[geisha75]

Hello,

I'm new here and not sure if this is the right forum, but it doesn't seem to fit anywhere else.

To give a little history, I suffer from severe GAD/panic and am bipolar NOS.

I had been with my psychiatric nurse practitioner for seven years. Six of those years were fairly good. She has a bulldozer of a personality but did offer me some good gems of advice and kept me mostly stable with some pitfalls of course (I've just accepted that my life will never be anxiety-free). She did have this habit of throwing out nonsense theories though when questioned. Also, after seeing how sensitive I am to meds, she was extremely reluctant to ever try anything new with me.

I had a bad relapse of panic and GAD this year after about seven years of minimal panic and moderate GAD. It was obvious that not only had her caseload increased and she was very rushed, but she was frustrated with me because I'd slipped back down the rabbit hole. I think she just didn't know what to do with me anymore because I'm not your easy patient that you can toss a script for Paxil to and rush out the door. I just sensed a change in her personality and didn't want to go back.

Needless to say, I managed to find a new nurse practitioner and met with her last week. She was amazing. She spent an hour and a half with me taking careful notes and getting all of my history and was very caring. She was also conservative in her approach with me, which is something I look for. My gut feeling was a very positive one, and my gut is usually right about these sorts of things.

Here's my fear - we discussed a transfer of records, but I can't remember if I signed the form to transfer them. And if I didn't this time, she may ask me to do it next time.

I really just want to start over and not have her mind poisoned by my previous n/p's crazy theories (example: she thinks my current relapse is the result of my putting my dog down over two years ago. I know you guys don't know the whole story, but I can guarantee you that as much as I loved my dog, I am not having anxiety over that) and frustration with me. I am sure she wrote in her notes how difficult I was to treat and that I wasn't following her advice about going out and pushing through panic and anxiety no matter what. The woman admitted she'd never had an attack and her compassion level was always pretty low.

I guess I'm just looking for people who have had similar experiences and advice on what to do if my current n/p has not yet asked for the old one's records. If I go to my follow-up and find she hasn't gotten the records and asks me to sign a release, what can I do?

And if she already has those records, how can I get her to see that my old n/p's impression of me was not always accurate? The woman wasn't my therapist. She acted like she had me figured out and that was *far* from the truth.

Thanks for reading this. I know it's long.

[Raindropvampire]

Could you tell you new NP just what you said here? That if she doesn't have them you just want to start over with a clean slate. If she does have them then tell her your fears about what the other NP might have said and how you feel it's not accurate.

You could even just show her this post or edit it to where you are comfortable and give it to her. I know sometimes it's easier for me to communicate in writing than it is for me to talk.

If she does have your file and has read it I'm sure she'll pick up on the other NP's lack of compassion. She will know that you two just weren't a good a fit and I truly believe she won't judge you based on what the other wrote.

[LucyG]

I completely understand how you feel. Who knows what Pdocs put in your medical records that is nothing more than conjecture?

When I left my Psych ARNP I also worried about what she'd written in my records. Fortunately, I never found another one I liked, and ended up going off meds and using various supplements to control my BP2 so it became a moot issue.

I wonder if you could ask to see your file?

[Lauru]

I was set loose by my last pdoc. My current pdoc is in the same office. I have the legal right to not transfer over my records. And my new pdoc was fine with that. He is very professional and a great guy. In fact, it was the office staff who told me I didn't have to transfer them over. If you did sign the paperwork to transfer them over, you have the legal right, at any time, to revoke that authorization. That being said, your new nurse could refuse to see you if you don't transfer over the records. But that would be VERY unprofessional and unethical. So if she does refuse to see you over that, you know that she is definitely NOT the right one for you. I say confide in her and stand your ground and see what she says.

[amandalouise]

Originally Posted by geisha75

Hello,

I'm new here and not sure if this is the right forum, but it doesn't seem to fit anywhere else.

To give a little history, I suffer from severe GAD/panic and am bipolar NOS.

I had been with my psychiatric nurse practitioner for seven years. Six of those years were fairly good. She has a bulldozer of a personality but did offer me some good gems of advice and kept me mostly stable with some pitfalls of course (I've just accepted that my life will never be anxiety-free). She did have this habit of throwing out nonsense theories though when questioned. Also, after seeing how sensitive I am to meds, she was extremely reluctant to ever try anything new with me.

I had a bad relapse of panic and GAD this year after about seven years of minimal panic and moderate GAD. It was obvious that not only had her caseload increased and she was very rushed, but she was frustrated with me because I'd slipped back down the rabbit hole. I think she just didn't know what to do with me anymore because I'm not your easy patient that you can toss a script for Paxil to and rush out the door. I just sensed a change in her personality and didn't want to go back.

Needless to say, I managed to find a new nurse practitioner and met with her last week. She was amazing. She spent an hour and a half with me taking careful notes and getting all of my history and was very caring. She was also conservative in her approach with me, which is something I look for. My gut feeling was a very positive one, and my gut is usually right about these sorts of things.

Here's my fear - we discussed a transfer of records, but I can't remember if I signed the form to transfer them. And if I didn't this time, she may ask me to do it next time.

I really just want to start over and not have her mind poisoned by my previous n/p's crazy theories (example: she thinks my current relapse is the result of my putting my dog down over two years ago. I know you guys don't know the whole story, but I can guarantee you that as much as I loved my dog, I am not having anxiety over that) and frustration with me. I am sure she wrote in her notes how difficult I was to treat and that I wasn't following her advice about going out and pushing through panic and anxiety no matter what. The woman admitted she'd never had an attack and her compassion level was always pretty low.

I guess I'm just looking for people who have had similar experiences and advice on what to do if my current n/p has not yet asked for the old one's records. If I go to my follow-up and find she hasn't gotten the records and asks me to sign a release, what can I do?

And if she already has those records, how can I get her to see that my old n/p's impression of me was not always accurate? The woman wasn't my therapist. She acted like she had me figured out and that was *far* from the truth.

Thanks for reading this. I know it's long.

question... lets just say for a moment that you have quite a history of medications and reactions. now lets say this new treatment provider prescribes something. and it turns out that you have a major, major reaction, to the point where this medication places you in serious medical problems..now lets say you have had this medication before but because of your extensive so many yrs with the same treatment provider you dont memorize each and every medication and each and every negative reaction from those medications because you are with the same treatment provider who already knows about and had documented your medicaiton and reactions..most people who have medication problems if that medication is tried again it turns into a serious problem some times life threatening.

that new possibly life threatening situation due to the meds your new treatment provider prescribes ***without having your records from your past treatment provider**** could have been avoided...

my point is the reason behind transferring files isnt so that the next treatment provider sides with the last one.. its for your best interest and safety so that the new treatment provider doesnt have to go through all the past mistakes/ prescribing already tried meds that turned out to not be right for you.

my suggestion is give the new treatment provider your files so that she has what she needs in order to appropriately and safely treat you without having to go through all the mistakes, meds that didnt work and all that, and be yourself, give her the chance to get to know who you are ***now***, what your present problems, struggles are and what you want to work on now in treatment.

[geisha75]

Thanks, everyone! My new nurse was very laid back and did mention something about not absolutely needing to have my old records, but also mentioned we could get them, so I'm unsure as to what happened. I had to fill out so many forms that I don't remember if I signed them. My memory gets fuzzy when I'm a nervous wreck, which has been the case pretty much 24/7 for the last year.

I am going to call my old n/p's office tomorrow and ask if a request came through. If it did, I'm going to tell them not to send them. There is an additional complication that just dawned on me tonight and has me very worried - my new n/p is a co-worker of my mom's. I told my old n/p plenty about my family because throughout the seven years I went to her, I had my share of issues. I can't have the new person knowing that.

I know the new lady is bound by HIPAA not to say anything, but she could still privately form a different opinion of my mother and that worries me. Much of it would be undeserving and unfair because I had times when I was just angry at everyone.

Unfortunately, I cannot get my own records because under HIPAA, you're allowed the charts, but not their personal notes, and of course she mixed the personal notes in with the charts, so you can't get a copy.

I feel like everything will be ruined if those records were sent. The new n/p will have all of these ridiculous theories and crap sitting in front of her and who knows what she'll believe? She was incredibly professional and kind and I'd like to think she would take my word for things, but I don't know. I could tell you guys a few stories, but it would make this an even more long-winded post.

Oh, and there's the benzo issue. I really wish I could ditch them once and for all because they give you a bad reputation. My old n/p was so conservative that she would barely change any part of my treatment plan despite me pathetically floundering this year. She had me on Klonopin which was decent enough for keeping some of the GAD in check but was useless for panic. I had a panic attack again about a month ago and was petrified they were returning, so I made the colossal error of asking the old n/p for Ativan instead. I had done this in the past because sometimes I would have more severe anxiety that was better helped by Ativan and she never had much of a problem occasionally changing me over. This time, however, she did and told me I was heading down a "slippery slope." I still don't understand why. I have never doctor shopped for them, have never once called her office for more between appointments, have always used one pharmacy and only take them as directed or as needed. So how is it a slippery slope? I tried to ask her why and she shut me right down.

She changed a lot in this past year which was why I sought out someone new and I'm glad I did, but man, she has seven year's worth of personal notes that could say absolutely anything. I figured she has spent perhaps a total of 30 hours with me in the time I've seen her and yet she acts as if she knows me so well and exactly what is going on in my brain. How could she even begin to understand?

[geisha75]

Oh no, I just typed a long response and poof, it disappeared.

Anyway, thank you to all of you who responded. My new n/p mentioned that it wasn't absolutely necessary to have the records, but also said we could get them. I filled out so much paperwork that I don't remember if there was a release in there. It doesn't help that my memory gets fuzzy when I'm anxious, which has been the case for pretty much the entire year.

Today I will call the old n/p's office and ask if there's been a request for them, and if they haven't sent them out, I will tell them not to. It will probably look suspicious, huh? Tonight an additional thought came to mind that scares me, and that's the fact that the new n/p is a co-worker of my mom's. Over the years, I have told my old n/p a lot about my family, much of which wasn't favorable. I have had periods where I've been so angry and much of what I said about my family was unfair.

I know the new n/p is bound by HIPAA to not say anything, but privately she may form an unfavorable opinion of my mother which would be undeserved. I would feel awful about that.

HIPAA's site states that you can have a copy of the records, but not the psych's personal notes, but of course the notes are mixed in with the records, making it impossible to get them.

Oh the stories I could tell you guys about the old n/p pulling ideas and theories out of her rear that made no sense and she wouldn't listen to me when I told her it wasn't the case. I figure that over seven years, she spent a total of perhaps 30-35 hours with me. How could you possibly know everything about me or how my brain works in that time? It wasn't even therapy! She would throw out some decent advice from time to time, but most of it was medication management.

Please keep your fingers crossed that the records weren't transferred.

[Perna]

I would talk to the new NP about the situation and how you feel like you want to start over and that you are "worried" what the old NP's notes might say, etc. It sounds to me like this new NP isn't going to just read anything and believe it, wholesale? But it might be good for her to have what was tried for meds, what worked and what didn't, etc. so she doesn't have to waste time suggesting things that might not work or guessing at what could be done "differently"?

[geisha75]

^Sorry for the two different replies above. I thought the one didn't go through but apparently it did.

Anyway...

I understand where you both are coming from when you say she should have a list of the medications I've tried, and this is when being an over-vigilant hypochondriac is handy. I've kept a list of everything that my previous providers tried with me and gave her a copy of it in bullet point form. It was a really long one too, unfortunately. I'm overly sensitive to these psych meds and almost all of them trigger my IBS.

Maybe that's why she didn't give me the impression that she felt the records were an absolute necessity? Because she had a list of every SSRI, SNRI, tricyclic, benzo and other psychiatric medications I've tried that gave me intolerable side effects.

[amandalouise]

Originally Posted by geisha75

HIPAA's site states that you can have a copy of the records, but not the psych's personal notes, but of course the notes are mixed in with the records, making it impossible to get them.

here in NY and if I remember right here in the USA a client can have copies of ***everything**** that is in their treatment files. including the actual session notes that a treatment provider writes. the law here that give a client that right to have copies of everything with in their medical and psychiatric records is called "right of access"

both my wife and I have complete copies of our medical and mental health records. it wasnt that hard to get them we just asked our treatment providers for them, they sent them on to the new treatment providers and then the new treatment providers photocopied the complete files for us. we have both the formal official forms write ups of when we saw our treatment providers and we have the sporadic word here word there brief type notes that our treatment providers wrote while we were right there with them.

suggestion talk with your treatment providers the Right of access law might be the same where you are.

[geisha75]

Well, it's done. According to my new psych's office, I didn't sign a release, and when I called my old one's office to cancel my appointment, they said they hadn't gotten any requests for records. Still, they sent me to my old n/p's voicemail to tell her not to transfer anything (just to be sure). What a bullet I dodged. The last thing I needed was my new person reading stuff that I said about my mother. Why that never dawned on me is beyond me. *smacks self in head*

The odd thing was I had no appointment on the schedule with my old psych. That is very strange. I stood there while the woman made it for me and she gave me a card for 11/17. So how did it get cancelled? It's a moot point, but it makes me wonder if someone from my new psych's office contacted them. Or maybe it was a computer/clerical error.

And of course I'm scared my old psych will call me back and accuse me of doctor shopping or something. I swear, one problem is solved and another one immediately takes its place. I don't want to talk to my old psych ever again, and she works Wednesdays and Saturdays, so now I'll be worried that tomorrow she'll call me.

I just want to be free. We had a long run together, much of which was positive, but this last year with her has had more negatives than positives and I want to leave it behind in the dust. The last appointment really was the straw that broke the camel's back. She was so dismissive and said a couple of rude things that left me walking out to my car in tears.