Fascinating pt/conundrum

[PikminOC]

If OP is indeed a patient looking for info under the radar then I'm a little hesitant to leave my previous post up, the one revealing just how guarded the medical profession has to be in the face of experienced drug seekers; however, upon consideration I'm happy enough to keep it up there for anyone else who's reading who is a medical professional, or about to become one, and who has yet to face these sorts of situations (I have no problem sharing past 'trade secrets' as it were, if it helps protect good Doctors from being duped and facing possible disciplinary actions.

I'm glad you and birchswing are clear about who you are. many posters are not.

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[Ceke2002]

I'm glad you and birchswing are clear about who you are

Always have been, always will be.

 

[birchswing]

I'm glad you and birchswing are clear about who you are. many posters are not.

Oh, I can't quite take that compliment. I had a satirical account as a dancing psychiatrist (she would *hate* to be referred to as such, though—there's a big difference between a dancing psychiatrist and a psychiatrist who practices the dance).

 

[Doctor Bagel]

I knew that from the first post. Most of me thought everyone was playing along; a smaller part of me was concerned no one was playing along, indicating a lack of critical thinking. My assumption was that the OP is a person who wanted to know what to say to a doctor who would otherwise dismiss the idea of prescribing opiates, but it also seems like someone who feels compelled to be open and honest and bring this issue into the light. I pretty much believe everything he/she wrote, except that I believe the person who wrote it wrote about him/herself. He/she wrote very well about his/her experiences.

But a doctor would never describe a patient's experiences so personally, nor would they spend so much time researching past treatment. My state only requires doctors to keep medical records 6 years, and in my experience they do destroy them after that time is up. So this whole idea of vast treatment history and a doctor caring enough to go through it--it doesn't ring true. Nor would a doctor be able to talk about the patient's experience so fluidly.

That's why I phrased my responses more to the question of how a society allows or doesn't allow a person to abate pain through political and cultural forces. I still think the OP has valid questions, and I thought people were responding to them in a knowing way. I tend to be a bit paternalistic on some issues, but I also think we only have one life and there's no use living it in misery, so without knowing a lot about the alternatives, I tend to think a person like the OP should be given a safe way to do what it is that works. On the other hand, there's a need for pragmatism in his/her situation, which may be why he/she created this thread--to find out what a psychiatrist would report back to the doctor currently prescribing, etc, and what the current doctor would do if he/she understood the role that the medication plays. I can see how taking a poll is somewhat requisite before opening oneself up to a psychiatrist like that. To the OP, you're probably not going to find what you're looking for from a psychiatrist. They will probably not validate you. You sound very sincere and earnest and even a bit scrupulous (which often goes in with OCD). I am in not in your situation, but I could imagine writing what you did if I were. I would suggest pragmatism above all else. I can understand the need to want to take things into the light. But we can't always get that. I doubt that your prescribing situation with your current doctor would change if you were to just consult with a psychiatrist (though, there's a slight risk as you seem to realize), but I also doubt a psychiatrist would tell you anything you want to hear.

Maybe, and as a poster here who is a patient and not a psychiatrist, maybe you're better able to spot this. I will say, though, that some psychiatrists, especially trainees, do devote a lot of time and energy to thinking about and understanding their patients, including doing more extensive collection of collateral information. I agree that it's not that common and likely impossible for a busy psychiatrist seeing patients in 15 to 30 minute appointments, but we might think about our patients a little more than you think we think about our patients, again, especially if we're not operating in a high volume pure medication management type of model, which I understand is how your psychiatrist operates.

I'm also questioning the "safe way to do what works" part of your statement. I get that the patient described here is suffering, and suffering a lot -- most of our patients are. However, long term usage of opioids isn't necessarily "what works," and honestly is really harmful in the long run for this patient. I see a lot of patients who think benzodiazepines are what works for their crippling anxiety -- you've seen where that can go. About a psychiatrist telling this patient what he wants to hear, I think it could actually happen for the reasons I listed above -- the desire to be the special provider who gets it, a narcissistic belief that you know more than other providers and than the medical community, laziness, a want to be liked. I see crazy prescribing all the time, which is also why I believe the op could indeed be a doctor.

 

[Ceke2002]

Maybe, and as a poster here who is a patient and not a psychiatrist, maybe you're better able to spot this. I will say, though, that some psychiatrists, especially trainees, do devote a lot of time and energy to thinking about and understanding their patients, including doing more extensive collection of collateral information. I agree that it's not that common and likely impossible for a busy psychiatrist seeing patients in 15 to 30 minute appointments, but we might think about our patients a little more than you think we think about our patients, again, especially if we're not operating in a high volume pure medication management type of model, which I understand is how your psychiatrist operates.

Yes, this, thank you. I must admit I didn't pick up on 'vibes' from the OP, because to me it's not at all unreasonable that a Doctor would spend that much time with a patient and do their due dilligence in that patient's favour.

 

[Ceke2002]

Oh, I can't quite take that compliment. I had a satirical account as a dancing psychiatrist (she would *hate* to be referred to as such, though—there's a big difference between a dancing psychiatrist and a psychiatrist who practices the dance).

Part of me really wishes I had known what you were planning to do. I wouldn't have agreed with it, but in hindsight it actually would have been hilarious if you'd done a satirical parody of my Psychiatrist. I certainly could have given you a lot to choose from, or you could have just done the whole package - A retired Muay Thai fighting, however many he's up to now Martial Arts practicing, Heavy Metal headbanging, practicing Buddhist Psychiatrist with a penchant for quoting philosophy and meaningful prose - bonus points if you had him responding with an emphatic, fist pumping 'F**k Yes!' whenever a patient reported significant process.

 

[birchswing]

Part of me really wishes I had known what you were planning to do. I wouldn't have agreed with it, but in hindsight it actually would have been hilarious if you'd done a satirical parody of my Psychiatrist. I certainly could have given you a lot to choose from, or you could have just done the whole package - A retired Muay Thai fighting, however many he's up to now Martial Arts practicing, Heavy Metal headbanging, practicing Buddhist Psychiatrist with a penchant for quoting philosophy and meaningful prose - bonus points if you had him responding with an emphatic, fist pumping 'F**k Yes!' whenever a patient reported significant process.

The original inspiration was actually my psychologist who, in his words, "fetishisizes" the frame. I took the idea of strictly enforcing the frame to its absurdly logical conclusion. I can't remember what made me think of the dance part. I think of some weird stories. I've been working on a comedic short story in which a patient sees her therapist for marital issues. The patient has married a dog, but refers to the dog as her husband. The therapist knows that the "husband" is a dog due information received from another client who is a friend of the woman, but the therapist can't reveal this, of course—he can't even acknowledge he sees this other client. So, the therapist is in the position of counseling a woman on a relationship with her husband, in spite of knowing the husband in question is a dog. The short story starts off with the woman complaining that her husband always walks in front of her when they're downtown shopping and how that annoys her. There are subtle hints like that throughout. The reader doesn't know it's a dog till the end of the story.

 

[MacDonaldTriad]

In the first chapter on the psychiatric interview in K&S, it makes the following points:

• Being lied to angers most people, certainly no less psychiatrists who depend on trust to perform their work.
• Believing a patient’s lies is not a professional failure.
• Psychiatrists are trained to detect, understand and treat psychopathology, not to serve as lie detectors.
• A level of suspicion is essential, but the clinician who is determined never to be taken in will approach patients with such exaggerated suspiciousness, therapeutic work will be impossible.

Given the nature of this social media, it is small wonder we can be fooled. I guess we will continue to get fooled, but shame on them not on us.

 

[Armadillos]

In the first chapter on the psychiatric interview in K&S, it makes the following points:

• Being lied to angers most people, certainly no less psychiatrists who depend on trust to perform their work.
• Believing a patient’s lies is not a professional failure.
• Psychiatrists are trained to detect, understand and treat psychopathology, not to serve as lie detectors.
• A level of suspicion is essential, but the clinician who is determined never to be taken in will approach patients with such exaggerated suspiciousness, therapeutic work will be impossible.

Given the nature of this social media, it is small wonder we can be fooled. I guess we will continue to get fooled, but shame on them not on us.

I really like those points above in general applied to all fields of medicine, too often I see docs who are so obsessed with not letting the malingers/addicts/etc. ever "win" that it greatly impacts the care they provide to those patients who genuinely need it.

The surgeons always told me that if your not taking out some normal appendices, your missing tons of abnormal ones. I think the same is true in psych, if your not unknowingly fulfilling a few pts secondary gain motives, then your missing out on helping a lot of other people who need help.