Complaining about psychiatry

I had an appointment last Thursday. I'm supposed to have appointments every two weeks because of how bad my psychosis was and to make sure I stay stable. Well, they cancelled that appointment and rescheduled it for today. This morning, because I know how terrible they are, I called to confirm my appointment and they said no appointment for me today AND my doctor is leaving the practice soon. I have an appointment scheduled for next Thursday (six weeks after I last saw him because of my hospitalization and two cancelled/rescheduled appointments), but I highly doubt I will be seeing him. I really want to see him so I can switch from regular Invega to Invega Sustenna and lower my Zyprexa dose.

I need to start making phone calls to find a new pdoc at a different office. I tried a few months ago with no hits. Everyone either sucks in a similar way I'm dealing with at the moment or isn't accepting new patients. I have a feeling I wouldn't be hospitalized every other month if I didn't have to deal with this *****.

You need a new psychiatrist. That kind of unpredictability in treatment and appointments is harmful. I am a champion for psychiatrists, normally. I write and speak about the psychiatrist-patient relationship regularly for patient groups and readers. They practice a very difficult and small branch of medicine. They are badly needed. There aren't enough of them. They are underpaid and work under difficult conditions. However, your psychiatrist has an implicit contract with you. He has to do his part. At a minimum that means keeping appointments and being consistent fulfilling his obligations for your care. You have every right to be angry and every right to look for another MD.

I'd write him a respectful but honest letter telling him exactly how his mistreatment has effected you. Maybe it'll motivate him to perform better at his next job and give you some closure so you can start fresh with someone else.

I'm sorry you have not received the care and attention you deserve, spikes. I agree that your psychiatrist is putting you in a vulnerable position because of his casual regard.

I have been going to my psychiatrist for 13 years. His care has definitely kept me out of the hospital for the last 10 years. In the years prior, I actually can't blame him that much for my hospitalizations. Many were straight from IOPs, or were likely related to bad therapy (from different people) or ineffective medications that came along with me from IOPs. Not that my psychiatrist always makes perfect decisions, but he is always very attentive.

I hope you can find the most detailed list possible of psychiatrists accepting your insurance. I'd get that list from your insurance website. And even then it isn't always necessarily up-to-date. Don't hesitate to contact others. Consider doing online research. Of course sometimes even the best doctors get a bad review or two, but if most are good, it's a good sign. Be picky. You deserve the best possible care!

There are some strategies you can use to get an appointment with a new psychiatrist even when you get the dreaded "not taking new patients" message.. Many physicians will open space in their practice if the referral comes from a clinician they know or possibly from one he doesn't know but hears the need.

Your first line of approach would be your therapist. Therapists usually work and refer patients to psychiatrists when they see evidence of an illness that needs more sophisticated diagnosis. They may have a preferred list of MDs they go to or they may call a new psychiatrist on your behalf if you have someone in mind. She can even ask around and find out more about the psychiatrist you are interested in whom she doesn't know. It's a place to start.

Your PCP (or any physician you see regularly) is your next level of approach. Physicians work with physicians and refer all the time. You can also bring a name to him and he can break the ice and the "we aren't accepting new patients" log jam. It's called professional courtesy.

Your third level of approach, a clergy. Many clergy refer congregants for care confidentially when the need arises. Of course this only helps if you are a member of a congregation. Even if you don't know your clergy, you can make an appointment with him and see if he works with a psychiatrist he trusts. Clergy are held to the same standards of confidentiality as physicians and therapists.

Your fourth level of approach, cold calling yourself. Sometimes you get lucky working off an insurance company provider list. Sometimes you hear, "we aren't taking new patients". It's a frustrating process, especially if you are ill and struggling.

Remember there just aren't that many psychiatrists to go around. It helps to have a strategy when looking for one. Hope I've given you some ideas of how to find a new MD.

Thanks for the responses. I don't have a therapist or PCP, but I brought this up at the IOP and they made a recommendation for a clinic in a different city. I have a hard time believing they are underpaid and work under difficult conditions when some of hte places I've called say the doc is only in two days a week and my doc and the doc in the IOP takes vacations all the time. I've been in the hospital a lot and even they seem to always be leaving or just coming back from vacation. If they're that underpaid, stop flying to freaking France every other month...

Have you tried to call any other pdocs?

Are you able to get to a large teaching hospital? The one I go to has probably 50 pdocs (including residents) and the care is excellent. My pdoc is on staff so I don't change. If you have a resident you will change occasionally but not like you are describing and I think you'll have a relationship with a supervising pdoc on an ongoing basis even when the residents move on. My experience with the residents has been very good when I've been IP or in the ER when I had lithium toxicity and was hallucinating.

I drive 2.5 hours each way to where I go. That's not an option for everyone and honestly if I hadn't followed my pdoc there I probably wouldn't have made that my first choice but it is what works for me and I don't plan to change, even when my pdoc retires.

I know how hard it is; before this pdoc I had some really bad experiences and I am constantly thankful that I have the pdoc I do and have had for 16 years.

FYI some times doctors only work 2 days a week in one town then have an office in another town for a couple of days.
Could that be the case?
I really wish you good luck in finding a new pdoc.
I am lucky to have had the same one since 2002.
bizi

You have to consider that psychiatry is the only branch of medicine where MDs are attacked by their patients, spat on, stalked, have their families threatened, have delusional patients create dangerous fantasies about them and act them out, get physically injured by there patients, lied to by their patients repeatedly, have patients become abusive and doctor hop when they hear things they don't like, and in general put up with inordinate amounts of abuse. The pay scale for psychiatrists is not in line with that much risk. Young medical students don't choose psychiatry precisely for these above reasons. The average age of a psychiatrist is over 50. They are not being replaced. You think its hard to find a Dr now. Wait 10 years.

No radiologist, cardiologist, or pediatrician has to deal with this level of risk. Young doctors know that. Why should they go into a branch of medicine to treat us when they can go into dermatology and make twice as much money and no one assaults them. Keep in mind, just because the psychiatrists disappear doesn't mean psychotic or violent or suicidal patients will suddenly disappear. The estimates are that their will be a critical shortage of psychiatrists to treat severe mental illnesses in just a decade. Something in the system needs to change.

You are very much in error. Read my above post. I know you are angry but neither are you privy to the larger picture. We risk losing a generation of psychiatrists because of the risks they face, the support they don't get, and the compensation they deserve. Wait 10 years. You think it's hard to find an MD now, wait till the average age of a psychiatrist is in the 60s and they start retiring.

Why are you defending them? I'm pissed that every other month my doc is in a hotel room in France while I'm here trying to decide whether or not to kill myself, waiting for my disability check so I can eat. Do you think it's okay that over half my appointments are cancelled, and only a fraction of the time they call in advance to tell me that?

Hi Spikes, I'm not defending anyone. Unfortunately the only thing one can do in your situation is to look for another pdoc. Have you called any?

I'm so sorry your Pdoc is treating you this HORRIBLE way, spikes! I completey agree with what ALL the other wise, wonderful posters have already wisely said better than I ever could! DEFINITELY try to look for another Pdoc if you can! You deserve to be treated MUCH, MUCH BETTER THAN THIS! Just try to look for ALL the clinics and Pdocs that are covered by your insurance and perhaps try to look up for some online reviews about them! Just try to get AS MUCH INFORMATION AS YOU POSSIBLY CAN! That's VERY important! I hope you'll be able to find the Pdoc that's better suited for you! It's hard to find a good Pdoc but IT IS POSSIBLE! PLEASE NEVER GIVE UP HOPE AND NEVER GIVE UP YOUR SEARCH! THINGS CAN AND WILL GET BETTER! THAT'S A PROMISE! WE ALL CARE ABOUT YOU! Don't worry, you'll find PLENYT OF SUPPORT HERE, SPIKES! THAT'S A PROMISE! Take GREAT care of yourself, ok, spikes? YOU DESERVE TO BE TREATED WELL BECAUSE YOU'RE IMPORTANT, YOU MATTER, YOU HAVE VALUE AND YOU'RE WORTH IT! I PROMISE YOU ALL OF THAT BECAUSE IT IS TRUE! PLEASE REMEMBER ALL OF THAT AS MUCH AS YOU POSSIBLY CAN BECAUSE IT IS TRUE! Remember that YOU'RE A WARRIOR! Keep fighting and keep trying your best! That's all we humans can do after all and IT'S ALWAYS MORE THAN ENOUGH! Sending many kind, safe, sweet, warm and WONDERFUL HUGS TO YOU, SPIKES, JUST LIKE YOU ARE!

I did but no one's taking any new patients except for a place I've been to before that I don't want to go back to (but apparently I have to so I'll call them Monday).