Monday, March 22, 2010

A Quick Call to the Psychiatrist, Regretted

Ooooh, am I so peeved at this woman!

Then again, why WOULD she know who the hell I was, calling, anyway? I'm just a new patient.

Don't put down your cell for pressing matters if you don't want it called. Of course, ones' definition of pressing might differ from someone else's, but it was 9 minutes after her office closed, and the call was 90 seconds or less, so I figured it wasn't a huge bother. It could have been longer, had she not acted the way she did, but she REALLY did not represent herself very well at all. Then again, since she had no idea who the bloody hell was calling her, that's probably partly why I'm pissed off.

Still, all my defenses are going to be UP UP UP like you wouldn't believe, when next I meet with her, and the pressing need behind the call is going to stay buried. From her, at any rate. My psychologist will know, but hell if she will, and I don't give a damn if that means my treatment isn't correct because she needs to damn well earn my trust, and act like a doctor, a psychiatrist with at least a SPECK of empathy, and not a bitch.

Strong language, but the phone call was . . . . jarring. I sincerely regret ever picking up the phone to call that woman. I give her 4 appointments to see if this relationship is workable.

I don't know if I have it in me to seek another psychiatrist, but for my own health I shouldn't give up on psychiatrists entirely, and I know I'm catastrophizing and over-magnifying and blowing things out of proportion, partly because of how infinitely STUPID I feel after that short phone call. All sorts of distorted thinking & thought patterns . . . . it's just, . . . .

I'm like a dry tinderbrush right now, and anything could light me afire at this point. Even the stress of thinking about going to see her, after that stupidness of a phone call. I'm too impulsive, and that call is one impulse I really, really regret. If she's any kind of a psychiatrist at all, she hopefully won't try to make me feel stupid (er) than I already feel about it. If she does, I'll take that as a sign that she's got no sense of empathy or speck of human connectedness about her at all. Which would make me wonder what the heck kind of psychiatrist she is, anyway.

See, though all of this flailing around wondering, spurred on by my embarrassment over a teeny phone call where little was said, is a whole lot of to-do over what is likely nothing. Making straw men out of nothing. Making up potential issues where none may exist.

So we'll see, but as I say, I'm going to have all my armor on because I'm tired of feeling emotionally beaten up or having the rug pulled out from under me and bloody surprised like the way I was at the first appointment; she's got to EARN my trust after THAT stupid maneuver, as well as after her manner with me on the phone, granted that she didn't know I was a patient for half of the very short phone call, though.

Anyway, UGH. Despite the shortcomings of my first two psychiatrists, at least I knew that they genuinely cared for my well-being. Also, neither of them thought I was stupid or annoying, as far as I knew. Well, my first one was sometimes . . . well, it depended. In the end, though, I knew he was sincere.

See, this seeing a woman psychiatrist thing is fraught with a psychological minefield, in addition to all the other problems that have come up. I have plenty of reasons not to trust women.

Monday, March 15, 2010

How It Is, & Thanks Shrink Rap!

Dinah, of the Shrink Rap blog, was true to her word and wrote a post regarding what I described in my previous post here, about my Psychiatry Bait-and-Switch experience, as I title it below. She titles her post, "Hey, What are YOU Doing Here?", and then talks about what her experiences as a psychiatrist have been at different facilities as well as in her own private practice have been in regards to the initial interview and the procedures for it, as well as what the standards are for it as laid out by the American Psychiatric Association (I think).

In the comments, one commenter/psychiatrist brings up sections of the American Medical Association's recommendations & guidelines for practices relating to issues regarding how a psychiatrist should conduct ones' self regarding splitting duties/fees, (at least it is implied that if you are splitting the duties that much, then isn't much of the fee for the session going to the person doing much of the work, thus splitting the fee?) . . . . as well as allowing ones' self, as the psychiatrist, to be used as a figurehead, not being in the patients best interest at all.

I thought those were VERY interesting and informative to read about. Both the post, including the standards from the APA, and in the comments, the further standards and guidelines especially directed towards psychiatrists, from the AMA . . . .

It's an interesting discussion, of which some has spilled over into the comments on my own post, entitled Psychiatry Bait-and-Switch, here on my own blog, from people who followed the link to that post from the Shrink Rap blog. Please feel free to join in the discussion there.

It is heartening to see that there are doctors out there who do not support behavior that is so fringe and will speak up to inform about the profession, and who are embarrassed on behalf of their fellow psychiatrists, and that there are those who care enough to post an informative post for me like that; Dinah, I really appreciate it.

I know it's my own choice about what to do about my own health care, and given everything going on with me, at present I feel that it's best that I'm under a psychiatrist's care, than none at all. That should tell you something, about the pressures I am under. How trapped I feel by circumstances beyond my control.

I added up all the medical expenses from March and expected medical expenses through the end of May and it adds up to $1800 or more, just shy of what we need to hit the deductible - I really don't want to go into surgery without it being met, but it's not like we have $1800 in 2.5 months to meet all these expenses, either, let alone the $2800 the MRI people want. So I'm shutting down, because I can't cope with the reality of the life that is in front of me.

I. Can't. Handle. It.

And.

I am in constant pain, that is wearing me down, and I don't know if I'll have the OOOMPH and the willpower to bull through and do the painful work needed to recover from another surgery, let alone continue with the work needed to continue with my current recovery. I'm feeling so burned out. OUT. OUT OUT OUT.

EMPATHY is NOWHERE TO BE FOUND, and I AM ALONE as if there was NO ONE. ALL. BLOODY. BY. MY. SELF. and it hurts.

I can't think my way out of this one. Money doesn't grow on trees, and recovery doesn't happen overnight.

So, as long as there's no more Energy Healer, and I can scrape up the dough from somewhere for both meds and visits to see her, I'll go to the psychiatrist unless something untoward happens, with constant revisions as time and experience go on, with her. My condition requires being in someone's care, right now. Those are big ifs, though. If I can't afford the care I need, then I'll just have to, well, say that mental health care is unaffordable, both the doctor visits, and the medication. Even if it is essential. Even if this is America, where you aren't supposed to be in danger because you can't afford health care. Who says? That's the way our system is.

I'm tempted to not post this, but I want to lay bare the real truth of how it is, so here's how it is.

Thursday, March 11, 2010

Psychiatry Bait-and-Switch

New patient appointments with psychiatrists are usually 90 minute appointments, and subsequent appointments are generally 15 to 20 minutes to deal with medication issues, unless you are also seeing the psychiatrist for your psychotherapy, which many insurance companies don't like anymore.

I do not know if it is an acceptable practice for a psychiatrist to "farm out" part of the initial interview to a colleague at their practice, such as an LCSW (Licensed Clinical Social Worker) or other mental health professional, and then come in for the last 20-25 minutes and be filled in on the most pertinent details (things like family history that I had already addressed in the New Patient Information packet that I had been asked about again in the interview were not brought up in this "fill in the psychiatrist" process, thank goodness; perhaps it was assumed that she had read the history, and that she'd read the interviewer's full notes later) . . . . . .

I do not know if such a thing as this is an acceptable or accepted practice . . . I do not know what my insurance company would say about it, either.

Shockingly, I wasn't interviewed by anyone I'd consider a mental health professional, though I think the people within the group practice there might disagree. I was interviewed by an Energy Healer. AN ENERGY HEALER. Of all the mumbo jumbo hocus pocus crap, pardon my language . . . . . this is fine, for those who believe in it. It is not fine for me, because this is not what I was there for, and despite the fact that her "degree" includes courses in psychology and psychodynamics (when I first went there to fill out the new patient forms, I picked up the business cards of everyone there, and a flyer or two, including the one for this Energy Healer, to take home with me to read, to get a "feel" for this different kind of a place that I'd be going to), I do not consider her a mental health professional.

I also consider it a wasted opportunity on the part of the psychiatrist, because with the limited time we are allowed in subsequent "med check" appointments by the insurance company, she has missed the opportunity allowed in this first, longer appointment in getting to know me that she could have had in interviewing me herself.

Now, if her practice is busy enough that she can't take new patients on without farming part of the interview out to a colleague, then at least do it to one of the LCSW's or PC (personal counselor? professional counselor?) at the practice, and not to the energy healer . . . . .

With as long as it took me to find a psychiatrist last time, and as quickly as I found one this time (although that might be a warning sign, I don't know, although the open philosophy the practice holds would indicate, I HOPE, that they'd not try to force one down a path you aren't comfortable with), I AM happy to have gotten in to a psychiatrist at all, AND the time I DID spend with her (none of it one-on-one, though, the energy healer was still in the room the whole time) I thought she was sharp, in a good way, on the ball, knew her stuff, made a decent impression for the negative impressions that I'd already had going, having been thrown for a loop or two by being farmed out to the energy healer, and a really negative interaction with the office staff at the front desk, which was another throw-me-for-a-loop interaction that is causing a huge amount of anxiety.

The thing is, I cautiously quite like her; the psychiatrist, that is. Based on the little time I had with her.

Counter-balancing that, though, is the resentment at being forced to open up to someone that I'd never have opened up to, had I not been forced to. She's not going to be part of my ongoing visits, as the med checks will be with the psychiatrist herself, but when my arthritis and the prognosis would come up it was assumed that what the doctors had said about my future wasn't really how things had to be, because what the Energy Healer does is supposedly supposed to change that kind of thing. I resent that she or they assumed that I was or would buy into that way of thinking, as well. Although, since that's their worldview, how could they not think that way? It would be like asking them to be something other than who they are, so I suppose I couldn't ask anything else.

At my next appointment, my problem with the staff in the office will be mentioned, unless the anxiety becomes so great that I have to call her and mention it before then (ie, it might prevent me from coming back, and if it does so, I may be done with psychiatrists forever), as well as my resentment at being forced to open up to someone that I was not prepared or expected to open up to, that I would not naturally trust, will also be mentioned. These things are important to maintain a good working, trusting therapeutic relationship between the psychiatrist and myself, although I worry about complaining about the office staff, as well as complaining about the procedures she's established for taking on new patients. I have to counter-balance those worries with how much anxiety the office staff interaction has and is causing me, as well as the amount of resentment caused by the bait-and-switch thing, the amount of resentment caused by the fact that I never would have opened up to this other woman if I hadn't have been forced to.

I still wonder if it makes me a bit of a, pardon my language, bitch, that I had this office staff problem, and problem with the new patient procedure, though. Still, on the latter, I've never HEARD of anything like it, especially involving a non-mental health professional, at least as most of the mainstream world would define the term . . . . .

I was raised to be a bit leery of psychiatry/psychiatrists, and this whole experience just leaves me extremely unsettled, despite the fact that the psychiatrist seemed really good, although I don't have much to go on, there, and I have to make some judgements of her based on more than our interactions; I have to judge her on her intake procedures, office polices, and other things.

She's got me titrating up EXTREMELY QUICKLY on Seroquel, so we'll see how that goes; depending on side effects, we may slow it down a little.

I'm hoping that the peeps over at Shrink Rap see this post, and respond with a post on if they've ever heard of acceptable or not practice of farming out part of the new patient intake interview . . . . whether it be to a more mainstream mental health professional with a lesser degree, or to a more odd "specialty" such as happened to me. Even if it's acceptable within the profession, it's still a missed opportunity on the part of the psychiatrist, as I stated above, to get a good read on the patient.

I see her again in a couple of weeks, on a Saturday morning of all things!

Sunday, March 07, 2010

In Which I Go To Church, & Burst Into Tears

Today I went to part of my church's worship service, the main meeting: Sacrament Meeting. The other two parts, well for women, are Relief Society, and Sunday School. For men, depending on which Priesthood one is called to, you go to Elders Quorum, or High Priests'. Then it is Sunday School, along with the women.

Now, some congregations have their Sacrament meeting first, before these other meetings/lessons, and some have them last. Ours has it last. Part of the reason is we meet in our building with several other congregations, or "wards", as our term is, and we have to stagger the schedules. Often, it is felt, that if Sacrament meeting is held last, that some people will feel that they can come to church late, which is not something the leaders want to encourage, and so it is more often practiced, when possible, that Sacrament meeting is first. Still, it is sometimes not possible to always do so.

Anyway, that's more than you likely ever wanted to know about the LDS Sunday Meeting schedule, lol, and that doesn't even take into account the Primary (which is the children) or the Young Women & Young Men's groups, either.

So, today was the first time since surgery that I've been to church. I could have gone back earlier, but I haven't. Going to church is a HUGE anxiety disorder issue for me. I mean HUGE. Being around all those people, ESPECIALLY crossing over the threshold into the chapel . . .

Today, though, my tears had naught to do with the anxiety disorder, at least, not how you might think . . . .

After I'd been sitting on the back bench for a few minutes, right before the meeting was about to start, a familiar feeling in my left leg and knee brought me up short and aware and I looked around at the benches and behind me to the overflow area at the padded folding chairs, and I was filled with horror - every seating surface I could see was angled, with the front edge higher than the rear edge.

If you don't know because you may not have read the posts about earlier in my recovery from this total knee replacement, I have been having an odd side effect that the surgeon has never heard of, which I talked to him about a bit at my recent appointment, just a little. When I sit on chairs or surfaces that are angled upward at the front edge, from the back, ie, the front edge is higher than the back end/edge of the seating surface, something in the way it presses against the back of my leg/thigh somehow causes an escalating pain reacting in the knee that he recently replaced, which is still recovering. I'm guessing there's some nerve(s) or bundle thereof that sends a signal to a bad spot, setting off a chain reaction . . . perhaps it's a quirk of my anatomy, or perhaps when they were cleaning out all the junk in the area when they were getting ready to put stuff in, something wierd happened, I don't know.

But bad things happen, when I sit on surfaces like that, and the longer I sit on them, the worse it gets. Even when it is not a steep angle at all. I certainly hope this is not a permanent condition; I hope it resolves within the year that it takes to recover completely from the surgery. I hate to feel like Goldilocks, complaining about this or that.

When I looked around in horror, realizing that everything around me in the chapel, was constructed in a way that would cause me escalating pain, I burst into tears, even as a song began that entreated one not to despair, and to count one's blessings . . . . and I thought, "How could God do this, how can I come here and be in PAIN, how am I expected to do this, this seems so WRONG . . . .", all the while the verse went on, saying to not discourage, etcetera . . . . . and I was bawling my eyes out.

It was a tough couple of minutes, that. Of course, it isn't God that did it to me, nor even the surgeon, really. It's not like he's ever heard of this happening before, and we'll pray that it doesn't become permanent. It's not as severe as it was at three weeks, although I'm four times as many weeks out now and I still have the effect, so I'm a bit worried . . . . . I also hope it doesn't happen to the other leg; if it does, I'd assume it's a quirk of my particular anatomy, but . . . that would still suck. Again, though, I'm not going to assume it's going to repeat itself. I'm going to assume it resolves before the year is out, but keep an eye on it's progress, because at 6 months if it is still appreciable that will worry me . . . . you don't notice how many seating surfaces fall under this category until you have a problem with them.

I spoke with the Bishop, who is what another type of congregation might call a pastor, except ours is unpaid, and is "called" out of the general population of the ward, generally every five years although the period of service can vary, as seems to be the case with this one, after the meeting, about why I'd burst into tears so suddenly right as the meeting started. I'd noticed the Bishopric's startlement and attention when I'd done so (I did so silently, but they did see and notice, as they are a caring trio), as of course it would have seemed to have come out of the blue for no reason. He said, well, remind me next week, but we don't want you to be in pain; we'll pull in one of the chairs from the foyer (lobby) for you.

I was quite startled by that! These are like soft, wing chairs one might see in a house or a nice waiting area of a reception area of somewhere, and comfortable. You might see these in someone's LIVING ROOM . . . . even more so than where I just said, really. So now I'm worried that people might think, "Who is SHE so special that she gets a special chair, in the Chapel, anyway?". I even said that to somebody, a former Bishop of the ward, and he said, "Nah, we're not like that here, and we wouldn't want you to be in pain; we'll make sure that you are set up just right."

So it sounds like things will be okay, but I'm still going to stick out like a sore thumb, which is going to set off my anxiety disorders like fire alarm bells ringing, despite what the last gentleman said; I'll keep trying to repeat his kind words in my head, but I have a hard enough time with my anxieties and going there, and being in a situation that's going to make me stick out in a way that's going to cause stares and whispers and attention is, um, well . . . for a person like me, it is kind of a nightmare.

Even if he says people aren't like that. People are people, and something so out of the ordinary (and never in the years I was going more regularly did I ever see someone sitting in a soft wing chair in Sacrament Meeting) is going to cause a stir. How to handle it is the problem, and I don't have a session with my psychologist until the Tuesday AFTER next Sunday.

Oh, and to make matters worse, my husband WORKS next Sunday, so I'll be flying solo, so to speak. A neighbor will take my daughter to church for the whole thing, then run back here to get me in time for Sacrament Meeting (as the same angled padded folding chairs are the seats in Relief Society and Sunday School, I'm not sure how to handle the rest of the schedule; I can't expect them to haul around a big 'ole chair around the church just for me, and I know I can't sit on angled chairs for three hours either or I'd be screaming in pain too.)

I didn't think of the seating for the rest of the schedule issue until after we'd left church. I can't begin to impose on anyone for THAT, so I guess I'm stuck for now. We'll see. Sacrament Meeting for now, that's the most important part, being able to partake of the sacrament, anyway.