Frustrated Trying To Find A New Psychiatrist

[catjudo]

I have worked with the same psychiatrist for a very long time (12+ years). I like him. Respect him. Trust him. But it is a two hour drive (each way) to his office. He does not take insurance and it is expensive to see him.

I'm currently not taking any medication except for the occasional valium. My psychologist and my psychiatrist both know this and they understand my reasoning behind it. Through the ups and downs of the past year and having stayed on medication consistently for most of that year...I really don't feel like my symptoms are truly any better controlled on the medication than they are off of it. My psychiatrist has tried very hard to come up with something that will work but it seems like either side effects are just intolerable or the medication doesn't really make a difference for me.

I talked to my psychiatrist a couple weeks ago and he agreed that I was thinking my decision through rationally and was considering all the options and potential consequences. He's just at a point that right now he doesn't know what else to try. I do not see it as a failure on his part, he has done a lot for me. If anything, I see it as a failure on my part (though I know I shouldn't) because despite all that he has tried I can't seem to improve or respond the way that I should.

He is still more than willing to see me as a patient but did suggest that maybe I look for a psychiatrist in the city where I now live and at least get a second opinion. He is comfortable with the idea that maybe there is someone out there who has more experience working with some different medications than he does and it certainly couldn't hurt to see if they have any different ideas that might help me. I did try this a couple of years ago but the psychiatrist that I saw ended up being a horrible mistake and I decided to just stay with my same, old psychiatrist at that time.

So I've been looking for a new psychiatrist the past week or so and it is so difficult. I'm trying to find someone who is on my insurance because it certainly would be nice to not have to worry about the huge out-of-pocket expense. Maybe I'll have to let go of that idea and look outside of my insurance providers but then I definitely wouldn't even know where to start. But just when I think I've found someone who seems like they might be a good fit I call to find out that they're not accepting new patients. Or they have office staff that are idiots and either don't return calls or can't have a coherent conversation (if it's that frustrating setting up a new patient appointment, it doesn't really give me confidence in having to deal with them on a long term basis). Or they have some sort of crazy policy like even though they accept my insurance I would need to pay for the whole appointment out of pocket just to make the appointment and then at the appointment they'll refund my money minus my insurance co-pay (this just seems absurd to me and I wonder if the insurance company even knows they're doing this). Or insisting that they won't make an appointment with me unless the new psychiatrist has had a phone conversation with my current psychiatrist first. While I understand that my old psychiatrist has valuable information, at this stage I'm basically looking to interview a psychiatrist and see if I feel like they are a good fit. They'll be working for me. I'll be paying them. I can't help but feel that I should get to meet them and decide if I even want to work with them before turning over all of my past records and letting them have a conversation with my current doctor. When I recently started going to a new primary care physician she did not insist on having a phone conversation with my old primary doctor before making an appointment...I met her, liked her, and then did a records request so my records from old doctor would be sent to her. Why should it be any different for a psychiatrist...just because it's mental health? That's just BS!

Trying to find a new psychiatrist sort of feels like banging my head against a brick wall. I don't just want the first random psychiatrist that I'm able to get an appointment with. I have a really good psychiatrist. The idea is to find another really good psychiatrist and see if they can think of anything my current one might have missed. It shouldn't feel like I have to jump through hoops just to get an appointment with a new doctor. The whole process is so frustrating and overwhelming that I'm on the verge of giving up. But I know I certainly have no chance of getting better if I do that. I just don't know what to do differently to make the process easier and more successful.

 

[Lucycat]

Do you have specific symptoms that you want the medication to 'sort'. Is it really medication that is required or would some new attempt at a different type of therapy relieve the problems?

I am just wondering if actually the medication that you seek maybe doesn't exist ( yet). By all means get a second opinion. That sound like a very wise suggestion.

 

[KwanYingirl]

Google trauma psychiatrist and the closest city you live near

 

[franciemarnie]

Have you ever considered Somatic Therapy? That releases trauma energy in the body. The primitive brain which dissociates us, activates fight or flight, etc. in an effort to help us survive cannot understand words or thought so talk therapy can't access that, though it can intellectually enlighten.

You haven't failed in any way. It might be a different kind of treatment is called for. I went to shrinks from 24 to 54. Didn't fix a thing inside, though I learned a lot.

Just an idea.

 

[catjudo]

I guess I should have mentioned that I am also bipolar. There are some symptoms that are purely chemical. But when the bipolar symptoms aren't well controlled, it makes it more difficult if not impossible to work on the trauma issues.

 

[Lady of Longbourn]

@catjudo I know you have bipolar disorder and I am bit worried you can't find any medication that works for you. :(

Keep trying. It took me months to find my current psychiatrist mostly becasue of my own diagnose. I really hope it wont take you that long.

 

[KwanYingirl]

No wonder why you stick with the guy you know. I moved out of state and called all the shrinks in the phone book and chose the one that was willing to work with my diagnosis and he had to get special permission to take my insurance. I've been with him for 11 years.

 

[catjudo]

Google trauma psychiatrist and the closest city you live near

When I read this my first thought was thanks for the obvious. But, really, thank you. Of course I had done some "googling" already, but after reading this I took a deep breath and started searching online in a different way than I had before. I wouldn't have done that if it hadn't been for this reminder.

I scheduled an appointment this morning with a new psychiatrist. He's still almost an hour drive from my home...which is crazy to me because I live in a pretty large city with lots of providers, I don't understand why it's so difficult to find someone who seems like a potential fit. But he is technically in the same metro area that I live in. He is an in-network provider on my insurance!! :) I don't know if he will be the right psychiatrist for me, but the process of setting up the appointment, etc certainly went a lot more smoothly and the way that it should. The appointment is still three weeks away (he could have seen me in two weeks, but I'll be out of town) but I do at least feel good that I've made a step in the right direction.

I am bit worried you can't find any medication that works for you.

I've never found a really great fit for medication. There are some that have certainly helped in the past, but they just don't seem to be working as well for me anymore. It seems pointless and stupid to continue taking the medication if my symptoms aren't any better controlled on it than off of it. There are other medications that I could take, but I've talked before about how things like atypicals are so sedating to me that I'm not really able to function and live while taking them. If I take them I'm basically exchanging one set of symptoms that keep me from living for a different set of side effects that keep me from living.

Honestly, my current psychiatrist is really good and he's tried a lot of different things. It is really difficult for me to believe that a different psychiatrist is going to have some other idea that he hasn't thought of but I won't know unless I try.

 

[KwanYingirl]

Yeah, now that I look at it, my post was kind of blunt wasn't it? I was in a hurry and wanted to suggest this as I helped a friend on the west coast find a trauma psychiatrist from where I live on the east coast. It worked out really well for her. I do hope you find a good fit!

 

[Lady of Longbourn]

@catjudo I understand that. I take an atypical and my psychiatrist recently brought it down to it's smallest dose of 5mg which I am really gratful. A few years ago it was at 20mg, it's highest, maxed out dose. It really helps but then sometimes I question if it was worth it; all the weight I gained, all the sleep it messed up, all the fogginess it still causes. Sometimes I still think "There had to be something else." It works most of the time.

 

[catjudo]

I can't do this. At this point I've had two appointments with the new psychiatrist. It's awful. No way I'm going back to him. When I left his office last week I barely got to my car before I just started sobbing. While still sitting in the parking lot I called my long-time psychiatrist's office and set up an appointment for next week. His secretary was going to work me in that same day but I had to pick up my daughter from school and honestly I just didn't have anything left in me to deal with another psychiatrist appointment in the same day.

I've cried off and on, at the drop of a hat, for several days. I think I'm about finally cried out. And now that I'm thinking more clearly, I don't know if I'm over reacting to the new psychiatrist. I think it's a matter of the things he said may or may not be true, but I don't feel like he knows enough about me to have said those things to me. And certainly he could have found a nicer way to say them.

I am on disability for bipolar disorder as well as my PTSD. I have been on disability for about 14 years. I hate it. I never wanted to go on it in the first place because it felt like a personal failure. I've had tried several times over the years to go back to working full-time and I've never been able to sustain it for more than a few months at a time. I have had a part-time job for the past three years. In some ways I'm proud of myself that I've been able to maintain it for so long. On the other hand, I feel embarrassed and kind of pathetic that it is all I can handle. I work from home, so I don't have to deal with the anxiety of commuting or dealing with people face-to-face. I really only work an average of about 10 hours a week and even with just that small amount, there have been two or three times in the past three years where my doctor has made me take medical leave and I've been out of work for a month or more. I have also learned to realize when I'm starting to feel overwhelmed and unwell and I have the flexibility to reduce my hours by giving away shifts to other employees who want more hours. It is not unusual for me to reduce my hours below the 10 per week or even to give away all of my shifts for a week or two so that I can get back on even ground. I kind of feel like a loser because I can only handle such a small amount of work. I'm also afraid of pushing myself beyond that because I am the only one to take care of my daughter...I have sole custody, her father was abusive, he is not an option for taking care of her even temporarily; my family all lives at least a couple hours away and my parents were my abusers. I'm afraid of trying to work and push myself beyond what I can really handle and then not being able to care for myself, let alone my daughter.

At my very first appointment with the new psychiatrist, when all he knew was that I had been on disability for 14 years and that I currently had a part time job (not how many hours I work, or how I'm able to deal with it, not how severe my symptoms are, not what kind of education I have, what kind of work I did before disability, etc) he starts giving me a lecture on how disability isn't supposed to be forever and I need to get out and get back to work. I need to just start trying different jobs until I find something that works. I was so taken aback and hurt. It's not that what he was saying was untrue, but I felt like he didn't know enough about my individual circumstances or history to be giving me such a lecture just yet. I already beat up on myself about this enough and he was just making me feel worse.

I do not think of myself as a dependent person. If anything, I've been accused of being independent to a fault. I have a very difficult time asking others for help. I try to handle everything on my own no matter how full my plate gets. My long time psychiatrist gets frustrated with me because I frequently stop medication because I repeatedly think if I just try hard enough I can handle my symptoms on my own. He gets frustrated with me because I let myself get too symptomatic and sick before I finally make an appointment and ask for help.

At my second appointment with the new psychiatrist he asked about my anxiety symptoms and I said they had been increased in the past couple of weeks since I had first seen him. He knew I was not asking for any kind of medication for the anxiety...I was merely answering his question. He launches into a lecture telling me I have a dependent personality and I can't just rely on and expect doctors and medication to fix everything for me. I feel like that was really off base. But even if there may be some truth to it, he can't possibly know enough about me yet to make that judgement.

He spent 20 minutes with me at the first appointment. We got into no detail. Often when I tried to answer a question he would cut me off and move on. He spent about 20 minutes with me at the second appointment and the conversation was similar. That 20 minutes at the second appointment also included time to discuss the fact that he had over charged my insurance company and billed them for things that he hadn't actually done. I tried to discuss this with his office staff over the phone the day before but she told me I'd have to discuss it with the doctor at my appointment. His billing seems shady and seems ridiculous that I'd have to use part of my appointment time to discuss the office staff's billing error.

There were other things that just didn't feel right. Like the fact that he knew I was there because my symptoms were resistant and we'd had a difficult time finding a medication combination that worked for me. At the first appointment he had prescribed a couple of medications that I had taken before, but never together. He started me out at a small dose that he said we would titrate up to a therapeutic dose and to come back in two weeks. At the second appointment he said that we could probably increase the dosage but he'd rather wait because he didn't want to treat this to aggressively. Okay, it's not really my place to know whether we should have increased the dosage or we should wait a while longer before doing that. But he had already said that I had a moderate to severe depression, he knew that I'd taken these same medications before at higher dosages but the idea that he didn't want to be too aggressive with my treatment just seemed like the opposite of why I was even at a new doctor. At the very least, maybe he could have explained his decision a different way. I don't know.

So do you think I'm being overly sensitive? Or would you also walk away before investing any more time with this doctor?

 

[KwanYingirl]

All I can offer is my experience. I had been going to a group practice. The pay and work load must've been unbearable because there was a swing door of shrinks leaving and new ones starting. I never saw anyone more than twice and the new one would completely change my meds. Physically I was in a constant state of tremors and massive depression. When I moved to Maine I have had the same shrink for 11years!!! I would've fired him if he challenged my disability status. I manage about 30 hours a month. If I try to do more, I get confused, distracted and depressed. Also more PTSD symptoms. 20 minutes is not long enough to make such black and white diagnoses. If he's anti-disability I'd find someone that will stick up for you when they do your reevaluation. It's the docs records that they will use to determine if your still disabled.
As for disability, I identify with all you said about feeling like a loser, not keeping up with work, etc. it's there for us we deserve it and without it we'd be living on the street. There is no shame for being disabled