[MRT6211]

Hey everyone,

I've been a frequent flier in viewing feeds around here and finally today I made an account because there's something I need opinions on. Hopefully you all can help me out and welcome me to the psych central community!

So I moved to a new city to start medical school in July. In the year leading up to this, I was in weekly therapy and seeing my psychiatrist every 1-2 weeks because I was having a lot of issues with anxiety and depression. Since I got here I have been trying to find good providers that I feel like I can settle in with for the next few years. The first therapist I saw was absolutely awful (I'll spare details), and I left him after 4 sessions, and started seeing a new therapist in the same practice. She is much better and I like her a lot, and I get to see her twice a week, so at least I got that going for me.

With finding a psychiatrist though I haven't had much luck. The first guy I saw gave me meds I said I didn't want because I tried that class of drugs before and didn't like the side effects and then when I got them, I realized they interacted with my medications for a medical issue I have, so I couldn't take them. When I emailed him about it, he emailed me back a week later, called me by the wrong name, and didn't even apologize. I cancelled my next session with him. Several months later I decided to try again. This new lady I saw didn't want to prescribe anything in the first appointment, and our appointment lasted for 2 hours where she grilled me on stuff that my T had written in her notes that I was very uncomfortable talking about (and no, it was not essential to know to prescribe). Then our second appointment several weeks later she came very unprepared to (I'll spare the details but it was obvious) and then only recommended one med, and it would've caused cognitive impairment, which is not an option because I am a medical student...which she knew...and then finally at our third appointment she prescribed (yay! Or so I thought...) and then I went to pick them up at the pharmacy and the copay was $50/month which I can't afford at all (we had a conversation about how I couldn't make rent that month prior, so she knew I was struggling financially). I left in tears and I'm still very distraught about it. I emailed her informing her of the issue I encountered and she told me to: "find a list of meds that are covered or affordable and we can pick from there." I was livid upon receiving this response. I felt like she was asking me to just do her job for her...isn't it her job to make a list!?! And help me figure out the co-pays!? I'm stressed out enough as it is, to put that on me I felt was ridiculous. Not to mention she didn't even apologize. And then I emailed her back and told her that if that was the case, I wasn't interested in seeing her anymore, and she just said "okay, best of luck." And then CC'd my T on the email. (As if my T didn't already know... *rolls eyes*). I felt like that just reaffirmed that she didn't care about me in the first place!

Anyway, sorry this post is so long. I just want some advice I guess. Is it me? Am I the problem? Am I overreacting? Expecting too much from my providers? I had a really great psychiatrist that I really liked in my old town and maybe I just expect every PDoc to be like her... Should I even bother trying to find a new, third, PDoc? Do I just give up on meds and hope that therapy works miracles for me?

Thanks in advance for the help everyone. I hope I'm posting this on the appropriate forum!

As far as the med list goes, what she was asking for you to provide is your insurance company's list of medication formularies. That list is different from insurance company to insurance company, so it is reasonable of her to ask for that information. You can simply either go to your insurance companies website to print this off or call them and ask for a copy. That list will help the doctor know what meds are covered at different copay brackets on your specific insurance. That was a reasonable thing for her to ask for; she was trying to help you in prescribing from the formulary, but she doesn't generally have that list herself.

[MickeyCheeky]

Good luck with everything I'm sorry I can't be more helpful to you

[Misssy2]

I understand what you are going thru.
I was forced to change Drs due to Medical Coverage..and its been NO FUN at all.

The first psychaitrist...basically told ME..I was a lot to handle. OH yea? Of course i am I have mental health issues!

None of the Drs want to give me the medication that helps me the MOST...which is benzos...I only want 2 a day...they will only give me 1 because I have had alcohol problems recently. Yea, I'm drinking because i can't control my anxiety.

I need a mood stabilizer...I have been so out of control with moods..and called there various times..and this Dr. did call me back but I was already drunk...so moot in talking to him at that point.

I too have been to all required therapy sessions...haven't missed one...but I'm still stuck on the fact as to if I want to stay with these Drs.

In my area..they have Current Care which I STUPIDLY signed up for...this way all Drs can see your treatment. If I didn't have Current Care..none of them would know I had an alcohol problem and I would get the medication I need.

The thing that pisses me off so much with the medication...IS...I can have a reaction on ANY medication I am taking with alcohol...so why is it the only medication that helps me can't be prescribed....all chicken of losing their licenses.....and the patient level of care has gone out the window.

[Victoria'smom]

You have to find out what meds have what co-pay. Certain meds are cheaper if you pay out of pocket because they're on the generic list at different pharmacies. I would compile a list of meds you can afford and which pharmacy has it for cheapest. Then look for a new psychiatrist.

[kecanoe]

I had a gastroenterologist tell me to find out which meds were in my health insurance co's formulary so that he could prescribe something they would pay for. So I don't think your pdoc was out of line. Each insurance company is different, and each pharmacy can be different as well. I don't think that a Dr would have time/energy to know every insurance co and every pharmacy. Even the pharmacists have to look up what the price is on their computers.

Have you checked the website that there is a link to on the psych meds forum? They will tell you the price that you can get any specific medication at for lots of different pharmacies. I have seen differences in the hundreds of dollars on some meds. My hubby takes a med that insurance won't pay for because he is on two similar meds. At the pharmacy we usually go to it was almost $200, but we found it at another pharmacy for $27.

Yes, how infuriating; but.....

For some doctors it is your responsibility to provide the office the list of covered meds. This is easily obtainable. Your benefits plan manager should be able to fax out the list or provide you one.

I would fully expect a complete consultation with a new psychiatrist or any physician. They need to make up their own minds, familiarize themselves with your history, and establish their own method of treatment (including medications). Changing your script is not uncommon. This is what I experienced when I got a new psychiatrist. I admit I was really frustrated with her. Was she also inferring my first one was doing a bad job? I found out though they consulted on my treatment together before she added a medication.

Ask for generics. They are identical. Many plans will only cover them. My abilify is not on the list, but my psychiatrist wrote a letter and I got an exception.

[Cyllya]

Yeah, both medical doctors and mental health professionals can be obnoxious in their own way, and psychiatrists are in both of those categories.

I'd say you should be forgiving of the following things:

Recommending a drug in the same class as something else that was no good for you. It's pretty common for people to get benefit from one drug when a really similar drug was ineffective or had bad side effects. Heck, in some cases, people can get horrible results or great results from the same drug depending on the details of how they take it (dose, dose frequency, extended-release versus instant-release pills, time of day you take it, whether you take it on an empty stomach, etc.). Granted, I don't know which class of drug you're talking about, or what you're being treated for, so maybe I'd agree with you that it's nuts if I were more aware of the situation.

Recommending a drug that potentially has unacceptable side effects or interactions with other drugs. Again, I don't know which drug you're talking about, so maybe I'd agree it was absurd. All drugs potentially have horrible results. (Example: Amphetamine is intended to treat cognitive impairment caused by ADHD, is often used off-label to treat cognitive impairment caused by other things, and is often used by people without impairments as a cognitive enhancer... but it still potentially causes cognitive impairment.) Generally, the really bad effects only happen with a small number of people, otherwise the med would be too unpopular to be on the market and often the government won't approve it. Unfortunately, it's hard to know whether a med will be good for you before trying it.

Having no idea what certain meds will cost for you and needing you to provide that information. It actually isn't their job. I can still understand your frustration about it though. Insurance and medical billing is so confusing from the patient's point of view, and even if it's easy to get that information, even easy tasks are a pain for people dealing with untreated mental illness. I wonder if some of the psychiatrist's office staff might be able to assist?

Saying "okay, best of luck" when you fired her. That's probably the least bad thing for her to say. It's not like she should argue with you or anything.

Asking you a bunch of questions about your circumstances, history, etc. in an intake appointment before prescribing anything. I get the impression psychiatrists generally want to re-evaluate you rather than trusting the diagnoses of your previous providers, especially if the previous provider was a general practitioner or not even a medical doctor at all. (Therapists are trained in psychology, not psychiatry, so I think it'd be fairly irresponsible for a doctor to treat you based purely on whatever psychiatric diagnostic labels your therapist gave you.) Granted, it's bad that she didn't prescribe anything in that first appointment.