I *loved* this comment from PreMedAA so much that I’m going to write a whole post in response to it. This comment followed my early-November post about my annoyance with my new psychiatrist.
The background for readers who don’t want to refer back to old posts (plus filling in some gaps I’ve previously omitted to help hide my real identity): I switched shrinks when I moved to a new state over the summer. Hubby and I knew that we wanted to start to try for a family sometime this autumn, which was my first in a faculty position after 3 years in a health sciences postdoc. Having discussed the issue of medication and pregnancy at length with my old shrink (a fellow in geriatric psychiatry at one of the best psychiatric hospitals in the nation who I very much miss), I was keenly invested in seeking the best care possible in my new setting. My old shrink was supportive, and asked me to keep in touch with her about my treatment in this new setting. My old shrink appreciated that since Hubby and I have started talking seriously about kids, two limitations have been foremost on my mind: a) I’m able to work up to my full potential because of ritalin, and taking a 2-year break from it in order to conceive could potentially tank my chances for tenure, and b) having spent 9 years in pre- and postdoctoral training, I’m no longer a spring chicken. If we’re going to start a family, we need to start trying soon, or we risk running out of time.
S0, imagine my dismay when I called for an appointment at my new university’s med center specialty AD/HD clinic (in July) and found out I’d have to wait 2 months in order to get an appointment (September). My dismay was further magnified when I met my new doc and discovered how inexperienced she was. I brought up the pregnancy & meds issue at our first appointment in September. She promised to do research before our next appointment, and wrote me a prescription for the SSRI I take for PMDD (note: she wrote it for the bi-weekly dosing, which is quite standard for treating PMDD). When I came back in October, she hadn’t yet done any research on pregnancy & ritalin. I brought up the research I’d done on my own and with my old doc. She promised to look into it and get back to me. When I came back in November, she still hadn’t done any research and seemed to have forgotten about the bi-weekly dosing of SSRIs for PMDD (despite having written the prescription herself just weeks before). She promised to consult with her network of supervisors and colleagues, and assured me she would call me in a week. I had to call her a week later to remind her of our phone appointment. She was rather unprepared when she called me back, and asked me to come in before Thanksgiving for a short chat in person about the literature & promised to bring an important research publication. I made (& paid for) the extra appointment, for which she ran 30 minutes late. She forgot to bring the article (promised to fax it, but it still hasn’t happened & I’m not holding my breath), but still couldn’t say anything conclusive or provide me any strong evidence for any option during pregnancy. She pushed really, really hard for my trying fish oil, which apparently shows decent efficacy with young children (alas, if I were only in the 2nd grade and just learning simple multiplication instead of spending my days doing matrix algebra…). So I’m still on hold, and yet can’t get another appointment in the clinic until early January.
So, my hubby and I have put off trying to conceive for an additional 6-7 months, and 4 months of that delay is due to my new shrink being inexperienced and inefficient. I’ve also wasted a total of 4 hours of my semester in the waiting room filled with people who function at a far, far lower level than I do… and to put this in practical terms, 4 hours = the preparation of 1 full lecture or 4 written pages of a research article. The bottom line is that I sought a specialty clinic thinking it would save me time and effort, and I probably could have received better treatment from a GP.
(I suspect that quite a few ADDer readers have had similar treatment experiences. My situation is anything but unique.)
So, now I’ll deal with PreMedAA’s lovely comments…
Would you have preferred for the resident to attempt to cover her ignorance and simply take her ‘best educated guess’?
A physician at any level may not have confident answers on the tip of their tongue, especially if their patient has a keen grasp of pharmacology and medicine.
I agree with you; no, I wouldn’t want her to ‘cover’ by making a guess, but a competent medical professional in a specialty clinic shouldn’t need 3-4 months to come up with an answer to this sort of question, regardless of who the patient is, or how threatening the patient’s competence is to the physician’s ego. It’s not like ADD is a new condition, and I’m hardly the first woman who wants to get pregnant without tanking her career by going totally med-free.
Stating that you know more about something than a doctor may or may not be true. Your ‘knowledge’ may have been garnered from secondary sources or your educational background may be insufficient to properly digest the primary pharmacodynamics proposed by the manufacturing company. Your doctor is not a CPS or PDR, if they were, those compendiums wouldn’t exist.
Actually, I have a Ph.D. in the health sciences, and my research specialty is self-regulation, the set of skills directly impacted by the medical condition of AD/HD. It takes longer to get a Ph.D. in my field than it does for a M.D. to complete medical school, and I have 3+ years of postdoctoral training on top of that. Furthermore, I’m 2+ years past diagnosis, and have been very actively involved in my treatment. This has included spending a great deal of my free time reading the literature on AD/HD and medication. Yes, I read the primary sources, and yes, I understand them, even the “yucky” stats part in the middle. In short, I have more years of research training in the field, and unless my doc has ADD herself, then most likely I also have more first-hand experience.
If you were particularly impatient, which you claim to be, then perhaps stating your acceptance of her consultation of her reference books in your presence would have saved you both time, as its likely that she didn’t feel dragging out the books in front of you would inspire much confidence, which you could have offered to alleviate.
For pete’s sake… the November post as just a blog entry, not a direct transcript of my conversation with my doctor. I actually would respect her more if she had dragged out her reference books. Of course I consented to allow her to consult with colleagues and do further independent research. I’ve repeatedly told her that I understand that residents are still training, and have also repeatedly expressed a desire to consult about primary references (i.e., current research). She’s the one who’s not been willing or able to meet me halfway on this. How much more open, supportive, and non ego-threatening can I really be? How long should someone be reasonably expected to wait?
You claim to know more about treating ADD/ADHD than your 1st year psychiatry resident-attending physician which is unlikely unless your a physician yourself and in the case of Adderall…at least a pharmacologist.
I’m not writing anything else about my specific academic credentials because I risk outing myself, and that’s not a good thing pre-tenure. Just a few points… a) she’s a 1st year resident, not an attending; b) it’s “you’re,” not “your,” and your sentence structure doesn’t make much sense; c) finally, if you’d bothered to read any of my other entries, you’d realize that I take ritalin, not adderall.
But since you don’t have time to permit your physician to ensure the validity of her counsel, then perhaps you ought to consult with a pharmacist about the possible effects of your drug regime on pregnancy…and perhaps they would be familiar with your atypical SSRI rotation.
The possibility that you havn’t done this already on your own suggests that such comments in regard to having a superior clinical knowledge of your diagnosis may not be advisable on your part, especially towards a medical professional.
Doctors are not gods, and the rest of us are not “lesser” beings. Contrary to the belief of many MDs, they don’t know everything, they do make mistakes, their time is no more valuable than anybody else’s, and they don’t deserve to be treated any better or worse than anyone else. I’ve given her plenty of time, and she’s wasted it. As a faculty member who is currently working 60+ hour weeks, I don’t have time or the patience to train somebody how to do their job OR remind them about how they’ve treated my condition at previous appointments. In these circumstances, I shouldn’t have to bend over backwards or jeopardize any aspect of my future in order to keep them from feeling badly about themselves or their abilities.