yesterday's Strange Moments in Medicine: would you be bothered?

In My Humble Opinion
1

Hubby and I each had doctor visits yesterday and each had an odd moment. Your opinions solicited.
1: I went to my doc for a Depo shot. I go every 3 months. Every time, they do the same thing, take me back, get a weight, get a bp, stick me in a room, doc comes in and spends two minutes, then he goes, nurse comes back and gives shot. The office is usually on time and very efficient.

Yesterday’s appointment was for 2:30. They took me back at 3:05, got a weight, stuck me in a room, doc comes in and spends two minutes, goes, nurse gives shot.

I thought, “Oh, they didn’t take my bp.” I didn’t care. My bp is normal.

Standing at window to make next appointment, I can see my chart. Last visit and this visit both visible. Last visit has weight, bp, etc. This visit has weight, bp, etc. Last visit’s bp is 120/68. This visit’s bp: 126/68.

I didn’t say anything, made the next appointment, and left.

2: Hubby has psychiatry appointment. He’s being treated for depression and anxiety and social phobia. He has seen this doc three times before, all progressively shorter appointments. The last appt. lasted about a minute as the doc left his Wellbutrin dose alone and doubled his Neurontin. The depression is not controlled. Hubby has been complaining about difficulty swallowing. His internist suggested that he’s having a side-effect of Neurontin and suggested he speak with his psychiatrist about the possibility. Hubby says he will request a different tack since the Wellbutrin/Neurontin combo isn’t doing much.

He’s called back. Gone less than five minutes. When the issue about the swallowing is raised, doc says it’s anxiety. When hubby brings up his internist’s thoughts about Neurontin, his doc says that he should drop the Neurontin, gives him a ten-day prescription for Wellbutrin, and tells him to find another doctor.

(If anyone is seeing a psychiatrist in the Lancaster/Zanesville/Columbus Ohio area that you’d recommend, please let me know.)

Thoughts?

2

Falsified medical records? You bet your sweet bippy I’d be bothered.

3

I’m a little confused as to why the psychaiatrist thought Wellbutrin/Neurontin would help your husband’s depression. The Wellbutrin is only effective as a short-term anxiolytic, and the Neurontin is for epilepsy and neuropathic pain.
Has he tried Xanax (Alprazolam)? it’s supposed to work well in combined depression/anxiety.

Neurontin has pharyngitis as a listed side effect, but not dysphagia.

Psychiatrist doesn’t sound like a fun guy though, what with the don’t-question-my-treatment-or-find-yourself-a-new-doc.

As to your BP, maybe the nurse forgot, or got you confused with another patient , but most likely she was lazy. Complain.

4

Your husband’s symptoms sound similar to mine. I have also tried that combination and it didn’t work at all. Now I am on Effexor and it works great. When he finds a new doctor, tell him to specifically ask if Effexor is right for him. It is used to treat a combination of anxiety and depression.

5

Bothered enough to raise a stink and/or switch doctors? This is one of those situations where I’m probably being too passive, but as a one-off event, is this significant, in your opinion?

Gabapentin is apparently prescribed for depression, especially for people who aren’t responding to more “normal” drugs. I found this:

Hubby has tried to get treatment before for his conditions, but nothing has ever been successful and he usually gives up. Wellbutrin always helps at first, and then the effect seems to fade despite ratcheting up the dosage. He’s been on a number of other drugs in the past 10 years, but many of those were before I met him–which means he didn’t keep records of what they tried.
:frowning:

Shagnasty, did you have difficulty swallowing on the combination, or do you just mean the depression/anxiety/social phobia? Good to know, either way.

6

ABSOLUTELY.

Nothing on a medical record should ever ever be falsified. How do you know other things aren’t wrong?

7

Falsifying medical records is a great big, red flag no-no and every nurse knows it. But pointing it out to the doctor should do the trick.
“Look, last time I was in I did not get my bp checked, but she wrote it down in the record as being taken. I wanted to point that out.” The doctor needs to know so he can note it.
Change doctors over it? That depends. Do you think he’ll get angry and defensive about it? Probably not, IMO, he’ll probably just say “Oh. Thanks for pointing that out,” note it, and talk to the nurse about it later. Up to you if you’re comfortable enough with that response to continue having treatment there. It’s possible if she was triaging multiple patients (is your doctor in a group? treat more than one patient at a time?) that she was running into rooms, taking temps, bp’s, etc… and simply forgot and wrote it in later. Which is why, even if it takes a couple extra seconds, you’re supposed to CHART IT WHEN YOU DO IT. But a lot of nurses and doctors do leave their charting for later, and sometimes, this is what happens.

8

[QUOTE=jsgoddess]
He’s called back. Gone less than five minutes. When the issue about the swallowing is raised, doc says it’s anxiety. When hubby brings up his internist’s thoughts about Neurontin, his doc says that he should drop the Neurontin, gives him a ten-day prescription for Wellbutrin, and tells him to find another doctor.

[QUOTE]

Ooh, patient abandonment. Your state’s regulators would probably like to know about this.

9

Sort of OT, but my BIL is a psychiatrist. He uses Neurontin to treat depression and anxiety.
-Lil

10

I tell you, the more I think about it, the more pissed off I’m getting. We’re left trying to replace a specialist with no notice. It took months to get in to see this guy and he gives a ten-day prescription? (Not that the Wellbutrin is helping all that much, but still.) Bah.

11

Call his office. Ask for the office manager. Tell him/her that you want a referral to a different physician immediately, or you will report him for patient abandonment. He is required to refer you if you’re in the middle of treatment. He can’t just drop your husband like a stone and say “he’s cured, I gave him meds.” Just because your husband questioned his treatment. What a… well, this isn’t the pit. I’m so sorry you’re having to deal with this. What a pain.

12

It’s unlikely that the person who charted your BP was a registered nurse. Few Docs can afford them in the office. She was probably just a trained technician or aide. Professionalism is not their strong suit. Even in the hospital, I see workers like this faking vital signs because they forgot or were too lazy to do it. You should let the doctor know. He/She is probably not aware of this.

As for your husband’s psychiatrist - good riddance. Neurontin is often prescribed for the anxiety component of a problem or as a “mood stabilizer” for patients whose depression is suspected to be bipolar (manic depression). It is the IN drug right now and being prescribed for almost everybody these days. However, it is not a benign drug as your husband has discovered. It has plenty of potentially distressing side effects and should be stopped if he is experiencing problems. There are plenty of other choices for the anxiety. Paxil often works for his constellation of symptoms but there are many other options. I would not recommend Xanax though. This is an extremely addictive drug and can lead to real problems down the road. It is excellent at relieving anxiety but is very short acting and must be taken frequently. I can not tell you how many people I know who developed terrible dependence problems with it. When they finally realize that they must stop taking it the withdrawal symptoms persist for many months.

He needs to find a good psychiatrist (psychopharmacologist) but I would also recommend some (at least brief) psychotherapy with a social worker, psychologist, or psychiatric nurse practitioner. This will often help tremendously and this person can act as a go-between with the psychiatrist and will be taken more seriously when discussing his response to the medication.

13

I forgot to say that he might consider finding a therapist first. Therapists tend to know who the good psychiatrists are in your area and often have excellent working relationships with them. Few psychiatrists want to spend time doing therapy these days but feel more confident prescibing for a patient who is being monitored by a reliable therapist. This is often the most efficient way to find a decent psychiatrist who will work with the patient and therapist until finding the right combination of medications to relieve the symptoms. It is well worth the extra money.

14

Yeah, you might wish to hire an attorney. Pfizer today agreed to pay a $420 million fine for illegally marketing Neurontin for non-approved uses. The FDA has only approved Neurontin as an anti-epilepsy drug, not for psychiatric purposes.