaction I talked to my pdoc on the phone and we decided to stop the med, but he forgot by the next appointment and thought we agreed to only lower it. So then when I told him at the next appointment I had stopped it he seemed taken aback and asked me a little accusingly why? I explained that we had talked about it and then he was like oh, right we did. Haha. I guess it was a bit of a knee jerk reaction from him.

I give him credit for admitting he was mistaken. My pdoc frequently forgets what she instructed me to do. My mind races 1,000 miles a minute and I don't forget what people say. In fact, it's like theor words are recorded in my brain. She'll deny what I remind her of, then reference her notes and grudgingly admit.

~~~~~~~~~~~~~~~~~~

[yellow_fleurs]

BethRags, I can see why that bothers you with her denying what you even talked about. I would not like that either! Yes, I give my pdoc credit for that, too. Actually he admitted it in front of a resident and student which I think was probably even more difficult to do, and also a good example for those he was training.
He also was willing to admit on a few occasions when he was not sure what was going on with me and willing to keep working with me to figure things out. This helped me to trust him even though my experience with medication was not good. I hope talking with your pdoc helps and that they treat you with respect.

[*Beth*]

I want to thank each of you, you've all been incredibly insightful and helpful. Clearly, there's plenty of experience with psychiatrists here

So I went to the appointment and told her that I was concerned about our session on Tuesday, and had left the office feeling very upset. To me, she seemed to be taken off guard and a bit shaken. (I firmly believe that not enough people speak out to pdocs and therapists - then the mental health professionals wonder why people stop coming. Well, if people aren't heard - or if, when they explain what's happening for them they get lectured to, are they inclined to return?)

She actually tried to change the subject. I went with that for a few minutes, then brought the dialogue straight back to how upset I was about what I felt was her shaming me. I also asked her what she suggests I should do in case of a genuinely bad med reaction on a week-end (which for her is 3 days of every week).

She denied that she was trying to shame me, but admitted that perhaps she had heard more clearly about the changes I'd made with the Abilify than about the reasons for which I made those changes.

As for what to do about the 3 day week-ends she nodded, that's true, that's true...and told me that I can always go to the ER. And I said that unless I admit myself IP (which I won't), no ER doctor is going to make a med change.

She nodded and yawned (she always yawns when she's uncomfortable).

Then she vaguely commented something about realizing that there might be times when I do need to make a small change myself, blah, blah...

Whatever. I am proud of myself for being upfront instead of canceling. She can be an excellent doctor, and she can be a serious jerk. One action I can take is to being a little notebook in with me and write down the key points of what she says, checking with her that they are correct. That way she can't deflect or gaslight (the "I think you were having a difficult day and misunderstood me" BS).

So I left feeling somewhat disappointed with her, but strong in myself. I'll see her Tuesday afternoon; it'll be interesting to notice her behavior that day.

[~Christina]

Over the years I have fiddled with doses and flat quit some meds outright.

I see my Pdoc every 3 months, but he’s always been available to make some changes if need be by phone, he covers 3 different counties so his schedule is packed. But if I really need to see him I will get put in.

My Pdoc has never made me feel bad for making a change or just drop meds with out getting in touch with him. I honestly don’t know how I would react if my Pdoc every treated me that way... yes our providers has good days and bad but to make you feel that why? No no no . Be a damn professional, we are adults not 2 year old toddlers sticking a fork in a electric socket.

People dealing with mental illness are notorious for changing meds or stopping them.. we struggle with some really awful side effects, I mean akathesia ??? It’s horrific !! Who wants to continue swallowing a pill daily that is causing that ???

Sarah is absolutely spot on in addressing this with her. Fantastic advice as always.

I’m sorry you have to deal with this.

[*Beth*]

Originally Posted by Pookyl

I’ve got a pdoc who is only available Mon-Thurs.
We have an action plan in place for any eventuality that might occur Fri-Sun. That being said there is only very rarely something that can’t wait. If I have an episode beginning on the days she is not available I’m allowed to manage it by tweaking my meds.

Well, that seems to me to be a reality-based safety net. When I'm 100% honest with a doctor and they return my honesty with a degrading lecture I feel backed into a corner. I kept thinking...next time I won't be honest with her, because I don't want to go through this again.

[*Beth*]

Originally Posted by ~Christina

Over the years I have fiddled with doses and flat quit some meds outright.

I see my Pdoc every 3 months, but he’s always been available to make some changes if need be by phone, he covers 3 different counties so his schedule is packed. But if I really need to see him I will get put in.

My Pdoc has never made me feel bad for making a change or just drop meds with out getting in touch with him. I honestly don’t know how I would react if my Pdoc every treated me that way... yes our providers has good days and bad but to make you feel that why? No no no . Be a damn professional, we are adults not 2 year old toddlers sticking a fork in a electric socket.

People dealing with mental illness are notorious for changing meds or stopping them.. we struggle with some really awful side effects, I mean akathesia ??? It’s horrific !! Who wants to continue swallowing a pill daily that is causing that ???

Sarah is absolutely spot on in addressing this with her. Fantastic advice as always.

I’m sorry you have to deal with this.

Excellent points, Christina. Every one. Bottom line, she was not empathize, nor was she compassionate. Your pdoc sounds like he's mature and reality-based.

Blaaaahhh...I have had several run-ins with my psychiatrist over the 2+ years I've seen her. Just about the time I start to slightly trust her she pulls this sh-it on me. Once, in July, my therapist went into a session with Dr. W. and I to mediate. That went incredibly well.

And darned if tonight I'm not coming unglued. Feeling incredibly anxious and like depression keeps putting fingers on me.

Dr. W. is a colleague of my dear, dear therapist...if it wasn't for that I would be at least checking into other pdoc options, just as a possible alternative. Then, too, most of the pdocs I've seen over the years have ranged from weirdos to downright a-holes.

Well, my thoughts are racing so fast it sounds like complete insanity in my mind. Discouraged. My therapist has been out for a week (back on Monday and I have an appt. that day, praise the universe). I had been holding my own really well! Then THIS. Aaaaah...gonna take some ZZZQuil and go to sleep.

[~Christina]

Originally Posted by BethRags

Excellent points, Christina. Every one. Bottom line, she was not empathize, nor was she compassionate. Your pdoc sounds like he's mature and reality-based.

Blaaaahhh...I have had several run-ins with my psychiatrist over the 2+ years I've seen her. Just about the time I start to slightly trust her she pulls this sh-it on me. Once, in July, my therapist went into a session with Dr. W. and I to mediate. That went incredibly well.

And darned if tonight I'm not coming unglued. Feeling incredibly anxious and like depression keeps putting fingers on me.

Dr. W. is a colleague of my dear, dear therapist...if it wasn't for that I would be at least checking into other pdoc options, just as a possible alternative. Then, too, most of the pdocs I've seen over the years have ranged from weirdos to downright a-holes.

Well, my thoughts are racing so fast it sounds like complete insanity in my mind. Discouraged. My therapist has been out for a week (back on Monday and I have an appt. that day, praise the universe). I had been holding my own really well! Then THIS. Aaaaah...gonna take some ZZZQuil and go to sleep.

I’m glad you stood your ground and kept guiding her right back to the damn problem.

I have seen a lot of people over the years have Pdocs that I call pill nazis ! Those people I’d like to force feed them psych meds to hopefully induce horrible side effects so they would find more compassion and understanding !!!