[cool09]

You tell them something important or critical about your past or present and they act like they didn't hear you. I thought they're in the business to take information from you and process it! I recently told my Doc that I think about suicide a lot and he just continued the conversation like nothing happened. (I've never told a Dr. that suicide crosses my mind.) And I told him about mental disorders that run thru one entire side of my family and some other important things related to my med history, etc. and he hardly gave me any feedback. After all of that he talked about a problem he's having with his boat for about 5-6 minutes. This is the best PDOC I've ever had in 27 years and I like him very much (been his patient for 7 yrs) but I just don't get it sometimes. I realize they're people, too and they can tolerate so much.

I've had some PDOCs (and Residents) that were just horrible including one who was sick and deranged.

[Wren_]

Some react more than others ... after seven years though i think I'd be wanting more reaction than what you received I'm curious though ... wouldn't he have the history on your family by now? and your med history ...

I don't understand the lack of reaction in this instance where you know each other and if this is new info as far as the thoughts

I suspect hearing a patient is having suicidal thoughts is not particularly unusual for a pdoc. My pdoc's reaction varies with how truly at risk I am at the moment. And medical/family history is probably recorded in notes, but again not out of the ordinary from a pdoc's perspective.

If my pdoc sees I am truly at risk (have a plan, already showing impulsiveness, severe change in affect/demeanor/ability to function, etc., ) he definitely reacts and takes action, but he doesn't jump immediately into that mode. He takes the time to feel that out.

Don't assume he isn't making note of what you are telling him and processing it against what he already knows about you and what he knows in general about the symptoms you are displaying. Sounds like you have worked well together; he's just not reacting in a way that you expected.

I've learned over the years that often what we are most stressed about doesn't raise the same level of alarm in pdocs, and sometimes they are more alarmed about things they see in us that we haven't really clued into. Odd thing is that generally my pdoc is right on target when his alarm bells go off even when I don't see the problem myself. It's a strange paradox.

[ultramar]

I think pdocs do want to know what's going on (i.e. suicidal ideation) and they make note of it, but their job is primarily medicating when necessary, adding, subtracting, changing doses. And this is only warranted, normally, when things are completely out of control, and in such a way that is beyond the scope of therapy to help (imo).

I think they look at the whole picture, and in this sense family history is only one part of a much larger picture; it's not deterministic, just one part of the puzzle. Once they know you, I think pdocs are primarily looking for radical changes from your baseline that may require medication, and safety. I think everything else in between (which is a lot) they leave to you and your therapist, if you have one. Not that it's not important to share what's going on, just that I wouldn't expect much of a reaction. Your therapist can help you with suicidal ideation (I would think), but if the pdoc doesn't think a medication change will help you with this, they want to know, but it's really out of their purview.

[jesusplay]

they are MDs, they aren't psychologist or therapist.

[Perna]

My primary care physician can be like that. I think it's because they probably have 25 patients a day x 325+ days, and he still leaves half my last name off my prescriptions/lab test orders after 5-6 years, seeing him every 3 months. But the smile and handshake at the beginning of the appointment are so caring :-)

When my appendix burst in 2003 it took me to figure out what was wrong, grabbing information from all the people treating me and asking the right questions and finally putting the information together in the right order. That took 5 months (the $3,000 appendectomy only ended up costing $30,000 and almost killed me 3 times).

They can only pretty much work in the moment. Your aunt being schizophrenic isn't actionable to them? You often thinking about suicide; there's really no pill for that? Did they suggest you get a therapist? That's probably most pdoc's best effort after they've given you original meds and tweaked them over time. My doctor is never around when I have an emergency, I have to go to the ER and even some of the follow-up, I have to go to a doc-in-the-box for that.

Ever since I lost 30+ pounds and was earnestly telling my doctor about it and how I did it and how wonderful the program was, etc. and he turned and handed me a brochure on a 1500 calorie diet. . . you know, if case I wanted to diet? They listen for key words, make sure their test results are okay and you haven't had anything else concrete go wrong and then, NEXT!

With my doctor, when he doesn't respond where or how I want him too, I hammer him with it until he does. You interrupt him; "I'm glad your boat hasn't sunk yet, Doc, but is there anything we can do about these constant suicidal thoughts?"

[SkinnySoul]

Well, my T is also a psychiatrist and he is nothing like that. You can see he struggles not to react. Not to mention he remembers every freaking detail of everything I tell him and he doesn't even take a note. I think it depends on the person...

[wotchermuggle]

I think my Pdoc is great and she doesn't really "react" either. She is calm regardless of what I say. I think that she probably doesn't react to things that my therapist might react to, because that isn't her job - to be a therapist. She still offers ideas, suggestions, and we do talk about current issues, etc., but she doesn't freak out if I say I have been having a hard time with suicidal thoughts or anything.

I like that she is calm. My therapist is always calm, too, but he obviously displays more empathy and we discuss things in a deeper context.

I wouldn't want her to "react". I need her to stay calm about me because I don't want to ever be hospitalized. If she stays calm, I can stay calm.