How do I tell my doctor that she messed up?
November 16, 2008 9:50 PM   Subscribe

My doctor prescribed me something she shouldn't have, and now I'm at a loss. She's been a great doctor for me in the past, and I have a good relationship with her. How do I talk to her about this professionally, without getting angry or emotional? There is a lot

Apologies in advance for the length of this question, but it's all very relevant info.

I have been taking Effexor for almost 10 years now, and for at least the past year I have been trying to wean myself off of it (there are a lot of good reasons for that, but it's not germane, so please just trust me that it needs to be done). As many of you know, the withdrawal symptoms are absolutely crippling. I did my research and went to my doctor to talk about getting help with the withdrawal symptoms. We talked about using Prozac - a drug with a very long half-life, and thus few (if any) associated withdrawal symptoms - as a way to help me ease off the Effexor. She said that she was not very well versed in the issue, and so she left for a while to discuss it with her attending physician, as well as a pharmacist. After this, she prescribed Paxil instead of Prozac, saying that the effect would be the same, but Paxil might be better for me because it has fewer side effects.

In my research, I had only come across Prozac as a way to mitigate the effects of Effexor withdrawal, not Paxil. I asked her over and over again whether or not I would be able to stop taking the Paxil cold turkey once I had successfully weaned myself off Effexor, and she said yes. She said that Paxil also had a long half-life, and that it would be functionally the same as Prozac for me.

The good news is, it did help me get off Effexor. The bad news is, everything she told me about Paxil seems not to be true. I stopped taking it yesterday, and today I had some of the worst withdrawal symptoms I have ever experienced, just as bad (if not worse!) as the ones I felt when I tried to stop taking Effexor without the help of another drug. Brain zaps, nausea, vomiting, migraines - I had it all. I had to start taking the Paxil again, because I just couldn't function.

Confused, I went back to do research about Paxil online. Everything I've read says that Paxil is well known for having terrible withdrawal effects. The half life of Paxil is 24 hours, not 1 week as it is for Prozac. I'm back to square one. Sure, I'm off the Effexor, but now I need something to help wean me off the Paxil! I feel incredibly frustrated and cheated. I've wasted my time and my money, and now when I go back for my follow-up appointment, I worry that I won't be able to hide my ire from my doctor.

It's probably important to mention that I'm a law student, and I've taken several Health Law courses. This is a cut and dry informed consent issue, and from the massive amount of cases I've read on the subject, I know that I could sue and almost certainly win. I don't want to do this. I like my doctor, and if I get litigious, I'm going to be burning a lot of bridges - not just with her, but with the entirety of the university hospital that she is affiliated with. The hassle just wouldn't be worth it. But the problem is that I don't know how to talk to my doctor without mentioning all this. I don't want to run into my appointment screaming "You misrepresented your knowledge! Lack of informed consent!", but I also don't want to sit idly by and pretend that this was an acceptable mistake for her to make. I understand that a lot of doctors don't know much about the withdrawal associated with antidepressants, but there is such an enormous amount of information out there warning about the Paxil withdrawal effects that it would be incredibly easy for me to show that she breached the standard of care here.

So, in short, how do I bring up this subject in a professional way? How do I impart to her that this was actually quite a big treatment error on her part (and I suppose even moreso on the part of the doctor(s) she consulted with) without being emotional and confrontational? It might be simpler to let it go, have her prescribe the Prozac she should have given me in the first place, and start over... but I don't think I can (or should!) keep my mouth shut.

Thanks in advance for your advice!
posted by timory to Health & Fitness (19 answers total)

This post was deleted for the following reason: deleted at poster's request -- mathowie

 
If you really don't trust her than don't go back to her. It's not a matter of you liking the woman, it's not personal, it's your health. Not going into the logistics of her fucking up but if you really feel that she should've known better than how are you going to trust this woman with your health. And don't sue, even if you could win it's not like you lost a leg or anything, the rest of us will appreciate it with for the sake of our insurance premiums.
posted by BrnP84 at 10:07 PM on November 16, 2008


I went back to do research about Paxil online. Everything I've read says that Paxil is well known for having terrible withdrawal effects.

Reading people complain about meds on the internet isnt "research." You are not a doctor and you didnt even bother to get a second opinion about this. Youve essentially found what you are looking for to get angry on the internet. Thats not healthy or smart. Filing frivilous lawsuits is a good way to fail the ethics part of the bar, btw.

Chill. Talk to her. Seek a new doctor if need be. Dont assume you know better until youve spoken to an actual doctor.
posted by damn dirty ape at 10:15 PM on November 16, 2008


IANAD, but from the way you've described the situation, it doesn't seem obvious that "quite a big treatment error" was made. You say she consulted with another doctor and a pharmacist? What research have you done that makes you confident your opinion is now more informed than the three other people you previously trusted? Are you aware of any contraindications that would've led them to avoid prescribing you Prozac?

I'm not trying to make light of your suffering, but every accepted treatment has exceptions; maybe you were one? At the very least I would get another professional medical opinion before accusing your doctor in this manner.
posted by abc123xyzinfinity at 10:19 PM on November 16, 2008


Also, Paxil can act like a stimulant and cause mood imbalance or anger. You could be experiencing a mood issue right now.
posted by damn dirty ape at 10:19 PM on November 16, 2008


Response by poster: Guys - wait. I said right up there that I don't want to sue. I mentioned it so that nobody would suggest that it's something I do. I'm not sure how to make that clearer. I DON'T WANT TO SUE. I am not planning on suing. I have no interest in suing. I am asking how to talk to her about it without letting my frustration and anger show.

Dont assume you know better until youve spoken to an actual doctor.

Maybe I really didn't word this question correctly, but what I am asking is exactly this. I have a follow-up appointment with my doctor. I want to know how to talk to her about this. I'm sorry if I've offended or made it seem like I am on a rampage. The whole point is that I like my doctor, I am not in the least bit thinking about suing her, and I just wanted to get some advice about how to approach this with her.
posted by timory at 10:21 PM on November 16, 2008


I haven't done the research either but on first reading I have to kinda agree with dirty ape, it seemed very psychosomatic. You said you asked her over and over again before even doing your own "research" , kinda seemed a little like you were looking for a "I told you so!!" situation.
posted by BrnP84 at 10:23 PM on November 16, 2008


I just wanted to get some advice about how to approach this with her

Ok, my advice on how to approach your doctor would be to not accuse your doctor outright that she messed up. Ask for her opinion in light of your difficulty, and if you feel that you no longer trust her, find another doctor and ask her opinion as well / instead.
posted by abc123xyzinfinity at 10:26 PM on November 16, 2008


She is a fool, but you are also foolish for not reading up before changing meds. If a doctor kills you via malpractice, lawsuits are not much help except to your heirs. Unfortunately anyone with a chronic condition must become an expert in their disease to avoid bad treatment.

What is your motive for confronting her?

Is it:
a) You trusted her, she did you wrong, now you would like to see her humbled and apologize
b) You want better treatment and no bullshit in the future
c) both

I have been almost killed by M.D.s more times than I can count. If your motive is (c) the best response for the next (and last) meeting is to make a detailed itemized list of dates, reatments, symptoms (brain zaps), and references. Keep the meeting businesslike - the agenda is your health, and you are taking meeting notes. Make it overwhelmingly obvious the she screwed up but don't ask for an apology. Your motive should be to educate the doctor to save the next patient that this happens to. Afterwards, chalk it up to experience and go to another M.D. that does better research.
posted by benzenedream at 10:28 PM on November 16, 2008


First, arm yourself with research rather than anecdotes. I am making no assumption on what research you have done, but if you used Google rather than Google Scholar, for instance, you are far more likely to find that Paxil does everything under the sun, from causing to curing cancer, from having no side effects to instant death. Google Scholar is the way to go if you want real information.

Second, speak to an actual doctor/pharmacist for a second opinion. Do not base any discussion with your current doctor on information you found online (even Google Scholar ;). The pharmacist who filled the prescription would be a great person to ask.

After you have done that, then when you have your follow-up simply stick to the facts of the situation. Describe your symptoms and what you did to alleviate them. There could be something else going on, and your primary doctor is the right person to help determine what that may be.
posted by Nixie Pixel at 10:30 PM on November 16, 2008


"I haven't done the research..."

That statement at the start of your sentence is a very good indicator that you should keep your uninformed opinion to yourself.
posted by 517 at 10:32 PM on November 16, 2008


Despite what the internets and your Health Law classes have led you to conclude about her med mal liability, leave out the "and if I sued you, I'd really have a case," vibe and just call asap and tell her what happened in a factual manner. Bringing up lawsuits and discussing malpractice concepts is not going to get you feeling better and may have no legal basis, in any event. I'm confused about the misrepresenting her knowledge -- she said that she wasn't well versed in the issue and got input from two professionals who were, correct? You don't state whether she is a psychiatrist, but maybe a second opinion from a psychiatrist who specializes in medication management would also be advisable.
posted by *s at 10:33 PM on November 16, 2008


It sounds like you're asking how to not show you're doctor that you're angry. Why not just let her know you're angry? I mean, don't make a special effort to be all dramatic, but it's OK in a situation like this to be upset. Why are you so concerned about hiding it?

It's good that you already know you're not going to get all litigious. Sounds like you're fairly clear on how you feel.

Maybe just start off with, "I'm sorry to have to bring this up, but it's really bothering me and I just have to tell you about it." Then go into your story. Don't worry so much about not upsetting her. If she can't handle it, it's good for you to know, but really: people get angry in situations like this. Heck, she probably has special training on how to handle it.

Now, what would make me really livid is hearing some kind of "special training" response, like "I'm sure that must be very upsetting for you" or "I'm so sorry _you feel that way_". Ugh. Do people really think we're not on to that?

Or that a personal apology from an AT&T customer service rep will really fool me into thinking the company is somehow feeling sincerely contrite? I mean, come on.
posted by amtho at 10:35 PM on November 16, 2008


Response by poster: kinda seemed a little like you were looking for a "I told you so!!" situation.

I researched after I started feeling this way. I trusted my doctor because she has been good in the past, and I didn't have a reason to believe she would prescribe something incorrectly. I was shocked by my body's reaction, and I don't think it could be psychosomatic, since I wasn't even aware this could happen (I mean, getting help with withdrawal symptoms is the reason I went in the first place, right?). But I can see how

In any case, I had no idea that I would come off so inflammatory in this question. I guess I must sound so ridiculous that I deserve a good finger wag. I'm sorry to have bothered everyone with this, and if anybody knows how I can delete the question, let me know - do I have to email a moderator?
posted by timory at 10:36 PM on November 16, 2008


To clarify, by "factual manner," I mean, I took x drug on y date as prescribed and I had the following symptoms, a, b, and c, without mentioning the internet/class part.
posted by *s at 10:36 PM on November 16, 2008


"You know, I'm concerned that I couldn't get off of Paxil because I had really bad withdrawal effects when I tried. The reason I brought up fluoxetine at the last visit was because of its unique pharmacokinetics; it has a week-long half-life. I'd still like to try it, instead of Paxil, on the theory that its long half-life will provide a more gentle withdrawal period. This is backed up by [some literature I found on the internet]."

It's actually not a bad idea, either, which is the other reason I'm helping you here. Of course your doc has to be the final arbiter of what she's willing to do - she may know something about you or your meds that I don't. You have to be the final arbiter of what you're willing to do.

You can sue for anything, but you certainly couldn't win this one. Doc used her best judgment, outcome wasn't all that bad, you're not badly harmed. It'd get thrown right out of court. Consent's not an issue; you consented to try her plan. There's no implicit guarantee that there won't be any side effects from any medication changes ever.

Unless you somehow feel that you could prove such a guarantee was issued. In which case, I'd say you are nuts and should stay on your meds.
posted by ikkyu2 at 10:36 PM on November 16, 2008


I have heard anecdotally that paxil has really difficult withdrawl symptoms, and although internet research isn't the same as medical expertise, there is a sound basis for you to feel that she made the wrong call.

So that's what you should say to her:
"I experienced what felt like really bad withdrawl symptoms. My internet research confirms that others have had this problem. I feel that you misrepresented this drug to me, that I was not properly informed about it, and that you made an error in prescribing it to me. I am feeling angry, upset, etc. I am also feeling a loss of trust in you as my doctor. How can we move forward from this?"

This isn't a wild accusation - it's you saying how the situation appears from your point of view. She will have an opportunity to tell her side and try to rebuild trust between you. If she is able to do this in a way that you find satisfying, then great, go from there. She may not be able to give you back your time and money, but she can make an effort to improve your relationship and her care of you. If not, find another doctor.
posted by mai at 10:37 PM on November 16, 2008


Yeah, bummer that this happened, but right now is not the time to be making this decision. Chill out, let the side effects wear off, and look at it again when you're in a more reasonable frame of mind.

Note that you are thinking about this from a lawyer's point of view. (Well, of course, you're in law school, and they're teaching you to think like a lawyer.) But your role in this matter is not that of a lawyer, so maybe you should drop that. Think of yourself in the role you are actually in. You are a patient, under the care of a doctor. Concentrate on the relationship between yourself and your doctor, what you want that to be in the future. That will help you find the course of action you want.
posted by exphysicist345 at 10:37 PM on November 16, 2008


Just because you explain to your doctor that you are frustrated and angry, doesn't mean you can't continue to like her, or that she will necessarily be defensive.

It is in your doctors best interest to listen to you carefully and to find a solution. I'd say explain it to her just like you've explained it to us. Her reaction will tell you everything you need to know about whether she should continue to be your doctor.
posted by lunaazul at 10:40 PM on November 16, 2008


I guess I must sound so ridiculous that I deserve a good finger wag. I'm sorry to have bothered everyone with this, and if anybody knows how I can delete the question, let me know - do I have to email a moderator?

You haven't come off as inflammatory, and you aren't bothering people with your question. I think that people might see the question as putting the cart before the horse, that is making an assumption and then deriving emotion from that assumption before you necessarily have all the facts.

That people would counsel you to seek further information first is not an indication that your question is a bad one, or a problem in some way. I think perhaps some perspective outside the situation might be useful to you. You gave more information than "I am angry and want to know how to talk with my doctor without blowing up" so the responses you receive will reflect that.

Walk into the discussion with your doctor without assuming you know more about this medication than he or she does, and you will find your anger diffused. Stick to the facts of what happened, and perhaps mention what you have gathered online without accusation, and you will be much better off than walking in with even controlled anger. Humility will help here.

Good luck!
posted by Nixie Pixel at 10:51 PM on November 16, 2008 [1 favorite]


« Older Bill Joy is awesome, and I want to meet him.   |   Where's/what's this weird statue? Newer »
This thread is closed to new comments.