Hey, I like my new doctor

Hear hear!! I didn’t fully appreciate how important those pills were until my partner started taking them after sinking into severe clinical depression (the doc’s words, not mine). I am so grateful for them, despite not needing them myself. They are literally a lifesaver.

It kinda ties in with piny’s post down below: having to admit you need help, especially pharmacological help, sucks ass, because we’ve been fed all of this bullshit about how if we just Stay Strong, the depression will magically cure itself.

Hell, I know I need meds and am waiting for my health insurance to change even though I know I’ll probably look back and think I was stupid for doing it, because I’ll feel so much better once I’m back on. Because that “tough it out” habit is really hard to break.

I’m happy that you’ve found a good doctor, kactus, that meets your needs. Interestingly though, I’ve heard friends frustrated with doctors who ‘just want to prescibe pills and get them out the door’.

As a med student, I’m really interested in what people like and don’t like in their doctors.

Lets say your doing something that’s unhealthy (say… smoking a pack a day)… would you want your doctor to try and give you options to quit? Would you prefer he kept his distance?

“As a med student, I’m really interested in what people like and don’t like in their doctors.”

I am a medical school professor, and I am interested in the same thing. Let’s hear more from others.

I have had experiences with a doctor that I wanted to talk to about anxiety and depression, but as soon as the words came out of my mouth I was handed a prescription. No real communication, and I’m certain he didn’t even bother making eye contact. I think there’s got to be happy medium in there somewhere. Glad to hear your doctor seems to have found it!

For the past ~10 years, my experiences w/ primary care doctors have not been very good. I’ve tried to be good and go get a physical every year (okay, maybe every two years). At one point I did find a doctor who I really liked and who seemed to be actually listening to me when I spoke, who asked me questions, and who seemed genuinely interested in my health. But then she moved! Aside from her, the other primary care doctors have been the kind who rush into the room, go through a series of standard questions, cut me off before I can finish answering, and then run out. I understand that a big part of the problem is that they have too many patients. I don’t know what can be done about that. But I *would* like them to pay attention to me and listen to me. Even if we don’t get a whole lot of time together, I *am* paying them for their time and expertise about *my health*.

Also, earlier this year my partner had surgery to remove his gallbladder (he had gallstones). When he went to the doctor he described the intense abdominal pain he’d been experiencing, and the doctor kept saying it was indigestion. My partner said it didn’t feel like indigestion at all, and was there anything else it could be? The doctor stuck to his story. Finally my partner asked point blank, “Do you think it could be gallstones?” (he had done some research ahead of time… we both work at a Big Health Web Site). He said the look on the doctor’s face was as if a lightbulb had turned on over his head. :P Only then did the doctor order an ultrasound and sure enough, it was gallstones! My partner was really disturbed at the idea that the doctor wouldn’t even have considered it if he hadn’t mentioned it first.

Geez, maybe I should change my name to Chatty Bitch. . . =)

kactus: Did you at least have the pleasure of saying “told you so”? Or making a joke about medical malpractice? “Gee, good those were benign, otherwise in a few years you could have been hearing from my lawyer!”

The last time I went to a medical office for a physical exam I was in college and I went to the Student Care Center, which (at least for my school and IME) was a pretty painless experience. I sorta fear trying to find a doctor now. Like, how do you weed out batshit conservatives and the generally incompetent?

Treating the patient like an adult instead of a particularly stupid child works pretty well.

This should be embroidered on a sampler and hung on every doctor’s wall. F***, yes. Doctors and nurses need to realize that the patient has lived with hir body for hir whole life, and as such can be relied on to know both how that body usually works and when something isn’t working as usual.

(I’m particularly het up about this right now after being prescribed albuterol for four weeks of a seven-week cough that turned out to be laryngopharyngeal reflux. I.e., not something that can be treated with albuterol. Gah.)

Lets say your doing something that’s unhealthy (say… smoking a pack a day)… would you want your doctor to try and give you options to quit? Would you prefer he kept his distance?

This reminds me of a slight argument I had with my mom over Thanksgiving. She has acid reflux. She also smokes a pack a day. Acid reflux is made worse by smoking. So, yes, I felt compelled to mention it, but I let her rant on about how all of her friends have worse acid reflux that she does and they’re not smokers, so it can’t possibly have anything to do with it.

I think that if you’re seeing a patient for, say, asthma, and it turns out they smoke, you should probably mention that smoking could make asthma worse. Don’t make a federal case of out it, but I think it should at least be mentioned in passing.

Just my two cents, though, and easy to say since I don’t smoke.

Jacko said:

As a med student, I’m really interested in what people like and don’t like in their doctors.

Lets say your doing something that’s unhealthy (say… smoking a pack a day)… would you want your doctor to try and give you options to quit? Would you prefer he kept his distance?

Jacko and PhysioProf

Thanks for asking those questions.

First of all, fat people would like to be treated with respect and consideration.

So use larger cuffs to take our blood pressure, avoid the ‘Diet Talk’ (we’ve all heard it before) and avoid blaming and shaming us about our weight. Believe me, we know we are fat and I can guarantee that every single of us has tried to do something about it. Educate yourself that fat is NOT a sign of moral decrepitude, laziness or failure.
But coming a very close second, we want our medical professionals to treat our actual illnesses.

Part of that is not assuming any health problem we come to your office about is caused by our fat (obesity, if you will, although I dislike the term), and instead investigating and treating the illness as you would if a thin person came into your office with it. Realise that neither weight or nor BMI indicate in and of itself, poor health.

If you are serious about wanting to improve health care to fat people visit First. Do Know Harm which has stories of fat people’s actual experience of health care discrimination, so you will know what NOT to do.

“As a med student, I’m really interested in what people like and don’t like in their doctors.”

What I like about my dentist is that he’s straightforward and he talks a lot. Not social chitchat, though; he talks through every procedure while he’s doing it and answers every question I have. When I asked about the anesthetic he was using, he said how it worked, what sort of drug it was, what sensations I might feel, and how long it would last. He’s thorough and patient. I think I’d like similar qualities in my doctor, but it’s hard to say because what I’d like most is to have a doctor. When I first went in as a new patient, the dentist took an overall medical history as well as a specific dental history and he was the one to motivate me to go look for a PCP.

Well. Five phone calls later…

receptionist #1: We’re not making appointments until May.
PD: Could you give me a referral to another doctor?
#1: *sigh* Try [doctor with difficult to pronounce name]
PD: Er, do you have a phone number for the doctor?
#1: No. He’s in the phone book. You can look him up.

receptionist #2: We don’t take insurance. The first general consultation, which is an hour, is $450, and then every meeting after that is $350/hour.
PD: Er, I don’t think that’ll work for me. Could you give me a referral to another doctor?
#2: I don’t really know any other doctors. Try looking at the ## StreetName Building.
PD: *duly googles ‘doctor’ and ‘## StreetName Building’. ## StreetName is full of dermatologists, dentists, chiropractors, plastic surgeons, and one general practitioner: doctor #1*

receptionist #3: We’re not making January appointments yet. Call back later. *click*

Likewise with #4 and #5.

I did have an experience w/my parent’s doctor about half a year ago. I went in for bronchitis and told him my symptoms.

Doctor: What kind of phlegm was it?
PD: *describes*
Doctor: *big, cheerful grin* That’s the worst kind!

Er…thanks. I kinda knew that already. However, the doctor’s manner just upset me. It might be a diagnosis to him or whatever, but having bronchitis was painful and it wiped me out, so I was not cool with the big, cheerful grin or how he dismissed me with antibiotics after that.

So, my biggest suggestion is don’t mess with the kids.

YES! Also be aware that dieting in kids and teenagers increases the risk for eating disorders and also for “obesity”.

I am fat and unlike the majority of fat people I actually do have binge eating disorder. I cannot proof it, but I am pretty sure that the fact that doctors told me and my parents constantly that I had to lose weight when I was a kid played some part (although not the dominant one) in becoming a binge eater. Basically, through being shamed by my doctors and through being reminded by my parents that I should eat less all the time I became ashamed to eat in public and started to eat tiny amounts that did not satisfy me – only to binge later on when I was alone (and then feel horrible for bingeing afterwards).

Related to this: Don’t congratulate people for weight loss! Even in fat people it might not be a good thing. There might be an underlying disease, or you might support unhealthy behaviors (particularly if the weight loss is rapid). Support healthy habit instead, such as moderate exercise, stress reduction, and intuitive eating.

Also, don’t assume that a fat person cannot possibly have lost weight recently. I saw a pretty cool cardiologist once because my blood pressure was too high. I really had the feeling that he was interested in me as a person, that he took me seriously, that he listened etc. When he did an ultrasound of my heart he explained to me what he was seeing, how the heart works. Basically he did everything in a way I would have wished for myself. However, when I was ready to go home again he told me that moderate weight loss would probably cure my hypertension. The thing was that I HAD just lost 40 pounds, and that my blood pressure went up after I had lost weight, and I told him so. His reply was that I should just lose some more. Advice like this seems irresponsible to me for two reasons. First, how likely is it in my case that my hypertension could have been treated by weigth loss if a recent significant weight loss had obviously not made a difference to the better? Second, why recommend weight loss instead of weight neutral changes in life style if research clearly shows that sustained weight loss is not achievable for the majority of people? (By the way, I have gained all the weight back, however, my blood pressure has returned to normal.)

(that should be automatically happen, not happy. Lots of typos up there, sorry…)

I’ve gotten to the point that I simply refuse to see a doctor and do all of my health care through my midwife instead. Fortunately, I don’t get sick that often. I will ask her to order all the labs and stuff to check cholesterol and all that jolly rot.

Reasons to refuse to see doctors: failing to listen to me, fat-shaming (what, do you think I don’t know??!!) all the stuff you’ve seen above.

As a med student, I’m really interested in what people like and don’t like in their doctors.

First, get rid of the freaking BMI charts. Seriously. Burn them. Rip them to shreds.

Then, listen to your patients.

If there’s something wrong, as someone mentioned above, don’t assume it’s from fat. Pretend for 30 seconds that your patient is thin and having the same symptom.

jacko and physioprof…

Echoing what everyone else said about listening to fat patients and treating them with respect. It took me five fucking years to get a diagnosis for PCOS because every doctor I had shrugged and said, “lose some weight”. I was all of 130 pounds at the time. I also wish doctors had told me the real success rate of diets – less than 5% – I might not have wasted 30 years trying to fight physiology.

Also, try not to reduce your patients to utter despair. When I still single I had a doctor tell me that I’d probably never find a partner because of the PCOS. I hadn’t fucking asked her, but she felt compelled to prepare me for a life of loneliness based on… I’m still not sure what.

Jacko and PhysioProf, thanks for asking for feedback. I first of all want to second the recommendation to read First Do No Harm; the stories there will horrify you. Secondly, I have recently had a lot of experience with doctors because I developed IBS this year, which is diagnosed partly by ruling out lots of scarier things. The whole process of going to specialists and doing many tests was very anxiety-producing (and as you probably know, anxiety can trigger IBS flare-ups, so that’s fun).

What I really really valued in this whole process (which took over 6 months and 3 doctors to get an actual diagnosis) is the doctors who let me know that they took my concerns seriously. One GI I had was pretty flip; he basically told me to stop eating dairy and drinking coffee and I’d be fine–this despite the fact that I’d told him I stopped consuming both those things months before. It really seemed like he wasn’t listening to me at all and didn’t take my concerns seriously–but when I saw the notes he sent back to my PCP, I realized that he had taken careful notes and considered my case a serious one and was recommending further action. So why did he treat me as though I was just having indigestion? Why did he tell me to “wait and see” if that wasn’t what he was telling my PCP?

I think most doctors take their jobs seriously and do care about their patients’ well-being; what some are not so good at is communicating that to the patient. So my number-one request would be: trust your patients to know their bodies. They may not be able to describe symptoms as precisely as you can, and they may have some misinformation from WebMD or something, but if a patient says to you, “My body did not use to do this,” listen to them–and let them know that you’re listening.

But, it’s not drug dealing when you have MD behind your name, now is it?

THANK YOU to jacko and PhysioProf for asking this question. It’s really difficult to find anyone in the medical profession who wants to listen to patients or empathize with patients.

Ninety-nine percent of the time, a doctor never needs to tell a patient about modifications like diet, exercise, not smoking etc. We’re not stupid – we already know what you want to say. It’s just that 1) following recommendations is a little more complex than willpower, and 2) we know that many of the recommendations are either impossible (see: losing weight permanently, eating fresh veggies on a fixed income), or even bullshit (see: eating eggs gives you high cholesterol, HRT is great for almost all post-menopausal women).

I wish doctors could just drop the judgements and realize that they’re in the business of helping imperfect people do the best they can to maintain their health. And I wish we could all understand that health is NOT a moral imperative, and that engaging in unhealthy behaviors doesn’t mean a person forfeits the right to be respected.

I have depression issues to – that’s why I see a psychoanalist every week. She’s a social worker, so she can’t give me drugs – but she CAN (and HAS) helped me understand where my issues came from, and how I can resolve them.

Nice to know that therapy alone is working for you. Therapy alone did NOT work for me. I could not function and was on the verge of being fired from my job when my therapist finally said, “Okay, it’s time for you to go on meds now.” I couldn’t progress in therapy while I was still stuck in the spiral of self-recrimination and short attention span. So telling people that they shouldn’t take meds at all is about as helpful as telling an insulin-dependent diabetic that all they need to do is change their diet and they’ll be magically cured.

You are not going to be able to make those life changes without meds that work for you. (Not every med works for everyone, so I don’t want to genericize it too much.) Why? Because one of the biggest hallmarks of depression is a lack of motivation. There were a lot of things I wanted to do — go to graduate school, get a better job, find a boyfriend, etc. — but I literally couldn’t until I had some therapy and, yes, some meds. Once I had that crutch, I was able to get back on my feet and make the changes I’d wanted to make all along.

In theory I know that’s true. But when I’m on meds I still don’t feel like I can get into graduate school, or stop being alone which is a huge issue for me. So the meds end up not seeming worth it. And I know no one can change my life but me but if that seems impossible even on meds it doens’t motivate me to take them. Not that I mean to turn this into my whiny emo corner here.

Taking this back to what I like in a doctor, what I like in a therapist or psychiatrist is when they listen to what I’m saying about what’s bothering me, as opposed to telling me what’s really bothering me from their point of view. Or telling me I must not feel what I say I’m feeling because I’m functioning OK.

(I know the question was more about primary care physicians, but I haven’t had so many problems with mine, it’s more the psychiatric and therapy end of things that affects me.)

Where do you people find these horrible doctors? I’ve had two bad doctor experiences my life, and still got what I wanted out of them. I’m overweight, and I used to smoke, but never had a doctor berate me about it. I’ m also bulimic, though, which may be a reason why my doctors have been so nice about my weight. They ask if they can weigh me, since they know it could upset me-and when I was in a really bad way, I was able to refuse without any argument.

This year, my doctor was concerned about PCOS, because I wasn’t really menstruating, and like I said, I am overweight. Hormone tests came back with elevated male hormones, another symtom. My doctor told me that, if I did have PCOS, losing weight would be a good idea, and so I joined a gym. We agreed that, even if I didn’t have PCOS, losing weight and becoming more fit is a good idea anyway. Turned out I don’t have it, but the couple of months of worrying gave me the impetus for the gym adventure.

Never, in the entire process, was I made to feel ashamed about my weight. Yes, I was told I should try to lose some weight, but not in the generic ‘all fat people are the same, and they all need to lose weight’ way. My doctor told my why I, specifically, needed to lose weight (turns out I have an impaired glucose tolerance). Maybe that is the key-evaluating the patient in front of you, not your ideas about the ‘class’ of patient.

Full disclosure: My parents are both doctors, which may help with my ability to navigate the Canadian health care system.

Your doctor sounds a LOT like my ex brother-in-law… except when Khalid sold “happy pills” to HIS customers, that damned pesky Queens County District Attorney called it “possession of a controlled substance with intent to sell” and he got 6 years in a state correctional facility.

But, it’s not drug dealing when you have MD behind your name, now is it?

Hey Lorelei, your countdown took 41 comments.

Gregory, do shut up. Unless you’re living in my body with me – and I somehow doubt you are – you don’t have a darn clue as to what works, what has worked, and what will work.

Some people need meds, and some don’t; some need both meds and talk therapy. Some people can fix anxiety and depression by exercising. Some people have insurance that won’t cover the talk therapy, so we stick it out with only the meds until the insurance situation changes. You don’t know what’s been tried and what’s failed, so keep your judgment to yourself.

I had a great doctor who talked with me about the decision to go to meds. Then he gave me a run-down and said, “this drug has some sexual side effects, this drug has fewer sexual side effects but is associated with weight gain, and this drug…”

Cynth said
I would also like to…have nurses who actually give a crap and who are not ignorant wenches who do not care if you have a place to sit or insist on taking blood pressure with a cuff that is too small and is in no way going to give an accurate reading, do not insist that patients be weighed.

Um…as an RN…ouch.

First of all, the vast majority of “nurses” in doctors offices that you see at an office visit are not nurses at all, they’re medical assistants, which means they have about a year of education that includes basic vital sign assessment, blood drawing, and clinic office procedure, and they have a certification, not a license (nursing licenses, both RN and LPN, are issued by the state upon the passage of a licensure exam).

Nothing against MAs per se, I was one, but they’re education and their role in a clinic seeting often leads them to be task driven, employing context free rules to dictate their work, whereas nurses, RNs especially, are educated in the use of the nursing process and have the knowledge base to employ some critical thinking.

I know it seems like common sense that the blood pressure cuff has to fit to get a decent reading, but if your knowledge of hemodynamics is limited, you’re in a hurry because you’re understaffed and your office is overbooked again, you’ll probably overlook it and think that it’s not a big deal, except that it is a big deal if you get a false high and the MD (who may not have taken a pressure in years) sees it and says “whoa, this person needs meds.”

I’m sorry, this is kind of a non sequiter (and a rant), but I get really frustrated when nurses get illustrated as incompetent, lazy uncaring doctor’s assistants, because that isn’t at all what we are. We perform complex assessments and come up with creative solutions for people living with illnesses every day (most of the nurses in doctor’s offices do telephone triage, determining from sometimes limited information relayed by people who have varying degrees of knowledge about their health, whether patients need to be seen in the office, stay home or go the the ER, and that’s a simplified version of what they do). We have our own knowledge base, research and scope of practice.

All that said, I’m sorry your experience with nurses (if they are nurses, and frankly even if they aren’t) has been so negative. The ones you’ve seen aren’t reflective of the profession as a whole.

And while I’m here, there are a wealth of wonderful nursing blogs (just google) if anybody is interested in learning more about what a typical RNs day to day is like. As a profession dominated by women, it has a lot of issues both pressing on it and within it that are interesting from a feminist perspective.

Wow- love for Fillyjonk, Kate and Meowser. I’ll reiterate the point they had that resonate with me:

1) Listen to the patients re their bodies. We live in our bodies every moment of every day. When there is a new hurt that we know shouldn’t be there, we’re the ones who should no best that it doesn’t belong. Funny how my ankle pain was ignored no matter my weight (so from BMI of 21 to 35) and I had to sprain it so bad that the EMTs thought I broke it in order to get an x-ray done that showed the years of ballet when younger left me with bone chips floating around.

2) Don’t assume we’re ignorant.
and 2b) Keep up on the new info

Simply put- I’m being treated like an idiot by health professionals right now. I’ve been told “ohhh you have CFS, I’m sorry there isn’t really anything we can do for you” whilst my thyroid value is 2.37. I’m not stupid- I searched the NIH for normal thyroid values. Guess what? The normal range is 0.3-2 for TSH. Los Angeles area blood labs claim that 0.2-5 is normal and when I called my doctor on it I was told “all labs are different”. Oddly enough I’m a scientist and I know that isn’t right- a factor of 2 slop means someone is lazy or has completely inproper training. And not up on the current values because they just don’t care.

3) Ask people what they do, don’t assume. And while you’re at it read the freaking history! Just because I’m fat doesn’t mean I eat McDonalds all the time nor that I sit on my tush all the time either. I’ve had to deal with doctors making assumptions about what I eat and tell me to go to Weight Watchers. Umm did you read the history of anorexia, calorie counting triggers me bit in my history? Did you read the part where you ask “On average how many fruits and vegetables do you eat in a day?” and my response? Even worse is the “you need to loose weight, you should take up running!”- umm have we forgotten that I’ve made appts with you about ankle pain and by the way umm yeah that triathlon training I’ve been doing lately where I just told you about my 2 workouts a day would include running no?

For all y’all with PCOS, your bloodwork can come back COMPLETELY NORMAL. You must ride the dildocam for a proper diagnosis. Sorry.

My favorite stupid doctor moment was with my lovely GP, who offered me bariatric surgery after I’d lost 50lbs…I blame her question on pregnancy brain, because she was otherwise great.

For me, if a doctor mentions weight loss to me, I tend to have a sudden attack of selective hearing – including whatever else they ‘diagnose’ me with. I love the idea of doctor shopping, but that presumes there are enough doctors around in the first place. I won’t mention affordability, because as we, the uninsured, already know, doctors aren’t affordable for us anyway.

Another tip for How To Treat Patients More Humanely: don’t just run through the basic forms and call it good. If I’ve made an appointment about a documented case of whatever, with significant family history and knowledge of what has worked for close relatives, listen to it instead of just prescribing whatever the most common med is.

Especially where depression or similar conditions are involved. Yes, I’m a young woman without a degree at the moment; yes, you’ve had years more schooling than I have, with the pretty diplomas to show for it – but you also have no way of knowing what’s going on without my input, so take the time to listen. It’ll save us both time and frustration.

I loved my pediatrician. After a growth spurt and weight loss at 15, my doctor made it clear that she would advise against loosing any more weight. I weighted 141 at this point.

Sniper (#37) said:

Echoing what everyone else said about listening to fat patients and treating them with respect. It took me five fucking years to get a diagnosis for PCOS because every doctor I had shrugged and said, “lose some weight”. I was all of 130 pounds at the time. I also wish doctors had told me the real success rate of diets – less than 5% – I might not have wasted 30 years trying to fight physiology.

To sniper, kactus, and the others who have had troubles with PCOS, I’m absolutely floored that your doctor’s didn’t see this. We just went over this in class and being overweight is very very strongly tied (statistically) to PCOS, so that should have sent up a million red flags right there. To Orodemniades, even the pelvic ultrasound (dildocam) isn’t a definitve yes or no for PCOS (20% have normal ultrasounds)

As for the blood pressure cuffs, we actually just got ours last month. They cost a bloody fortune, but you had to pay extra to get the different sized cuffs. Go figure.

I think, and I see it in alot of my peers, that alot of doctors really have good intentions and feel that just saying, in the case of smoking, ‘i can assume you’re aware of the risks?’ is copping out to a certain extent. I have an aunt who smokes. A pack a day. The elevator conked out in her building and she huffs and puffs after walking two flights of stairs because of those damn cigarettes. I feel like taking her to the anatomy lab, making her feel how a emphysemic lung feels like a flimsy plastic bag and looks like a rotten cantelope!

We spend years and years learning to heal people, and I realize how much of a slippery slope the ‘maybe she just needs a little push’ line of thought but I guess it’s hard not to push just a tiny bit!

People often talk about doctors who give out drugs without question to anyone who asks, but that’s not been my experience of suffering depression and anxiety for a number of years. Most of what I got was “you’ll grow out of it”. Or worse, people assume that I’m just acting the way I do to piss them off, to “get attention” (honestly, people, nothing could be further from the truth!), because I “think I’m special”. I finally got given fluoxetine in 2005, and it’s helped me probably more than anything. I did try various therapies for years, starting when I was a child, so it’s not as if it’s an avenue I haven’t explored. People are so keen to dismiss the experiences of others.

As for how doctors should treat patients, my only opinion there is that I don’t want to be spoken to as if I’m a particularly stupid four year old. I went to enquire about a smear test (I’d never had one before) some years ago while I was at university, and I remember that the doctor then clearly thought I was a moron of the first water. Don’t speak to grown women in your “talking to kittens” voice, guys.

In my experience, the drugs are (as another poster put it) a “crutch” – and, as folks know, you can’t walk on a crutch forever.. sooner or later, you have to walk on your own, or you’ll never walk normally again.

It’s funny how nobody every makes that analogy to me about my asthma meds. I have both asthma and dysthymic disorder punctuated by episodes of severe clinical depression. And yet nobody ever asks if I want to be able to go off my asthma meds. I don’t want to go off of either. I can’t breathe without the asthma meds, and I simply cannot function without anti-depressants. Depression is one possible reaction to distressing situations; it is a particularly unhelpful and self-destructive one; the amygdala and hippocampus end up much, much smaller than they should be, and there is a shortage of glial cells. Depression is a physical condition–why wouldn’t there be a physical treatment?

And you know what? Certain disabilities do require that you use a crutch, cane, or wheelchair forever. I’m happy to use the crutch of my asthma meds to help me breathe forever, and I’m happy to use the crutch of my anti-depressants forever.

You can deal with the upbringing related issues and current problems that make you depressed.

Sometimes you can. But none of that addresses the biochemical brain vulnerabilities that make you depressed. You might also want to look into the research on serotonin transmitters–whether one has, genetically, two short, two long, or one of each of the chromosomes that determine serotonin transmitters is completely correlated with vulnerability to depression.

I don’t see why it’s so threatening to so many people to acknowledge that the brain is a physical organ, and like other physical organs (lungs, liver, skin) is vulnerable to endemic physical illness that can be best treated physically.

Back to the issue of how doctors should treat their patients. The worst doctors I’ve ever had have been gynecologists. I had recurring vaginal infections for several months. The doctor I was seeing insisted that the anti-bacterial cream she’d given me hadn’t given me a yeast infection when I called to tell her it had. Here was the conversation:

Me: Dr. X? I’m calling because the cream you just gave me gave me a yeast infection.

Dr. X: No, it didn’t.

That’s not an acceptable response. In general, showing respect for your patients and their observations is vitally important.

Here’s another bad example: later that summer, when nothing she had tried worked, Dr. X told me “Some times these things just happen to women.” That’s not OK, either. It was a way of dismissing something that was causing me rather intense irritation and preventing me from having sex, of telling me to suck it up and stop bothering her. I’m sure it was annoying to her to get a call from me very two weeks…but she didn’t seem to understand that it was annoying me every single day.

In related feedback, it’s really important to me that a docgtor be able to admit to me when he or she just doesn’t know what to do. If instead of saying “sometimes these things just happen to women,” Dr. X had said “Honestly, I’m baffled. I don’t know how to help you. I could refer you to somebody else, but I’m not sure anybody will have a good solution. I’m so sorry; this must be so frustrating to you,” I would not have been so furious. It just seems like too often doctors don’t want to admit any vulnerability whatsoever. But I can accept that a doctor is only human and that medical science is still evolving and changing. I don’t see why doctors can’t.

Don’t automatically blame the patient for his/her condition. I found my favorite gynecologist a year after all this happened. I went to her office with a bad yeast infection. At the end of the visit, she gave me the usual “Yeast Infection Facts” handout, and I kind of flipped, ranting on and on about how that stuff about wearing cotton underpants is nonsense, how I wear nothing but cotton, and that I know for a fact that with me it’s all about whether or not I’m sexually active, etc. She listened patiently to me and finally said “You’re right. I’ve never known cotton underpants to have anything to do with it. I don’t know why we keep telling people that.” Just hearing that she’d listened to me and respected my experiences meant the world.

One more thing: when I tell a doctor that something he or she is doing is hurting me, the doctor needs to stop that pronto, not dismiss what I’m saying. Here’s an example, from another bad gynecologist.

Me: You’re opening that speculum too quickly–it’s hurting me.

Dr. Y (not changing what she’s doing): That’s probably because it’s been so long since you’ve had sex.

NOT OKAY.

OH, yes, KH:

Have you ever lost a substantial amount of weight before?

Why don’t doctors ever ask this of me? Jeez louise. I have a 20 year dieting history. You’d think it would be rather key in establishing a) what I do and don’t know about nutrition, and b) how my body functions.

I also have to agree with jaed – My m-i-l’s thyroid condition went untreated for 25 years because she’d started heavy and gotten heavier; when she started getting fuzzy/tired, she was told simply to lose weight to have more energy.

In my experience, the drugs are (as another poster put it) a “crutch” – and, as folks know, you can’t walk on a crutch forever.. sooner or later, you have to walk on your own, or you’ll never walk normally again.

Yes, you do, but denying someone a crutch when they need it is needlessly cruel. When I tore my ACL (and bruised my femur, to boot), should the doctor have said, “Well, I could give you crutches, but you’d just become dependent on them, so I guess you’re going to have to crawl everywhere until your leg heals enough for you to walk”? Same thing with medication.

I’m still working throgh all of this stuff – yes, it’s hard, and it might be nice to numb out the pain with powerful drugs, but that crutch would actively PREVENT me dealing with my problems.

You really have no idea how anti-depressants work, do you?

Without them, my brain is in a constant fog. I’m cranky with a hair-trigger temper. I have very little short-term memory — you can tell me something and I’ll forget it completely 10 minutes later. I walk around feeling like I have a constant low-grade headache. I spent entire therapy sessions crying uncontrollably, with no progress in sight.

With the drugs, do you know how I feel? Normal. Like I can get out of bed in the morning. Like I can get to work on time. Like it’s actually worth doing something with my day other than sitting in front of the TV and numbing myself out.

But, hey, I guess being able to function in my day-to-day life isn’t nearly as important as sticking it to the evil pharmaceutical companies. Sure, it’ll ruin my life for me to be constantly depressed, but at least I’ll have the victory I knowing I didn’t do anything to alleviate my depression.

Oh, and I had seven years of therapy to go along with my medication. Surprise! Most of us on medication are getting therapy, too. It’s not an either/or — in fact, it needs to be both/and when it comes to medication, or even the most powerful medication won’t do any damn good.

You’re not morally better than we are for doing without meds. Sorry to take that crutch away from you.

Mnemosyne, you are clearly my depression sister.

Yeah, I don’t take drugs to be “happy” or to avoid dealing with my problems.

I take drugs because the physical effects of my anxiety disorder: insomnia, chronic muscle pain, constant headaches, panic attacks, rubbing the skin raw on my hands and not being able to stop, the feeling of bugs under my skin, and nagging consideration of suicide were so severe that I was quite willing to put up with chronic drowsiness, weight gain, sexual side effects, and chattering teeth to get some relief.

I came to the realization that having an anxiety disorder for me was rather like being stuck in an Edgar Alan Poe story like Tell-Tale Heart, or House of Usher, but without the murder and implied incest. I’m hypersensitive to the little things, to the point of paranoia about what is “really” going on. I obsess, and do something like knit until my hands are throughly wrecked with tendonitis, or ignore my traning schedule and just keep running until I’m laid out with an injury. I’d spend hours tearing apart paragraphs I wrote and putting them back together again, and then lie in bed revising and re-writing and re-writing them again.

Do you know how much of a relief it is to finish something on deadline, and not have to think about it until the check comes in? Or to think, “I should stop now” and be able to move on to other things? I read in the local paper today about another sexual assault/hazing case at an area high school and I was able to say, “I’m pissed but I don’t have to let it ruin my weekend.” And I was able to set that aside for an evening of Sondheim and Gogol Bordello.

Lorelei — Thank you for the link. My daughter has a needle phobia and we’re not really sure how to deal with it. I don’t know what kind it is though, and she has had immuniations when she was much younger.

rosehiptea — i have all my basic childhood immunizations too i’m assuming because i was small enough to be held down. the next time i remember getting any needles was when i was 10 and 13. i’m 18 now and haven’t had anything involving needles since besides dental work, and that was once. i was able to do it that one time because the dentist put the lidocaine on my gum for a really long time before the novacaine shot but i’m too horrified to ever do it again.

they have some really nifty things coming out right now, though, like the electric impulse numbing thingy and intraject. but i think one of the most important things with having needle phobia is to not have an asshole doctor. because of my fear of needles i try to not go to a doctor unless i can be guaranteed i can waive bloodwork and immunizations.

once i had a 104 fever for two days and i was so horrified of the hospital trying to put me on an IV i just stood out in the snow on and off until my temperature went down (i can’t even make that up, and thank god it actually worked). because i’ve had too many experiences of doctors giving me needlework that was arguably unnecessary and/or berating me for being phobic, well, they don’t see much of me.

Some of you seem so defensive about your medication use.

Ah, the favorite disingenuous whine of the passive-aggressive attacker. “Why are you so defeeeeeensive?” People are defending their use of medications because you attacked them. Defensiveness is, in fact, the appropriate response to being attacked.

Now, you seem to identify reliance on drugs, be they illegal or legal, as a bad thing. But you haven’t engaged with one single person’s observations about medications as a good thing. You haven’t explained why I shouldn’t want to be “addicted” to my anti-depressants, but my asthma meds are OK. You haven’t addressed the physical effects of depression. You haven’t addressed the physical changes in the brain that are depression (for a good book on this, I recommend Peter Kramer’s Against Depression).

All I will say to you, then, is that I don’t care whether or not I’m “addicted” to my meds. I spent 13 years being depressed and in talk therapy alone. I will never live like that again. If my choice is ongoing misery without meds or a liveable, even pleasurable life with an “addiction,” it’s no contest at all.

Regarding Gregory’s comments, I would have to say that my fluoxetine does not get me “high” and doesn’t “mask” anything. I’m not putting myself in a stupor. It’s simply that I find it much more difficult to function and to think clearly without that help. My depression isn’t as severe as some people’s, and maybe I’ll be off the medication one day, but when I was prescribed the medication, I was pretty much perpetually suicidal, over nothing. A person can’t live like that, no matter what people insist. I wouldn’t say life was perfect now, but it’s grown much better since I’ve been able to think straight and gradually learn to sort through my personal issues.

In my more bitter moments, I suspect that a lot of the people who complain about those on antidepressants are just annoyed that someone who isn’t them is getting some attention. I certainly feel this of the guy on another forum who told me my GP should be struck off for prescribing me fluoxetine for two years. And people are going to feel upset if they’ve been experiencing life one way and someone comes along and says “No, your experiences never happened, you don’t know your own mind, let me tell you the truth!”

lolololol gregory WAY TO RESPOND TO MY COMMENT.

Well, the other thing about definition, as far as I know, is that when a person becomes addicted to something, his or her body has become so habituated to the substance that he or she cannot function normally without it. But guess what? My body couldn’t function normally long before I ever took my first dose of anti-depressants. That’s why I take them. My body didn’t become addicted to a foreign substance. It was always in need.

Huh. I thought some about ‘what makes a good doctor’ for me:

My women’s health practitioner gives me solid advice and involves me in medical decisions (“You meet the minimum diagnosis of PCOS but I’ll treat your symptoms the same either way, so let me know if you want a formal diagnosis”, “You could go on a daily mini-pill and that would help with your symptoms, but I know you don’t really like taking more pills/hormones, so here’s a different plan”). My psych doctor has some kind of amazing skill with making good, solid plans seem like MY IDEA (not sure how he does this, it’s less transparent to me than with the women’s health practitioner but I don’t feel manipulated by it, I think he’s just a more subtle personality).

I have doctors who answer my email with flow-chart-like plans (“Try this and IF this happens, THEN try this”), which likely saves my HMO money but also treats me as if I know how to and can drive my own health.

I even have a PCP who had a bad reputation for being nasty with fat women (including a good acquaintance who made a formal complaint) a few years back. She’s nothing like this now and has been sensitive to issues with me (“If your blood sugar is stable at a certain [relatively high/overtly 'obese'] weight, can you aim for that weight by making small, reasonable changes to your diet?”), to the point where I’ve concluded she must have had some kind of sensitive workplace intervention.

That’s to me almost MORE valuable than just being nice in the first place, workplaces that provide doctors with ongoing training and working with them on good ways to communicate with and treat patients when there’s a problem.

Mnemosyne is my depression sister to.

I wanted to quickly address Gregory’s remark about working on the underlying causes through therapeutic interventions (psychoanalysis in his case). That is an extremely classist remark. I am poor, a single mom, a college student and on Medicaid. I get my meds, but I only got 6 therapy visits ever (because I am not classified as seriously mentally ill). Do you know what I learned from those 6 lovely visits.

I have no real control over the factors that are helping drive and trigger my depressive episodes. I can not fix my financial, medical, familial situation. Why? Because due to those situations, I have no power.

So, anyone telling me I can be happy without the help of those medications needs to live my life for a few weeks, then STFU!

OK… going back to lurking now.

Just throwing this out there. My theory is that many people’s depression is anger turned inward. Anger is a powerful emotion that can be both destructive and constructive. Anger that is unjustly aimed inward becomes debilitating depression, but justified anger aimed outward towards things like injustice can be a powerful motivator. I think if more people embraced this view and used their anger as a motivator, we’ve have a revolution and possibly a better world.

There’s a saying, “if you’re not mad as hell, you’re not paying attention.” And another one “ignorance is bliss.” I think both are true. I think happy people are people who wear rose-colored glasses and don’t see reality clearly. That’s not to say happiness is ignorance; I’m saying that constant bliss can only be achieved through drugs, ignorance, or some other form of blurred reality. Occasional bliss is available for anyone willing to accept it: puppy pictures, flower bouquets, a compliment to or from a stranger, a familiar tune, a tickle, a love note, a memory… But constant bliss… that’s not real.

So, anyway, I just think we should be really, really careful about medicating the depressives, because they could be future revolutionaries and powerful dissidents who we need to lead the changes to our social world.

Hector: Manic-depressive isn’t the name of a disorder anymore. They now call it bipolar. And guess what? There’s no test. So if a doctor says you meet some criteria for it then you’re diagnosed. It’s not like you can just take a blood test and they say, “oh, your cholesterol is too high and you don’t want to go vegan so let’s try Lipitor.” It’s not like that. This area of medicine simply isn’t as developed as other areas. Psychiatry is a very young science and they’re just making guesses about a lot of things. It’s just not as black and white as some of the commenters here think it is.

There’s a saying, “if you’re not mad as hell, you’re not paying attention.” And another one “ignorance is bliss.” I think both are true. I think happy people are people who wear rose-colored glasses and don’t see reality clearly.

??!!!!!?!!!…..sweet bedda matri! patienza, Lubu, patienza…..

Elaine, before anyone, including myself, can adequately respond to this statement, you’d have to define your terms. What is “mad” to you? What is “happy”? What, even, is ignorance? Is ignorance a not knowing, or does it include a not acting. And if so, how little activity is required to meet the “not acting” requirement? I’m not being facetious, I’m truly curious. See, from my reading of this statement of yours, I’m thinking that you and I have completely different notions of what constitutes being happy or mad, and perhaps even a different idea of what “ignorance” is.

Some background: my “setpoint” seems to be happy. Or, at least it has been for the past decade and a half. I’m forty now, and I’ve found that as I get older, my “background mood” is more volatile—more subject to change that doesn’t appear to have a strong relevance to anything going on in my life. I’ve noticed for the past couple of years that I’ve been fighting bouts of depression, especially in winter when there is so little sunlight. I’m thinking that the source of these (mostly) seasonal episodes is some combination of chemical changes in my body as I age, and SAD that is enhanced by the aforementioned changes. Exercise seems to help, but not entirely. I’ve always been physically active, so one of the typical armchair diagnoses, “oh, you just need to get off the couch and get moving” doesn’t apply here. What’s more, it seems to be a family trait, especially among women.

But back to the “happy.” Yep, I’m happy, generally. Paradoxically, even when I’m fighting depression—-I’m aware of my background mood as being “happy” during those times, in much the same way I’ve been aware of my generally body state as being “good” or “well”, during times of minor illness or injury (think: sprained ankle, but everything else feels great). That’s exactly how it feels: I’m fine, but there’s a part that isn’t—and unfortunately, that “part” doesn’t correspond to a body part, or an action, or change, or anything identifiable in my life. I actually experience it as something chemical, like an artificial chemical, a mask—except it’s not. It’s coming from within my own body. And it kinda freaks me out, because I’ve always been vigilant about keeping my body free from “outside” chemicals; I grew up in a home with substance abuse, and if there’s one thing I want to avoid, it’s going down that path. I’m not keen on side-effects either, but I’m less keen on allowing myself to develop the kind of debilitation that others have described here, before getting treatment. It may come to the point of needing medication, and I hope if I get to that point, I do the smart thing and just do it, rather than let pride, or fear, or “what ifs”, or ya-ya about cost or “dependency” get in my way.

Now, how could that be a worry for a “happy” person, anyway? Why do I describe myself as “happy?” Probably because of my definition of happy—when I think of the “h” word, I’m thinking of peace, of serenity, of absence of that fight-or-flight response that was honed so perfectly by my upbringing and subsequent marriage to man who became an abusive alcoholic. See, the first time I can remember calling myself “happy”—not the temporary happy from some small charming event happy, but actual, all-encompassing, bona-fide happy from my core on out? Was some time after I left my husband. The husband who broke into my apartment in the middle of the night and tried to kill me, but lucky for me I woke up before the door came bursting in. I got a break, you see, from the constant denigration, the constant fighting, the constant lack of sleep and watching my back, the siege. And I realized….

….that I felt better. A lot better. It was sinking in that maybe, just maybe, this was how people felt. How people not under siege felt. I thought about it. A lot. See, I had a good job; I “topped out” from my apprenticeship shortly after getting the divorce. I went on the road. I bought a house (that for a long while, I only got to live in on the weekends!). And shit, what didn’t I have to be happy about? No more asshole in my life. No more apprenticeship. House payment lower than rent (one of the pluses of midwest living). My bills were paid. My truck was paid off. I was “on the road” and loving it. And I could sleep at night.

Low expectations? Nahh. Straight-up Maslow’s hierarchy of needs. I could breathe. And when the stress gets thick? That feeling is right within easy reach, every time. A conditioned response—kinda like what “rising block” or “front kick” means to my body in karate class. Sometimes, if shit is heavy, I may need a little solitude, but really—just remembering that ache in my face from smiling—-. Yeah, that. I went out the weekend after my husband attacked me; I was determined I wasn’t going to let that asshole change the goals I had for my life. I wasn’t going to sit around and give him another opportunity. By accident, I met up with some other union folks, and went out and had a helluva time. Stayed out all night. My entrance into the hall wasn’t welcomed by everyone, see. And by chance, I met up with one of the first brothers to treat me like an equal—shit, equal, I was ready to settle for “human being”. But anyway, I stayed out all night, and when I woke up the next day, my face hurt. Almost like I’d been in a fight. It was from all the smiling I’d done that night—the talking, the jokes, the stories—the smiling made me hurt. Because it had been so long since my face took on that shape.

Maybe I’m ignorant. It’s bliss, y’know. But I think not. Because there’s something else.

The passion. I still feel it. Am still capable of feeling it. Still feel anger, too. Try not to let it eat me alive. I’m definitely “in touch” with my anger, enough to know it needs proper channeling, and that it doesn’t need to come out to play all that often. Passion is a good thing—-hey, it’s good to have righteous anger about the fucked-up state of the world. But. Everyone I’ve known who kept that anger as a constant presence in their lives, as a righteous, ethical, rational, —-nay, revolutionary—-force within their very bodies?

Have committed suicide.

Checks. Balances. The lives we need to live, just to get by—they don’t always allow for those checks and balances. Sometimes, our bodies betray us. Sometimes, we just gotta do the best we can with what we got. I’m not sure, not having really been there, but I have a sneaking suspicion that the folks who found a cure for depression via pharmaceuticals, have had some kind of experience similar to mine—-that, “wow, so this is how it feels. how it feels to be human again.” And despite my general pathology towards doctors and meds, I’m inclined to listen to what people say about their virtual “rebirth”. About feeling good again. Having a functional setpoint.

It’s not ignorance. It’s survival. It’s the opposite of ignorance. It’s wholeness. Awareness. Being. Again.

Pace.

EG, that is a perfect description.

Sometimes I feel like my depression, when I’m otherwise feeling well, is like a ghost. I can go for stretches of time without noticing it, but once in a while I catch a glimpse of it, just out of sight. Enough to startle me. And at times it haunts me with reminders of what it was like to live with it. It literally frightens me, that it might catch me and pull me back down into self descructive behavior.

This does not help me engage with the world. It’s a very self-involved thought process.

Suffering is the human condition.

*coff!* *choke!* *hack!* *koff!*

Excuse me? Excuse me?

Basta. All done with you. You came in here in bad faith. Just “throwing that out there.”

Astraea, I know the feeling of the “ghost”; apt phrasing. It haunts my husband and after 20 years with him, we are starting to figure out some of the signs of it a bit better, but I do tend to keep a “weather eye” out for potential heavy weather or storms and try to help/support him as best as I can.

There’s a cartoon joke on our refrigerator captioned “One Step Therapy”: a psychiatrist slapping his patient and yelling “Snap out of it!” I keep it there as a reminder of my previous attitude when I didn’t understand as much as I do now…

Elaine,

“Manic-depressive isn’t the name of a disorder anymore. They now call it bipolar.”

When you’re Manic Depressive, you can make all the rules you want about what you want people to call you. I actually AM Manic Depressive, and prefer that term over ‘bipolar,’ a word I find non-descriptive and vague.