[Bleufacez]

I got into an argument w. pdoc a few weeks ago over the phone. I had requested a DNR Order form from his secretary and to make a long story short... I created a panic and we got into an argument.

I feel that he doesn't give me credit that I'm doing my best to get better when in fact, I'm very much am. I haven't missed 1 appt w. him or T, take my meds every night, mood charting, exercising, & even asked about voluntary hosp.

My friend tells me that it seems he got offended that I asked for the form as an indication that I don't believe he can treat me. He feels that I haven't given him a chance to treat me yet because I've only seen him a few times and drug hasnt worked yet. He accused me of "keeping things" from him (but hello... I only see him for 20 mins/mo).

Argument was kinda ugly... with questionable professionalism. He ended it by telling me to talk to T about the form, refusing to sign (although, legally... I don't think he can do that), and hung up on me. Called him back and he never returned my call.

I gotta see him in a couple of weeks and I'm getting real nervous. I don't know what to say to him or if he's still upset w. me. I want to stick w. him because we click and I think he's good. But I'm feeling awkward now. Should I keep seeing him? My T thinks I should attend this appt regardless whether or not I'm keeping him.Then there's this trust issue.... What if he doesn't want (though he has to) to treat me cuz he thinks I'm a lost case? On the other hand... I don't want to look for another pdoc over a tiff.

What to do?

Wow thats different. I never heard of a psychiatrist giving out a Do Not Resusitate (DNR) form let alone sign it. here in the USA as far as I know DNR's are for physicians (physical doctors) and hospitals to give out So that the person can sign one if they don't want to be given life support measures if the situation calls for being brought back from the brink of death with respirators, monitors and heart shock machines (yes I know thats not the correct name of that machine but at the moment I can't think of the right word) and so on. I know if I had ever asked a Psychiatrist (Pdoc) or any other therapy professional for a DNR they would think I was going to kill myself and most likely hospitalize me for at least the 72 hour observational time period.

That is so cool that psychiatrists (Pdoc) give out DNR's where you are.

[Perna]

It doesn't sound like your pdoc is going to sign and I'd bet it's well within his rights to not treat you if you all aren't seeing eye-to-eye. You don't have to go to him and he doesn't have to have you as a patient.

I can't imagine why you'd be planning on a psychiatric emergency though that would hurt your health other than suicide. Doesn't exactly go with your protests that you're working hard at getting well. It's not like you can "accidentally" have a psychiatric emergency that endangers your health/life, especially when you're doing okay now and allegedly getting better. I think most DNRs are for heart and stroke patients who could have another heart attack or stroke at any time.

California, of course, is a different Myself:

"If you think you have a MEDICAL OR PSYCHIATRIC EMERGENCY, CALL 911 IMMEDIATELY or go to the nearest hospital. DO NOT attempt to access emergency care through this web site. An emergency medical condition is a medical or psychiatric condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in any of the following: serious jeopardy to your health, serious impairment to your bodily functions, or serious dysfunction of any bodily organ or part. An emergency medical condition is also "active labor," which means a labor when there is inadequate time for safe transfer to a Plan hospital (or designated hospital) before delivery or if a transfer poses a threat to the health of the member or unborn child."

http://www.permanente.net/homepage/k...145-17773.html

California DNR is not a psychiatric thing its a physical thing - I have relatives in California that are in the medical profession and I used to recieve therapy in california.

from http://www.emsa.ca.gov/aboutemsa/dnr_faqs.asp

What is a DNR Form?
A DNR (Do Not Resuscitate) Form (actual title: “Emergency Medical Services Prehospital Do Not Resuscitate (DNR) Form) is an official State document developed by the California EMS Authority and the California Medical Association which, when completed correctly, allows a patient with a life threatening illness or injury to forgo specific resuscitative measures that may keep them alive. These measures include: chest compressions (CPR), assisted ventilation (breathing), endotracheal intubation, defibrillation, and cardiotonic drugs (drugs which stimulate the heart). The form does not affect the provision of other emergency medical care, including treatment for pain (also known as “comfort measures”), difficulty breathing, major bleeding, or other medical conditions. Many patients make their DNR wishes officially known because they do not want to be placed on life-assisting equipment in the event that their heart or breathing ceases.

Maybe what is being talked about is simular to my having a Declaration for Mental Health Treatment form which is different then a DNR.

This Declaration for Mental Health Treatment form is basically for the client to put down in a legal paper stating what they are willing to do for mental health and what they are against for mental health treatment. Theres also a spot on the form for listing history both mental and psychical, including medication allergys. Then once the form is signed by the client and their representative (who cannot be one of their treatment professionals) and then the form is distributed to the representative, physician and therapy team. once everyone has their copy of the signed form the mental health treatment teams MUST follow that form IF the client is ever deamed not competent to make their own decisions for treatment. If the treatment team wants to do something different and the client cannot competently make their own decisions the treatment team MUST consult the person listed on the form as the persons representative. If they still want to do something different and the rep say no the treatment team cannot do any thing until they go to court and prove how following the treatment plan in the paper is harmful to the client in their present condition.

These papers which are not DNR's are available through the persons therapy professionals.

[Bleufacez]

Well... in the State of California you can ask for DNR form regardless of age or condition. Any physicians who has a medical degree can sign and it doesn't exclude psychiatrists. DNR forms are there mainly for EMS personnel but there's a different part for the hospital. A request of a patient for DNR should be honored. More on DNR in CA: http://www.emsa.ca.gov/aboutemsa/dnr.asp

Let me give a background.... my intention for asking was because there are times in moments of desperation I question my abilities. I was driving and I started to question that. Times, I wanted to self-medicate until I realize why I shouldn't (and it took a well 10 minutes to come to this realization). I realize that it's the depression talking but when its at its worse... I get delusional. I get tunnel vision and sometimes I don't even remember how I get from place A to place B. The fact is - no one can guarantee what will happen to each of us from minute to minute. So... I'm taking every precaution that I have.

I don't know if he has given up hope on me yet. Legally he has to give written notification for a reasonable amount of time. He hasn't done anything of the sort. I am really doing everything I can. Is there any input as to what else I could do to convince pdoc that I'm doing everything that I can?

so you are asking for a mental health treatment plan that will address your mental health needs. your psychiatrist could have helped you draw up a speciofic mental health treatment plan and maybe his reason for asking you to discuss it with your therapist because he may primarily be seeing himself as just prescibing your psychotropic medication needs and that your therapist is the one in charge of anything other than medication.

I personally don't think he is going to be mad at you for asking for a treatment plan form and wanting to have a set treatment plan. he will probably at your appointment go into more detail as to why he wants you to discuss your therapy treatment plans with your therapist instead of him.

What you can do is sit down and write out what YOU think you should have for a treatment plan, goals and so on including a timeframe and then take that to your therapist and between the two of you talking come to an agreement for a specific treatment plan and time line that is directly related to you and your problems.

[Meta]

I am not a psychiatrist and I cannot speak for them, but if I were a mental health professional and any client asked me a DNR form, I would be very concerned it was an indirect way to say they were planning a suicidal event of some kind. I would think it would violate their hippocratic oath to hand out such a form to a patient they are treating for depression which has a risk of suicide.
My prayers and thoughts are with you. Please reach out for more help.

Meta

[Bleufacez]

Hmm... how can I put this clearly.... what I have in mind w. DNR is that if I get delusional while driving and lost control of the wheel and get into an accident with an 8-wheeler carrying dangerous materials and I'm there unconscious barely alife - I do not wish to be resuscitated.

Or... if I ended up self-medicating and ended up in a DWI situation.... (same story).

I don't want any confusion in regards to the DNR request. I know I'm being silly but should I or shouldn't I keep this pdoc?

[ster]

I'm not sure reading what was posted. I tend to wonder If with him signing something like that you may try to pass from this world before

[(JD)]

Sorry, but in the USA you don't have to have a doctor sign your DNR.

I would have taken it as your PDoc did, I think, from what you said. This was a definite acting out attempt to jerk his chain (which you did quite well I might say )

I've had many DNRs in my history. It is MY choice that if the doctors feel I am at a point where whatever is going on isn't going to improve ever and I go into some type of cardiac or respiratory arrest, they don't try to bring me back. (I don't have one right now though.)

Your DNR should be on file with your lawyer, along with your advanced directives forms that are more specific with your intentions (spells out when to try, how long to try life support, when to take you off, or when not to put you on at all.) A copy of any of this, including your assignment of a durable power of attorney, should also be kept handy for you to grab (or another person to find) should you be in that accident you seem worried about.

No, I saw it as a cry for help. I hope your T is able to work through your dissatisfaction with life with you. Take care!

[Sarah116]

Wow!, I do not think I have ever heard or read of an experience like this! Go, stand up to Pdoc and show him he better listen to you and do what you want because you pay him and if not ( He is going down because the sheriff is in town!) () indicates joke. But really you pay in what about 300 dollars a visit! Rate him on rate the therapist also.

[biiv]

Hi Bleufacez
i understand your wanting a DNR if you fear getting into such an accident and i think your pdoc really should respect your wishes in this regard but is it possible he is reacting the way he is because he is worried about you taking matters into your own hands and deciding you have had enough of life? if so keep and this is not true keep trying to show him in the way you re living that this is not something that you are thinking about.
otherwise i wonder if he might not react better if you started by describing why you are afraid of getting into such an accident and see if you can work with him and your T to reduce the possibility of that happening? perhaps you can keep driving to a minimum or stop altogether until the meds kick in enough to stop the delusions? maybe you could put in place with them an alternative for whenever you feel yourself getting to a place where self-medication might be an issue? maybe you could even leave your car keys with a friend and pick them up when you need them so s/he can be sure you re not medicated when you drive? your treatment team may have some better suggestions than this.
just my two cents worth. i really hope you can get this sorted out for yourself. i would say try to understand where your pdoc is coming from before you decide to drop him entirely and keep trying to get him to see where you are coming from to see if you can both reach a solution you are both comfortable with. i wish you the best of luck with this and please do everything you can to make sure you are safe as well.
biiv

[Randy33]

Sky is right, a doctors signature is not required for a DNR. There are several ways to go about this. You have the write to submit a DNR directive to any and all of your care givers, and that does not require their approval or signature. You can download DNR forms online, I would make sure it was notorized as wel. That and more through instructions regarding your health care wishes can be done through legal documents via:

-Advanced Directive Living Will - a legal document making your wishes known to your doctors, what treatments you want or don't want. Laws regarding AD's vary among the states.

-Living Wills -a legal document

-Durable Power of Attorney -a legal document

-DNR - an order in your medical chart, by you, stating your wishes. These are accepted by doctors and hospitals in all states.

Legal documents can cover more specifically, a number of circumstances and what is to be done in case they arise, other things besides DNR's that many people don't think about. Advanced directives/Living Wills do not have to be complicated legal documents.

You can find these forms as well as the laws in your state from the U.S. Living Will Registry which is online.

I am a firm believer and advocate of such documents. We just had our Wills redone and all of these things were included as part of our wills.

Having such documents can greatly benefit not only you, but your family as well, should such a situation arise where they would be put in the position of making such decisions on your behalf.

I have also made my wishes known to all of my primary care givers who have documented them in my charts. It is also important to make your wishes known to your family as well.

In your particular situation with your Pdoc, I think the better thing to do would have been, at one of your appts. bring up the subject and explain why you would like to have such a document in your chart. You have every right to have a DNR in your chart, but you don't have to obtain it from the doctor or have him sign it. I think in this particular situation with your Pdoc, requesting such a form, via the phone through the office staff, would and should set off alarms. It would not be uncommon for a psychiatric patient who was considering or contemplating suicide to make such a request and without a consultation with your doctor first, I would hope the doctor would ask you to come in to discuss this so he can evaluate your current mental state. Regardless, after that, he can't prevent you from doing it, but at least he has been responsible, looking out for you immediate welfare.

I know you don't want this argument with your doctor to force you to change doctors and it sounds like you have had a good history with them. I think you should keep your appt and go in an apologize for the misunderstanding and ask him to let you explain exactly why you want to do this at this time and that you hadn't taken into consideration the concern that would cause regarding your present state of mind.

I would add that you do appreciate his concern about your well being and I would hope he would make the same gestures and apolgies to you as well. He is the professional and from what you say, it sounds like there were much better and calmer and professional ways he could have handled this whole situation. I think lack of communication on both of your parts, that led to the argument, can easily be resolved as long as your are open and honest about it.

If this is causing you a great deal of anxiety, you might consider calling to see if you can make an earlier appt so you can resolve this and feel better.

Best Wishes

[Bleufacez]

Thanks, Randy - you provided great and detail insights.

DNR in CA unfortunately, doc's signature is required. There are 2 ADs: hospitalization (AD) and outside of hospitalization (DNR). DNR only applies to EMS personnel and will need to be present "on the body" at all times for it to be honored or wear a visible medic bracelet. If tucked away... then it's useless. Since AD only applies for hospitalization situation (i.e. life support, intubation, etc) and no doc's signature is required - AD is not applicable to EMS staff, only DNR is.

Anyway... not sure how it is with other states. I wished DNR was as easy as signing AD. I have an AD for hospitalization and all I needed was a notary for that. I'm just missing the DNR portion. I have the forms ready... just trying to find a willing doc to sign. I might just have my podiatrist sign it or something.

I am getting anxiety seeing him and he was very concerned & really upset. I requested for an earlier appt but he didn't return my call. Last thing he said was to talk to my T (which I did). I will take your suggestion on my next visit (next Friday) and am getting jiggly legs.

Thanks, all - for the info & support!

[Randy33]

Bleu,

You really got me thinking about all this and brought up something I had not thought about. In light of the first paragraph of my previous post, after reading your reply, I just read about 10 different sources on DNR's and further information on living wills, advanced directives and powers of attorney. Without the others, it looks it is pretty standard to obtain a signature from your "attending" physician and two witnesses, who are not your family doctor or health care facility employees is usually required for just a DNR alone.

Since I have never persued just a out- of- hospital DNR alone, my wishes on that are included in my Advanced Directive, Living Will and Power of Attorney contained in my will. That did not require a physician's signature to be legal. These documents have covered every situation I could think of that may come up, including organ donation. Documenting my wishes in all my doctors charts, most of whom would probably never be involved in a DNR situation, helps me feel there is no question about my wishes whether or not they agree or would consent to signing a DNR. Although that might not be legal, under the HIPAA laws I do have the right to include that in my chart. At least any of those caregivers could make my wishes known to an attending physician, in the absence of the legal documents or my family while they were being found.

Since DNR's pretain to withholding of treatment for cardiac or respiratory arrest, this situation is usually something that comes up in light of a serious illness where you could request a in-hospital DNR by the doctor or facility treating you for that illness, which it seems would require signatures at that time. It seems pretty standard and the treating doctor can defer to another if they to not agree including moral or legal issues.

I think everyone does need to find out exactly what the laws are on all these documents, because I just read differences in a number of states, some completely opposite from others. Since I just redid my will, I really can only speak for the laws in my own state.

I read that places like OH and the Cleveland Clinic have different types of DNR's with either comfort care, comfort care arrest and specified. Also, if there is a conflict between DNR's and AD's and LW's, there are precedents of one over another, but again that may differ among the states.

Over all, it does seem like the best way to insure your wishes about DNR's out-of-hospital is through these other legal documents. In the midst of a serious or fatal illness, it does not seem necessary and a pretty standard procedure. To insure your wishes in such a situation, a durable power of attorney allows others to make decisions on your behalf if you are unconscious which could always become a possibility as well and without your legal consent in these other documents, it could become a battle of wills among family members.

The thing you mentioned I hadn't thought of was in the case of EMS providers. Without the papers or a DNR braclet or necklace, they are legally obligated to treat you. But unless one is seriously ill, I don't know anyone who goes around wearing these things or keeps a copy of these signed forms on there person. If I was in a car accident and brain dead, they wouldn't know that at the time and because they can't know they certainly should do everything to save my life. So I am assuming, if say artificial resperation is initiated by the EMS, and it is determined at the hospital I was brain dead, these other legal forms would justify the discontinuance of that or any further treatment including CPR.

For me, all these documents are a must if I want my wishes carried out and keep from putting such burdens of decision on my family.

Bleu, you and your situation are still the topic of this thread and I am proud of you for calling your doctor about seeing him sooner. I take it you have to make appt directly with him, vs. and office staff. I hope this all works out for you with him and I think it will if he truly cares about you. If he doesn't, then better to find that out now. Good Luck with this and your DRN, let us know how it goes.

[Bleufacez]

Just to conclude this topic...

I couldn't see pdoc on Friday since I got there 10 mins late and he literally refused to see me. He had me rescheduled. I was LIVID coming out there!! I jumped through hoops to see him. I broke a lot of laws and probably knocked off a couple of grandmas on the way but due to traffic on freeway closures I got there late. I even gave a courtesy call notifying him instead of showing up late. Anyway... I showed up after he rejected me over the phone and dropped off my hw along w. the AD/DNR forms. Then I called my T and told her what had happened.

My T has been a great mediator between us and... an hour later Pdoc called me and we chatted for a half an hour. He thought that all this time I was gamey and being vague w. him. I was like... WHY DIDN'T YOU TELL ME?!? We resolved the whole trust issue that night and also because he's very impressed with my hw. In addition, I had written him an essay about my experience with depression. So he said that based on my writings he's getting my personality a little and saw how motivated I am.

We didn't fully resolved the whole DNR thing but he said that he'd sign it if I really wanted to, although, he honestly doesn't want to. He just thinks I'm too young for it and afraid I might commit suicide after he signs it. So I said... I want it sign but not by you. I'm in no rush and I respect how you feel about the whole thing. And left it at that.

I see him in a couple of weeks and I'm going to answer his Q about the DNR. I need to explain my reasons w/o sounding suicidal and I just couldn't find the words until now.

I know you all were very confused about this but I'm going to explain as I will explain to my pdoc in 2 weeks....

At 17.5 yrs old I went to the bank and asked if I can open an IRA acct. The teller asked me if I knew what an IRA is. I said, "Why don't you tell me?" He didn't know that 2 yrs previously I went to a bank class and was told that I couldn't be a banker until I hit 18 so I dropped the class. So the teller explain what an IRA is and I said, "I want to open one." He responded, "Aren't you a little young to be thinking about retirement?" So I said,"How old do you think I should start thinking about opening one?" He said,"Most ppl start thinking about it in their 30s or 40s." Then I said,"So... what's wrong with opening one at this age?"

And that's the way I feel about DNR. Just like ppl filling out beneficiary forms, creating wills, buying a burial ground, or in less morbid case... a prenup. I like to be proactive. I've failed so many SI attempts and have come to a conclusion that it's not my time yet. God had let me live for a reason. So.. I self-persevere. But if I were to get in an accident and close to death... I will take it as my time and that my work in life is done. My life is full of sufferings and I wish not to be perserved or resuscitated.

I hope that explains it. Thanks for all of your input! You all have been very helpful.