Plastic surgery, Xanax, Adderall, and hormone replacement

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Sorry, I slipped into slang terminology there - bunting = IV injection. And someone sueing a Doctor for their own stupidity isn't something I hear of happening a lot here, I get the impression though that things are different in the United States.
People like to say we are sue-happy because you see high-profile cases with celebrities, but I don't think it happens to the extent portrayed.

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When they do sue, it's bc they took too many pills and downed them with alcohol.
Who's fault is that?

Well clearly the Doctor who prescribed the tablets in the first place, whilst acting as an agent of Big Pharma. Why yes, I am currently struggling to keep a straight face typing that out. :whistle:
 
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Okay. So we all deal with this.
Where do you start?

Look, I know your previous 'provider' gave you this nonsense. However, this is not my style and my style is based on data should you wish you investigate. This is what I can do for you after I can get a full report of your medical records.
 
BTW, plastics guys are not particularly happy to see these patients. I know there is this myth that they live off these patients, its not true in the 4-5 guys that I work with.
 
So let me get something straight, in the US if people want to see a Psychiatrist they can just book an appointment and rock up? They don't need to go through a Family Physician first to get a referral letter, before they can make appointment? I'm just wondering why drug seeking patients bother to go to the hassle of seeing a Psychiatrist when they can get the same stuff from a Family Medicine provider. I can understand if they're after stuff that is restricted to Psychiatrist prescription only, otherwise to me it seems like you'd just be creating an extra hoop for yourself to jump through. The reason I ask is because in Australia we're required to see a GP for a letter of referral first, before we can make an appointment with a Psychiatrist (no referral letter, no appointment). Even the CMHS system, as I understand it, for the most part still requires referral from a GP (or equivalent) to access services. As far as I'm aware the only medications that are restricted to Psychiatrist prescription only are stimulants such as Dextroamphetamine, otherwise everything else can be gotten directly from a GP - so if you've got the choice of going 'See GP, try to get pills', I don't really get why someone would complicate things by going 'See GP for referral letter, book appointment with Psychiatrist, go on a waiting list for said appointment to see said Psychiatrist, try to get pills'.
 
So let me get something straight, in the US if people want to see a Psychiatrist they can just book an appointment and rock up? They don't need to go through a Family Physician first to get a referral letter, before they can make appointment? I'm just wondering why drug seeking patients bother to go to the hassle of seeing a Psychiatrist when they can get the same stuff from a Family Medicine provider. I can understand if they're after stuff that is restricted to Psychiatrist prescription only, otherwise to me it seems like you'd just be creating an extra hoop for yourself to jump through. The reason I ask is because in Australia we're required to see a GP for a letter of referral first, before we can make an appointment with a Psychiatrist (no referral letter, no appointment). Even the CMHS system, as I understand it, for the most part still requires referral from a GP (or equivalent) to access services. As far as I'm aware the only medications that are restricted to Psychiatrist prescription only are stimulants such as Dextroamphetamine, otherwise everything else can be gotten directly from a GP - so if you've got the choice of going 'See GP, try to get pills', I don't really get why someone would complicate things by going 'See GP for referral letter, book appointment with Psychiatrist, go on a waiting list for said appointment to see said Psychiatrist, try to get pills'.
Doctors can require a referral at their discretion, but I've only come across one who does (it was a sleep doctor). Insurance companies used to require it more often (like I think my parents may have had to do that for me when I was a kid), but now you can pretty much call any specialist and make an appointment for yourself. Not that it's easy to get an appointment with a psychiatrist in general, but I've never had an experience where I've needed a referral. The bigger barrier is that they're booked. Actually I remember when I saw my first psychiatrist. This was pre-Internet days (at least for me), and my parents were the ones making the appointment. I very vividly recall them calling our insurance and telling them I needed to see a psychiatrist and the insurance just picked the one closest by. Nowadays I research doctors online and just call them directly to make an appointment. I'm not sure why my parents called the insurance company--I guess the alternative back then was looking in a phone book. Probably also had to be someone the insurance covered--we definitely had worse coverage then than I have now. I didn't even have a GP at that time, so there was no one to refer me to a psychiatrist. For medical care I went to this clinic where I technically was under the care of a GP but I never saw her (literally). I would see a nurse practitioner—there were a lot of them, so it wasn't a consistent relationship and I didn't go often, either. Given that the psychiatrist I saw put me on Ativan after a 15 minute appointment and didn't do any testing (psychological or physical) I would have been better off seeing a GP instead. It never occurred to me to start with a GP for mental health issues because I never had the type of relationship with a GP that I have now. It would have been much better if I had had someone who knew me and could have helped me when my problems started having had a history with me. Anyhow, it's kind of common for Americans not to have a GP. A lot go to Urgent Care (sometimes called "Doc in a Box") rather than waiting for an appointment. Urgent Care is not emergency care. It's basically primary care on demand. You just go there and wait to see a doctor.

Another thing is that with some specialists you can actually get in much faster than you can to see a GP. Family medicine and psychiatry are both squeezed pretty tight. Dermatology is another one where it takes a long time to get an appointment. If you waited months to see a GP just to get a referral to wait months again for a psychiatrist or dermatologist it would be doubly inconvenient. For some reason my cardiologist is the easiest to see. Neurology is about as long out for appointments as psychiatry. Family medicine is a long wait but not as bad as psychiatry. Dermatology is probably about as bad as neurology and psychiatry.
 
Doctors can require a referral at their discretion, but I've only come across one who does (it was a sleep doctor). Insurance companies used to require it more often (like I think my parents may have had to do that for me when I was a kid), but now you can pretty much call any specialist and make an appointment for yourself. Not that it's easy to get an appointment with a psychiatrist in general, but I've never had an experience where I've needed a referral. The bigger barrier is that they're booked. Actually I remember when I saw my first psychiatrist. This was pre-Internet days (at least for me), and my parents were the ones making the appointment. I very vividly recall them calling our insurance and telling them I needed to see a psychiatrist and the insurance just picked the one closest by. Nowadays I research doctors online and just call them directly to make an appointment. I'm not sure why my parents called the insurance company--I guess the alternative back then was looking in a phone book. Probably also had to be someone the insurance covered--we definitely had worse coverage then than I have now. I didn't even have a GP at that time, so there was no one to refer me to a psychiatrist. For medical care I went to this clinic where I technically was under the care of a GP but I never saw her (literally). I would see a nurse practitioner—there were a lot of them, so it wasn't a consistent relationship and I didn't go often, either. Given that the psychiatrist I saw put me on Ativan after a 15 minute appointment and didn't do any testing (psychological or physical) I would have been better off seeing a GP instead. It never occurred to me to start with a GP for mental health issues because I never had the type of relationship with a GP that I have now. It would have been much better if I had had someone who knew me and could have helped me when my problems started having had a history with me. Anyhow, it's kind of common for Americans not to have a GP. A lot go to Urgent Care (sometimes called "Doc in a Box") rather than waiting for an appointment. Urgent Care is not emergency care. It's basically primary care on demand. You just go there and wait to see a doctor.

Another thing is that with some specialists you can actually get in much faster than you can to see a GP. Family medicine and psychiatry are both squeezed pretty tight. Dermatology is another one where it takes a long time to get an appointment. If you waited months to see a GP just to get a referral to wait months again for a psychiatrist or dermatologist it would be doubly inconvenient. For some reason my cardiologist is the easiest to see. Neurology is about as long out for appointments as psychiatry. Family medicine is a long wait but not as bad as psychiatry. Dermatology is probably about as bad as neurology and psychiatry.

Wow, that's shocking! No wonder people are hitting Psychiatrists up for meds all the time if they can't get in to see a GP. Where I live I can literally walk 10 minutes up the road, between 7 am and 10 pm, wait 1-2 hours max (depending on how busy the clinic is, sometimes you don't even have to wait 10 minutes) and see any GP I choose - and it's bulk billed so no out of pocket costs whatsoever. Plus the clinic has a Radiology centre, and a small surgical section where things like simple fractures, cuts that need stitching, abscesses, and so on, can all be diagnosed and treated on site. Waiting lists for Psychiatrists have been reduced significantly to what they were 7 or so years back, but generally speaking, depending on who you book in with, the wait time is anything from 8 weeks to 6 months on average (give or take). There are teaching clinics here as well where, if you're happy enough to see a Provisional Psychologist or Psychiatric Registrar, you can get an appointment within 1-2 weeks.

I feel so frustrated for you sometimes. It's clear how much you want to work with a good Psychiatrist, and how much you could benefit from that, and yet it seems you're just totally stuck having to accept the idea that 'close enough is good enough' because your options sound like they're just not there.
 
:( What a crappy day.

Yeah. It just kept getting worse. Yesterday was better thankfully. I took a nap when I got home from work and things were a bit better with the world. My aunt's going for a second opinion somewhere fancy. I hope she gets better news.

I can't figure out a way to get this post on topic. Oh well. I just wanted to say thanks.
 
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Yeah. It just kept getting worse. Yesterday was better thankfully. I took a nap when I got home from work and things were a bit better with the world. My aunt's going for a second opinion somewhere fancy. I hope she gets better news.

I can't figure out a way to get this post on topic. Oh well. I just wanted to say thanks.

Start a new thread on your topic.
I think a lot of us would be interested.
 
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I meant on dealing with the death of a patient.
I think you had said that.

Oh right. It just got overshadowed by the rest of it. It's worth talking about, though I don't feel like it at the moment.

Yesterday my computer wanted to correct Adderall to paddle ball. I like that. I think I'm going to recommend a lot of paddle ball. "Can I have some Adderall?" "No, you can't. But here, have this. My computer said this is better."
 
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Oh right. It just got overshadowed by the rest of it. It's worth talking about, though I don't feel like it at the moment.

Yesterday my computer wanted to correct Adderall to paddle ball. I like that. I think I'm going to recommend a lot of paddle ball. "Can I have some Adderall?" "No, you can't. But here, have this. My computer said this is better."

Hey if this is what they mean by "meaningful use" I'm game.
 
I'm so not used to seeing Dextroamphetamine referred to as 'Adderall'. If I was a Doctor I could just see myself trying to decipher what the heck a patient was trying to ask for if they came in and said "I took this stuff before that really helped, it's the only thing that's worked for me so far, I can't remember the name of it though, I think it starts with A." Um, Absinthe?
 
When they do sue, it's bc they took too many pills and downed them with alcohol.
Who's fault is that?
It depends…do you believe in a Nanny State…or do you believe that people can actually make their own decisions (good or bad)? Then there is the whole idea of personal accountability, but that seems like a radical idea these days….
 
It depends…do you believe in a Nanny State…or do you believe that people can actually make their own decisions (good or bad)? Then there is the whole idea of personal accountability, but that seems like a radical idea these days….
Paternalism ("nanny state") is interventionist and doesn't apply in the question of liability. A paternalistic state would limit how much alcohol a person can buy per week. Prohibition is an example of paternalism.
 
It depends…do you believe in a Nanny State…or do you believe that people can actually make their own decisions (good or bad)? Then there is the whole idea of personal accountability, but that seems like a radical idea these days….

Doesn't matter what we believe or think. All that matters is the plaintiff's attorney...
 
It depends…do you believe in a Nanny State…or do you believe that people can actually make their own decisions (good or bad)? Then there is the whole idea of personal accountability, but that seems like a radical idea these days….

You prescribe, what have you noticed in your experience?
 
You prescribe, what have you noticed in your experience?

I'm not currently prescribing, though I do get consulted on a handful of cases a week. Most of my current pharma work involves researching utilization patterns/rates/etc. within a specific population and setting. I'm still working through the preliminary data, though there have been some pretty stark contrasts in utilization of stimulants, anti-psychotics, etc. The average number of medications given in a hospital is pretty astounding, particularly for the 65+ crowd. Many are needed, some…I'm not sure the data are there to support such frequent use. I'm looking at you SSRIs! :D
 
I'm not currently prescribing, though I do get consulted on a handful of cases a week. Most of my current pharma work involves researching utilization patterns/rates/etc. within a specific population and setting. I'm still working through the preliminary data, though there have been some pretty stark contrasts in utilization of stimulants, anti-psychotics, etc. The average number of medications given in a hospital is pretty astounding, particularly for the 65+ crowd. Many are needed, some…I'm not sure the data are there to support such frequent use. I'm looking at you SSRIs! :D

That;s pretty cool! Do you have a thread on this or more info?
 
Speaking of benzos I have tapered over 50 long term benzo users at my SMI clinic. My caseload is 100% benzo free

When I did private practice, less than 5% of my patients were on benzos. There were only three types patients I had on benzos over a month that I could think of off the top of my head.

1-Panic disorder-
I've never had 1 panic disorder patient that got completely controlled with SSRIs at maximum dosage. What almost always happened was by the 2nd or 3rd SSRI their panic attacks went from a few times a day to a few times a week, then added Buspirone at max dosage which then decreased it to a few times a month, then maybe add a B-blocker which further curbed it down but they still happened a few times a month.
Those patients got Ativan 1-2 mg pills, as many times as they had panic attacks a month plus 1-2 to keep in their pocket and pop in their mouth if they felt a panic attack coming on.
So, these patients only got a few pills a month. If they were found not to be abusing them after a few months I just gave them 30 and told them this was to last them a few months.

Yes I did tell these patients to do CBT. Most of them told me they didn't have the time, but they were not abusing the benzos.

2-Really bad anxiety and nothing's working or they're already on a heck of a lot of stuff and still have bad anxiety. These were only a few patients out of literally hundreds I had. I've had a few outilers where no SSRI, SNRI, or TCA I tried on them worked. Then I went to Gabapentin, B-blockers, etc and sometimes those worked, but if then nothing else did then I told them I was open to a benzo but I still didn't like it.

Seriously, I think maybe cannabis would be better for these patients but it's not legal (at least in most states as of now).

I did learn something being a young attending in private practice that I didn't learn in residency. I actually did have quite a few people whose anxiety was well controlled with gabapentin. It was tried out of desperation after the conventional meds didn't work, and then wow, some of these patients it worked very very well.

3-Some idiot doctor put them on a high amount of benzos and they've been on them for months to even decades so now I had to be the guy to get them off of them. Such people I couldn't taper off quickly so we did about a 5-10% reduction per month. I remember one patient I tapered her off of Xanax over the course of about a year. Getting her off of that med was like getting a monkey off the back.

A very bad pattern I noticed among some attendings is they put a patient on a benzo, then expectedly it stops working after a few weeks to months so they up the dose, then later again it stops working, then they up the dosage again.

Now the patient is on the maximum dosage and the doc instead of dealing with the problem for real tells them to go see a different doctor cause they're done with case.

What happened to me when I was doing private practice was the only few psychiatrists in town were all terrible (this was not in Cincinnati but a small suburb town about 30 minutes outside of Cincinnati. Cincinnati itself has plenty of very good psychiatrists, most in the university). Whenever one of those docs screwed over one of their patients in the above manner they'd dump their case to me. It got to the point where I didn't want to take their cases anymore cause the initial meeting was pretty much me always telling them in a diplomatic manner that their previous doctor screwed them up and did practice that's not acceptable by professional standards.

We weren't in the same office. They'd pretty much tell their patients they were done with them and there was only one other psychiatrist in town.....me. Trust me, I was not part of some arrangement with these bozos. If anything I felt like telling them I had little respect for their practice.

One of those patients I took after the psychiatrist put her on lithium with no labs before or after the lithium was started. She became lithium-toxic. She ended up going to the hospital with renal damage and ended up losing about 1 month of work. She was one of the few patients where I told her to consider getting a lawyer to review her case. The lawyer sent the psychiatrist letters demanding her medical records and the doctor refused to comply.

It was one of the reasons why I left private practice to work for the university despite what was > a $50K paycut. I felt like I was coming home to work in a place where so many people were hard-working, cutting-edge and very smart, and it showed in their work.
 
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Since I've yapped for years about bad psychiatrists, here's one I'd like to share, and yes I've had his patients after the guy scarred, err, cough cough, treated them.

http://www.cincinnati.com/apps/pbcs.dll/article?AID=/20080526/NEWS01/805260325/1077/COL02

https://cases.justia.com/ohio/tenth-district-court-of-appeals/2009-ohio-6901.pdf

Man, I can't find the video, but there was a local news video of one doctor that literally swiped her employee badge at the hospital, drove away, then at the end of the day swiped again. She was pretty much never in the hospital but by swiping her badge she was logging in she was doing her hours. Again, one where I've had the misfortune of having to see the damage created by her work or lack thereof.
 
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Since I've yapped for years about bad psychiatrists, here's one I'd like to share, and yes I've had his patients after the guy scarred, err, cough cough, treated them.

http://www.cincinnati.com/apps/pbcs.dll/article?AID=/20080526/NEWS01/805260325/1077/COL02

https://cases.justia.com/ohio/tenth-district-court-of-appeals/2009-ohio-6901.pdf

Man, I can't find the video, but there was a local news video of one doctor that literally swiped her employee badge at the hospital, drove away, then at the end of the day swiped again. She was pretty much never in the hospital but by swiping her badge she was logging in she was doing her hours. Again, one where I've had the misfortune of having to see the damage created by her work or lack thereof.

What's amazing if I am understanding that correctly is that a separate psychiatrist and neurologist both defended him? For what gain or purpose? In addition to 18 total witnesses.

This was a particularly disturbing charge against the victims: "appellant dismisses it by claiming it is not reliable because psychiatric patients are prone to lying and to distorting reality."

This is a less serious question than the case in question, but in that court case it looks like doctors are expected to abide by AMA ethics rules. Is that generally true in all states? I had always thought AMA participation was voluntary and the rules were guidelines. It would be nice if the AMA's ethics rules were enforced as law, but I didn't think they were. Not that in this case you would need them to prosecute--but they did mention that he violated them.
 
I'm waiting for the shoe to drop from the DEA regarding how BZD are being prescribed.

Benzos have been flying under the radar for some time now. Residents be careful when you prescribe benzos. It's like prescribing fire and having to carrying around a fire extinguisher at all times. If you don't know what fire does or how to use the fire extinguisher don't prescribe it.
 
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I just received an email from a pp patient who I have not seen in 8 months. 2 no shows. He states in the email "I was wondering if you could refill my Clonazepam". My reply "I never prescribed you that". Residents don't be push overs and don't be afraid to hurt some feelings. Man up when a patient lies or tries to convince you otherwise. It could save a patient's life, your license, and your reputation.
 
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When I did private practice, less than 5% of my patients were on benzos. There were only three types patients I had on benzos over a month that I could think of off the top of my head.

1-Panic disorder-
I've never had 1 panic disorder patient that got completely controlled with SSRIs at maximum dosage. What almost always happened was by the 2nd or 3rd SSRI their panic attacks went from a few times a day to a few times a week, then added Buspirone at max dosage which then decreased it to a few times a month, then maybe add a B-blocker which further curbed it down but they still happened a few times a month.
Those patients got Ativan 1-2 mg pills, as many times as they had panic attacks a month plus 1-2 to keep in their pocket and pop in their mouth if they felt a panic attack coming on.
So, these patients only got a few pills a month. If they were found not to be abusing them after a few months I just gave them 30 and told them this was to last them a few months.

Yes I did tell these patients to do CBT. Most of them told me they didn't have the time, but they were not abusing the benzos.

2-Really bad anxiety and nothing's working or they're already on a heck of a lot of stuff and still have bad anxiety. These were only a few patients out of literally hundreds I had. I've had a few outilers where no SSRI, SNRI, or TCA I tried on them worked. Then I went to Gabapentin, B-blockers, etc and sometimes those worked, but if then nothing else did then I told them I was open to a benzo but I still didn't like it.

Seriously, I think maybe cannabis would be better for these patients but it's not legal (at least in most states as of now).

I did learn something being a young attending in private practice that I didn't learn in residency. I actually did have quite a few people whose anxiety was well controlled with gabapentin. It was tried out of desperation after the conventional meds didn't work, and then wow, some of these patients it worked very very well.

3-Some idiot doctor put them on a high amount of benzos and they've been on them for months to even decades so now I had to be the guy to get them off of them. Such people I couldn't taper off quickly so we did about a 5-10% reduction per month. I remember one patient I tapered her off of Xanax over the course of about a year. Getting her off of that med was like getting a monkey off the back.

A very bad pattern I noticed among some attendings is they put a patient on a benzo, then expectedly it stops working after a few weeks to months so they up the dose, then later again it stops working, then they up the dosage again.

Now the patient is on the maximum dosage and the doc instead of dealing with the problem for real tells them to go see a different doctor cause they're done with case.

What happened to me when I was doing private practice was the only few psychiatrists in town were all terrible (this was not in Cincinnati but a small suburb town about 30 minutes outside of Cincinnati. Cincinnati itself has plenty of very good psychiatrists, most in the university). Whenever one of those docs screwed over one of their patients in the above manner they'd dump their case to me. It got to the point where I didn't want to take their cases anymore cause the initial meeting was pretty much me always telling them in a diplomatic manner that their previous doctor screwed them up and did practice that's not acceptable by professional standards.

We weren't in the same office. They'd pretty much tell their patients they were done with them and there was only one other psychiatrist in town.....me. Trust me, I was not part of some arrangement with these bozos. If anything I felt like telling them I had little respect for their practice.

One of those patients I took after the psychiatrist put her on lithium with no labs before or after the lithium was started. She became lithium-toxic. She ended up going to the hospital with renal damage and ended up losing about 1 month of work. She was one of the few patients where I told her to consider getting a lawyer to review her case. The lawyer sent the psychiatrist letters demanding her medical records and the doctor refused to comply.

It was one of the reasons why I left private practice to work for the university despite what was > a $50K paycut. I felt like I was coming home to work in a place where so many people were hard-working, cutting-edge and very smart, and it showed in their work.


One important point about number 3 is that if your going to give people long term benzos under a 'taper' due to chronic high dosing from another provider:

1) check their state drug report to make sure they aren't still getting benzos from other providers
2) have confidence that they are still not getting benzos from other sources(friends, street, aunt)

Patients are smart- they know that one of the ways they can get even more benzos than their usual allotment is to present to drs claiming they are being prescribed 6 mg of Xanax daily and "want to get off but I want to do it slow". In many cases what the patient wants is just a lot more benzos....these patients are often painting themselves as a victim of a wreckless doctor, when they were essentially scamming him/her all the way.

Because of these patients, I'll often say "what doctor x did is not my problem" and I'll either give the patient a very quick outpt taper or a referral to a drug detox center. Sometimes I will accept them as patients though as well.
 
One important point about number 3 is that if your going to give people long term benzos under a 'taper' due to chronic high dosing from another provider:

1) check their state drug report to make sure they aren't still getting benzos from other providers
2) have confidence that they are still not getting benzos from other sources(friends, street, aunt)

Patients are smart- they know that one of the ways they can get even more benzos than their usual allotment is to present to drs claiming they are being prescribed 6 mg of Xanax daily and "want to get off but I want to do it slow". In many cases what the patient wants is just a lot more benzos....these patients are often painting themselves as a victim of a wreckless doctor, when they were essentially scamming him/her all the way.

Because of these patients, I'll often say "what doctor x did is not my problem" and I'll either give the patient a very quick outpt taper or a referral to a drug detox center. Sometimes I will accept them as patients though as well.
As one of those patients, I can assure you there are in fact reckless doctors, but it's also reckless to do a very quick taper (depending on what you mean by very quick). As far as outpatient detox, I have investigated this for benzodiazepines, and I have not found any viable options. From what I've seen there are clinics that use barbiturates and a select few (insane) ones like the Coleman Institute that actually use flumazenil. It is far better to maintain gains and stay down than do an overly rapid taper that leads to kindling and a pattern of many failed withdrawals. There are people who are on these drugs and are legitimately scared of tapering because of how severe the effects are and how potentially dangerous they can be, but who also do want to withdraw. Given that the British National Formulary's own guidance (which I reference since the US doesn't seem to have federal guidance on this) is to do a slow taper, I wouldn't take a patient wanting to go down slowly as a warning sign. People who are prescribed these drugs often had anxiety as the original indication. If they're anything like me, they were terrified to take the drugs to begin with (I am terrified of trying or changing any drug), and with regard to benzodiazepines, their fears they were told were irrational (as I was) about taking the drugs are realized as being worse than they could have imagined. I think you need some sympathy to the fact that it is people with anxiety disorders who are in this position that the heartiest among us would find terrifying. Paralysis isn't the same as a desire to abuse drugs. It's self-protection--in every moment choosing what seems to be the safest option. Self-protection will make a person turn away from a very quick taper—it's not healthy, it doesn't feel healthy, and it's not necessarily safe.

EDIT: To clarify, I'm not defending claiming to want to do a slow taper as a way of enabling abusive activity--taking more than prescribed to get high. I guess I have trouble relating to that since I've never had that experience with benzodiazepines. Even when an oral surgeon and also a dentist certified in anesthesia tried putting me under with Versed, Fentanyl, and Phenergan and used more than 5x the normal dose they said they normally used of Versed, I was neither relaxed nor asleep. In fact, I was paradoxically agitated. So, I've never known the experience of benzodiazepines as good time drugs. They fix the anxiety for a short time and then do nothing but keep withdrawal symptoms at bay in my experience.
 
What's amazing if I am understanding that correctly is that a separate psychiatrist and neurologist both defended him? For what gain or purpose? In addition to 18 total witnesses.

One of the bozos defending the rectal-examination doctor was his partner in his practice. That guy too did horrendous things but while they are true I'm not going to state them publicly. The other guy I don't know who he was but I suspect he was either paid-off to say anything or was a friend willing to protect his friend despite how bad he was.

The guy that was in the trial was literally fired from at least 3 hospitals for his questionable practice.

As for the 18 witnesses, even a bad doctor is going to have successes. If a doctor were to rape 50% of his patients that leaves another 50% not raped.
 
As for the topic of the US being "sue-happy" and doctors practicing defensive medicine, etc., etc., I am starting a diet and was Googling how hungry is normal to feel. One of the top results was a story from 2012 of a teenager who starved to death, weighing only 40 lbs at her death. Her mother had her following the plan of a Georgia doctor who has a "Be Hungry" eating plan of eating no more than 2 lbs per day, regardless of what the food is (and it seemingly includes drinks as well). Obviously that would be really, really bad if you were eating 2 lbs of really water-heavy food, like melons or tomatoes.

Anyhow, the article is about how he was defending the mother who was charged with the daughter's death. He claims that the girl died from drinking bad water rather than from his "Be Hungry" eating plan.

I looked him up on the Georgia Board of Medicine site. He's an active cardiologist. No citations. No lawsuits. Nothing.

I found his web-site which is a bunch of gobbly goop religious nonsense. He's selling a book, which from what I can tell outlines a religous revelation he had that informs his Be Hungry diet plan.

Here's the article:
http://abcnews.go.com/US/hungry-doctor-diet-kill-georgia-teenager/story?id=16661077

This is the web-site of a *doctor* of medicine who is fully licensed to practice, hasn't been sued, hasn't been shut down and who seems to live in an alternative universe:

http://www.heartmdphd.com

This is why I don't think we're sue-happy. I've seen a lot of doctor say weird **** like this. If we were a sue-happy, overly litigious society, I think this guy would be bankrupt. If we were a just society, he wouldn't be practicing and would have had a stint in jail.

EDIT:
He calls people who criticize him "cyber stalking criminals" but he forgives them "for they know not what they do." (Yet he publicly shames them on his web-site.)

Here is a description of his diet and coaching materials on how to talk to your doctor about the diet without sounding "crazy":

http://heartmdphd.com/eatless.asp

I will admit that some of what he says is medically sound, but it is mixed with a cult of personality (not the Christian part--he seems to use Christianity to turn himself into a type of deity) and a lot of information that isn't medically sound.
 
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I have two very close friends who were prescribed Xanax from their PCP. I've discussed my concerns with them but I feel there is nothing much more I can do. I'm not a doctor yet and I'm never going to be their doctor. I have seen them abuse it as well. We would simply be having dinner and here comes the pill bottle and pop into the mouth a Xanax. "Why did you take the Xanax?" "Oh, because I felt anxious earlier." Then I have to explain to them why they just took it inappropriately and then they say their doctor said otherwise. It becomes a very tense conversation and since we have been friends for years I feel I don't approach it the way I would with a patient. Frustration.
 
As for the topic of the US being "sue-happy" and doctors practicing defensive medicine, etc., etc., I am starting a diet and was Googling how hungry is normal to feel. One of the top results was a story from 2012 of a teenager who starved to death, weighing only 40 lbs at her death. Her mother had her following the plan of a Georgia doctor who has a "Be Hungry" eating plan of eating no more than 2 lbs per day, regardless of what the food is (and it seemingly includes drinks as well). Obviously that would be really, really bad if you were eating 2 lbs of really water-heavy food, like melons or tomatoes.

Anyhow, the article is about how he was defending the mother who was charged with the daughter's death. He claims that the girl died from drinking bad water rather than from his "Be Hungry" eating plan.

I looked him up on the Georgia Board of Medicine site. He's an active cardiologist. No citations. No lawsuits. Nothing.

I found his web-site which is a bunch of gobbly goop religious nonsense. He's selling a book, which from what I can tell outlines a religous revelation he had that informs his Be Hungry diet plan.

Here's the article:
http://abcnews.go.com/US/hungry-doctor-diet-kill-georgia-teenager/story?id=16661077

This is the web-site of a *doctor* of medicine who is fully licensed to practice, hasn't been sued, hasn't been shut down and who seems to live in an alternative universe:

http://www.heartmdphd.com

This is why I don't think we're sue-happy. I've seen a lot of doctor say weird **** like this. If we were a sue-happy, overly litigious society, I think this guy would be bankrupt. If we were a just society, he wouldn't be practicing and would have had a stint in jail.

EDIT:
He calls people who criticize him "cyber stalking criminals" but he forgives them "for they know not what they do." (Yet he publicly shames them on his web-site.)

Here is a description of his diet and coaching materials on how to talk to your doctor about the diet without sounding "crazy":

http://heartmdphd.com/eatless.asp

I will admit that some of what he says is medically sound, but it is mixed with a cult of personality (not the Christian part--he seems to use Christianity to turn himself into a type of deity) and a lot of information that isn't medically sound.

After reading through his website, all I can sat is it's truly amazing how much one can actually rationalise an Eating Disorder. As for his (seemingly constant) use of the term 'wonderfully hungry', I was wonderfully hungry for 24 years and you know being wonderfully hungry did so much for me - if you discount the two separate death sentences I received, the Gastroparesis, Peripheral Neuropathy and permanent muscle damage I now suffer from, and the full upper denture I have to wear after losing all of my top teeth to malnutrition. Yeah, go hunger. :rolleyes:
 
After reading through his website, all I can sat is it's truly amazing how much one can actually rationalise an Eating Disorder. As for his (seemingly constant) use of the term 'wonderfully hungry', I was wonderfully hungry for 24 years and you know being wonderfully hungry did so much for me - if you discount the two separate death sentences I received, the Gastroparesis, Peripheral Neuropathy and permanent muscle damage I now suffer from, and the full upper denture I have to wear after losing all of my top teeth to malnutrition. Yeah, go hunger. :rolleyes:
I'm very sorry. That sounds like a very long, rough ride. It is quite shocking that he can promote something like that. In the US, even diet companies like Weight Watchers or Jenny Craig have very clear warnings that their programs are not for people with eating disorders, and yet here is a doctor whose plan itself is an eating disorder.

EDIT: Forgot to say my point is that I don't think we are sue-happy or overly legalese. There is a teenage girl who died at 40 lbs and this doctor has the gall to say that it was probably from drinking bad water rather than his eating plan, and he has faced no repercussions.

If anything I would say our tort system is very uneven. I think most cases of harm go unchecked but there are some where there is a large pay-out. It should probably be more even and more consistent.
 
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I'm very sorry. That sounds like a very long, rough ride. It is quite shocking that he can promote something like that. In the US, even diet companies like Weight Watchers or Jenny Craig have very clear warnings that their programs are not for people with eating disorders, and yet here is a doctor whose plan itself is an eating disorder.

Yeah Anorexia Nervosa isn't exactly what I'd call a laugh riot I can tell you that, but hey I'm still here, I've maintained a reasonable state of recovery/remission for the past ten years - still got some stuff I need to work on and I'll be starting to attack more of that head on with my Psychiatrist starting in the next session or so (delving into the deeper dynamics, that sort of thing) which I'm really looking forward to. Before I started working with my current Psychiatrist I was in a similar situation to what you've gone through trying to find a Psychiatrist who was willing to work with you on a benzo taper, because I'm kind of deemed to have what is sometimes known as 'Severe And Enduring Eating Disorder' or 'Chronic Anorexia Nervosa' (based on age of onset plus length of active illness) the vast majority of Psychiatrists, Psychologists, Therapists, Counsellors, *insert whatever other medical professional* either outright refused to work with me, or take me on, and those that did were basically only willing to offer treatment that would teach me to live with the disorder and maintain a minimally functional existence. After several months of getting nowhere fast, I eventually just said 'Eff this', and put together my own recovery program. Thankfully though I think the guidelines on treating long term Eating Disorder patients have since changed, and now there's a lot more emphasis on working within a recovery framework rather than going 'well, this one's scr3wed, better just throw her in with the rest of hopeless cases pile'.

I'm actually just watching an extended interview with the cardiologist in Georgia who is advocating this whole 'wonderfully hungry' eating plan (I use the term 'eating plan' very loosely). And, yeah, I might not be a healthcare professional of any description, but I don't think I'm buying what he's selling. Not to mention how the hell is this guy not in jail already, let alone still being able to practice - a 16 year old girl dies weighing 40 pounds and her cause of death wasn't starvation? Ah, okay then...o_O

Seriously, this is some off the wall crazy ****. :eek:

http://www.11alive.com/video/1777146094001/1/EXTENDED-INTERVIEW-Dr-Andrew-Chung-Part-One

http://www.11alive.com/video/1777229958001/50317397001/EXTENDED-INTERVIEW-Dr-Andrew-Chung-Part-Two

http://www.11alive.com/video/1777241721001/1/EXTENDED-INTERVIEW-Dr-Andrew-Chung-Part-Three

http://www.11alive.com/video/1777275041001/0/EXTENDED-INTERVIEW-Dr-Andrew-Chung-Part-Five

http://www.11alive.com/video/1777316021001/1/EXTENDED-INTERVIEW-Dr-Andrew-Chung-Part-Six

*part 4 isn't missing, the numbering off the links is a little off, kind of like most of what you'll be listening to...:whistle:
 
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Since I've yapped for years about bad psychiatrists, here's one I'd like to share, and yes I've had his patients after the guy scarred, err, cough cough, treated them.

http://www.cincinnati.com/apps/pbcs.dll/article?AID=/20080526/NEWS01/805260325/1077/COL02

https://cases.justia.com/ohio/tenth-district-court-of-appeals/2009-ohio-6901.pdf

Man, I can't find the video, but there was a local news video of one doctor that literally swiped her employee badge at the hospital, drove away, then at the end of the day swiped again. She was pretty much never in the hospital but by swiping her badge she was logging in she was doing her hours. Again, one where I've had the misfortune of having to see the damage created by her work or lack thereof.

One of the bozos defending the rectal-examination doctor was his partner in his practice. That guy too did horrendous things but while they are true I'm not going to state them publicly. The other guy I don't know who he was but I suspect he was either paid-off to say anything or was a friend willing to protect his friend despite how bad he was.

The guy that was in the trial was literally fired from at least 3 hospitals for his questionable practice.

As for the 18 witnesses, even a bad doctor is going to have successes. If a doctor were to rape 50% of his patients that leaves another 50% not raped.

Mongrel b@stards!

It was this type of calculated selection of vulnerable patients, manipulation of information, and close rank behaviours that allowed my former Psychiatrist to get away with decades of emotional, physical and sexual abuse of patients. My current Psychiatrist knew who I was talking about almost as soon as I finally got up the courage to actually say his name, he'd heard the stories from his fellow practitioners a generation above him, who regarded this creep as a 'charming psychopath who had ruined the lives of far too many patients, and should have been struck off decades ago'. But this a-hole remained untouchable for all that time because 'well he's a Psychiatrist, who specialises in addiction medicine, so clearly any patient making such sordid accusations must be delusional, neurotic, attention seeking, deceitful, untrustworthy, not to be listened to under any circumstances, etc etc', and former work colleagues trying to bring forth any sort of complaints related to cruel and sadistic treatment of said patients, 'well clearly these former colleagues just didn't understand the nature of treating addiction where physical dependence was involved' (regardless of the fact that he was medically inducing such a horrendously severe and rapid withdrawal in these patients, that no one in their right mind could look at it and say it was therapeutic -- not to mention the fact that there is at least two witnessed accounts of him being seen to derive pleasure from watching the patient's distress), but it's alright, because if all else fails he'll just call in his circle of mutual back scratching, pay off taking, equally despicable rank and file dredge of the medical fraternity, who's closed ranks have allowed them to maintain a cover of respectability, and they'll suddenly reschedule everything to be at his hearing and sing his praises to the high heavens.
:bang::mad: :punch:
 
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