Self-Diagnosing Patients a bit TMI

In My Humble Opinion
1

I rarely need to go to the doctor. However, when I do, I’ve almost always researched my symptoms and possible medications for what is wrong with me if it is something simple or something I’ve had before. I need to mention that I deal with medical issues on a day to day basis as I’m a medical malpractice attorney so I think I have better knowledge of medicine than your average Joe. I have no problem with the doctor testing me to make sure that what I believe I have is, in fact, what I have.

When I go to the doctor, if I know what I have; I tell him. Plain and simple. For instance: ‘Hi doctor, I need some antibiotics for this nasty sinus infection as I have pressure under my cheekbones and my mucus is green…usually a Z-pac works for this.’ or ‘Hi doctor, I have a UTI; last time I had this you prescribed Levaquin.’ For many years this always gone smashingly well for me since I had a regular doctor and he knew me and my medical history and the tested accuracy of my statements.

Well, now I have a new doctor and I’ve been seeing him for about 2 years. He HATES it when I self-diagnose. He never listens my diagnosis of what I think is wrong with me or what medications have worked in the past for that issue. I have tolerated him since he works in my building and I really haven’t needed him for much.

However, last week I went to see him for some anxiety medication. I used to get 5 very low dose clonazepam a month for my PMS symptoms. They worked wonders. I haven’t needed them for a while as I’d been on the pill which works wonders for PMS but not for my sex drive. So I’m off the pill again and need a little help getting throught the rough patches…I’m a VERY high strung person. Well, Mr. doctor went WAY the hell overboard and tells me that it would be ridiculous for me to be put on the clonazepam again despite the fact that it really helped. No, Mr. Doctor prescribes me freakin PROZAC. Mr. Doctor decides that after a 5 minute conversation with me that I have PDD (pre menstrual dysphoric disorder) and I need to be on freakin PROZAC every GOD DAMNED DAY OF MY MENSTRUATING LIFE due to the 2 days every month I get tense. I calmly explained that I did not think it was PDD and that I wanted no part of being on Prozac for problems w/ 2 days a month. He told me to try it or there would be no further relief from him.

My questions are this:

How many of you self-diagnose?
Do you think I self-diagnose too much?
How would you handle this most recent problem?

2

I self-diagnose if it’s something I’ve had before, and I’ll try to stick with solutions/treatments that have worked in the past. If the previous treatment didn’t work, I’m open to suggestions.

I think you’re doing fine.

I think you’ll be looking for a new doctor soon.

3

Health care is best treated as a partnership between you and your doctor. What Ethilrist said: get a new doctor who listens to you.

4

Many doctors are reluctant to prescribe benzos. However, I’ve heard they’re readily available on the black market. I wouldn’t really know since I’ve never ever bought anything on the black market, but since you only need them 2x a month I’d say $20 could probably cover you for a long time on some little ones.

5

clonazepam is a muscle relaxer, no?

I can see why he doesn’t want you on them regularly… them shit make ya feel goooood. But you’d think since you just want them for PMS, he’d let ya have a script.

You’re in the US or no? I don’t know if it’s like this there… but some docs get quite the gift bags and insentives for pushing certain drugs.

Wouldn’t hurt to get a second opinion.

6

I self diagnose and have doctors who listen respectfully. Of course, it’s not like I’m diagnosing leprosy or ankylosing spondylitis.

You probably don’t self-diagnose too much (or we both do). Some of us have professions/backrgrounds that lead to better than the lay person’s level of medical knowledge.

Get a new doctor. And tell your’s why you are changing.

7

Get a new doctor. I tend to self-diagnose things that I’ve had before (sinus infections, strep throat, etc.) and my doctor listens to what I say, double checks anything that might be observable to her, and either agrees with me or explains why she thinks I’m wrong. I would personally be uncomfortable with a doc who was reluctant to prescribe something you’d had before and worked and that you only needed a few times a month, but instead wanted you to medicate every single day for years. It doesn’t sound like he’s listening to you at all, and that’s not cool.

My whole family tends to self-diagnose, and sometimes the results can be either funny or tragic. My sister saw cradle-cap on her second child, and was sure it was some sort of terrible skin infection. I said, “I bet it’s cradle-cap.” “Oh, no,” she said, “this is really different, it’s something really horrible!” She told me she thought the child had psoraisis. I took one look at the kid–it was cradle-cap. That’s what the doctor said, too.

That was funny. My mom, on the other hand, nearly died. She had abdominal pain and was sure it was gallstones. She kept intending to go into the doctor, but she’s strongly suspicious of doctors since my dad died (she’s always believed he somehow could get the straight story from them, and otherwise they were lying to her) and was asking around for a GI she thought she could trust. This went on for months, until I heard about this and told her to hang up the phone immediately, and call her GP and tell him she needed to see him in the morning. She did–thank goodness. She had a tumor on her liver the size of a football, and another one in her colon. They took them both out, and she’s been fine for two years now. But that was a horrendous time, and would have been easier on everyone if she’d just gone to the GP as soon as she realized something was wrong.

The moral of that story is, it’s fine to self-diagnose if it’s something you’ve had before or know a fair amount about, but for the Deity’s sake, don’t rely just on that, and go see the doctor if you think anything at all is wrong. If you don’t agree with what she says, find another doctor (and in your case, BottledBlondeJeanie, I think you would be justified in doing just that), but don’t just assume that your diagnosis is right.

8

you are absolutely right to question your need to take prozac.

you’ve obviously been on and off clonazepam, and if it works for you without addiction or side effects, then go for it.

like you say it’s 2 out of 28 rather than an everyday solution.

get a new doc.

9

And I’ve heard that such activity is illegal and that you should know better than to post such “advice” on this message board. Consider yourself officially warned.

10

Get a new doc, or at the very least a second opinion. I can understand why some self-diagnosis annoys doctors, but if you had a drug that worked for you in the past, and your last doctor approved, and this one won’t even listen to you and prescribes and arguably over-prescribed drug …

Yeah. You need someone who’ll listen.

11

Part of the doctor’s hesistancy might have been that you were asking for clonazepam (a benzodiazepine). I’m in med school right now and one of the things we are cautioned about is drug-seeking patients (not implying that you are one of course!), in particular patients that are seen for the first time who insist that only a specific drug (benzos and opiates usually) that will control their symptoms.

One suggestion would be to have the medical records from the physicians who previously prescribed the clonazepam forwarded to your new physician. Your chart should document the fact that you have consistently used this medication without problems and that you did not demonstrate any drug-seeking behavior (i.e., calling for refills too frequnetly or too early) and that former trials of other medications had failed. If the doctor is still hesistant in prescribing the medication, see if he will do so if a contract stating that only x-number of pills will be given and that in the first couple of months of treatment that you will be seen regularly in the office.

Another reason that physicians (particularly people who are in family practice) prefer to prescribe the SSRIs like prozac is that they are much more benign drugs and are less likely to cause addiction or be used in a suicide attempt. Perhaps you might look in seeing a psychiatrist who is more familiar with your symptoms and be more comfortable prescribing clonazepam.

12

I would get a new doctor. Even if you get a new doctor who you’d still have to push to get the clonazepam, if he or she at least sits down and says, “This is why I don’t want to give you that stuff,” and generally treats you like a human being, you’ve gone a long way. Doctors are not gods.

My mom had a sinus infection recently and self-diagnosed it. Since she’d just had bronchitis, her doctor did want to see her, but after two minutes agreed with her and sent her on her way with eight days worth of sample antibiotics so she wouldn’t even have to get a prescription filled.

She is also on very low-dose Vicodin for pain from foot surgery she had last year – a nerve apparently got a bit damaged or something and is taking forever to heal – but she is being VERY careful with it and taking as little as possible. The last time she was there, her ortho gave her another prescription dated a month later because she’s obviously been very careful with the stuff.

I would find another doctor who treats you like a human being. Then see if you can’t document the fact that you only take this stuff a couple of days out of the month. Prozac sounds like overkill based on a five-minute conversation.

13

I’m chief of emergency at a small hospital. Self-diagnosis is common, and usually very useful. This is doubly so when the doctor does not know the patient well. It is occasionally irritating when the problem is much more severe than the patient realizes.

My diagnosis does not always agree with the patient’s diagnosis. But if he failed to address your concerns, you need to see a new doctor. If something has worked well in the past, there is often little reason to change it.

My experience? Most people do self-diagnose, and most people do NOT tell the doctor their diagnosis, prefering to estimate the doctor’s competency by whether the symptoms agree (which is fair enough, I do the same). You probably do not self-diagnose too much. I think patients need to trust their doctor, and vice versa. I would find another one.

Daily SSRIs are an expensive solution to your problem. The risk of a daily SSRI is larger than for taking a low dose benzo two days per month. If you are always a very high strung person, there may be a case for trying the SSRI while keeping you on the benzo, but this would hardly be the first thing to try. Medicine should be reserved for when simple lifestyle changes do not work.
Since 1999, the literature has been replete with the hazards of benzo addiction. These are very useful drugs. I strongly disagree that they should be considered a Class II restricted drug, as they are in many States. Addiction would not likely apply to a young person who took the prescribed amount for pills two days per month.

14

I’m glad the doctor I saw at the ER last month wasn’t annoyed by self diagnosis. “I dislocated my finger,” I would have said, indicating the offending digit, pointing about ninety degrees off-line in a direction the joint does not usually bend to. “Hmmm … I think this may actually be symptomatic of an endocrine dysfunction. We’ll have to run some tests.”

[hijack]BTW, this has bugged me ever since. The nurses & doctor had asked for pain severity estimations on a 1-10 scale while I was there. I told them 2, it was mainly just throbbing and aching. Probably went to a 3 after the doc reduced it. Then, they put a prescription for Vicodin in my checkout paperwork. :eek: Could that just be SOP-anyone who comes in with a dislocated digit gets Vicodin?! Yeah! Just hand out them narcotics like candy! :rolleyes: I never filled it-I took a couple extra-strength Tylenol that week, two or three times, when the ache was particularly annoying, but I never felt an urge to dope myself up …[/hijack]

OK, back to your regular program. :slight_smile:

15

I appreciate the advice…I think I’ll pull my old records from my doctor and be armed with them for my NEW doctor. The only time I’ve even gotten pain meds from the doctor was for passing a kidney stone. 5 benzo’s a month simply cannot = abuse…just a sane BBJ.

As far as a psychiatrist goes, there’s a stigma with that which I would prefer to stay away from. It’s nothing that therapy or anything can help…it’s merely hormonal haywire for 2 days, then I’m fine. More than anything, the Prozav prescription pissed me off…I’m of the opinion that they are WAY overprecribed. I’m wondering what kind of kickback docs get from prescribing them or if it’s just easy to tell your patient to pop a pill…

16

I, too, am very high strung and tend to have anxiety that affects me on a daily basis, but I’m unsure of how to get treatment. Can you go to your family doctor and explain to them “Hey, I’ve had this crap my whole life, can you give me some valium?” or will they make you seek more psychological help? I’m not crazy, but I can never seem to take the edge off. I don’t know if that is considered self-diagnosis or not… but I have no idea how to approach a doc about this…

17

What Doc Pap said. You need a doc who won’t immediately get disagreeable about your diagnosis, but will listen to you and still come up with his/her own diagnosis. AND be willing to discuss why your diagnosis is correct/a near miss/a total miss in their minds.

But you shouldn’t have a doc who just hands you what you ask for either. THOSE kind get investigated by the medical examining boards.

There should be mutual respect and give-and-take.

And jellen, in the US, a family doc (or any licensed physician) can prescribe benzodiazepines. So ask your family doc. Believe me, docs have heard it all.

I haven’t blushed since 2nd year medical school.

QtM

18

jellen, my advice would be to mention the anxiety, but not the valuim. MDs are infamous (QtM and Dr. Paprika above seem to be notable exceptions, hurray for them) for suspecting drug-seeking at the slightest provocation. Mentioning a particular medication too early is a definite red flag to them.

I am a psychologist who works with medically ill patients at a hospital. Our MDs are so afraid of addiction and drug-seeking that they are suspicious of everyone and undermedicate for pain–and this is with patients with multiple fractures or who have undergone amputation. Sheesh.

19

Besides, Valium is SOOOOO 1950s. Its good (and fun - you can understand why its addictive) for short term use (like BBJs) but I wouldn’t want to walk around in that drug induced haze my entire life. If you have daily anxiety, Valium probably isn’t going to be the best route.

There are a ton of anxiety (depression/OCD/etc - these things treat a lot of brain chemistry imbalance problems) drugs on the market. Talk to your family doctor - or even a specialist. Finding the right one can take some time - so don’t trust a doctor who, (like BBJ’s former MD) believes Prozac is the cure all for everyone (Me: Prozac, didn’t work well. Zoloft, bad for me - felt like crap, Paxil, good - but for others Zoloft changes their life. I started treatment in the pre-Prozac days, so I have some experience with the older drugs as well).

The advantage of seeing a specialist is that they will have a wider range of experience with the medication.

The advantage of a therapist and some other non-drug measures (meditation, yoga, bio-feedback, good old fashioned religion – whatever works for you) is that controlling your brain chemistry via medication your entire life sucks. I got off the drugs when we were trying to conceive, since the jury was still out on these things and a fetus. If its possible to learn to control your anxiety (depression, whatever) without the medication (and then get a little help from the meds if life goes out of control), that is preferable (BBJs situation is a little different, I’d jump on the drugs for two days a month as well)

20

Find a new doctor and report the previous one to the AMA for incompetence.