He's stopped returning my calls. And he's my doctor.
February 23, 2010 10:09 AM Subscribe
It seems that my psychiatric nurse practitioner, who prescribes my crazy meds, has quit me without notice. The Problem? I take a hefty dose of meds, I'm out, and I don't really want to have to quite cold turkey. An explanation and a few questions under the fold.
YANA doctor/lawyer/professional of any sort. However, I know many of you take the crazy meds.
Apologies for the length in advance. Specific questions at the end.
I take 200mg of Zoloft and 150mg of Wellbutrin daily. I have been taking them for about two years. Despite some qualms, they've been extraordinarily helpful.
I am supposed to see my psychiatric nurse practitioner (PNP) every six months to check in, etc. I realize the importance of this. But I forgot to schedule the appointment, and so it has been more than six months since I saw him (it's been just under seven). It was forgetful and irresponsible on my part, I realize, but I've been out of town, it's been very busy at work, life, etc.
Last week, I realized I was about out of meds, so I put in my refill request to my pharmacy online, like I always do. Usually if I'm out of refills, they fax my PNP a note saying I'm out, he calls the prescription in, and it gets filled within a day or so. This time, however, it was several days and I hadn't heard from my PNP or the pharmacy. So I called the pharmacy and they informed me that my PNP had sent in a note that said since I hadn't seen him in six months, he wasn't refilling the prescription. Ok.
So I called my PNP and left a message (as I always do, since he screens his calls). I told him that we need to schedule a meeting ASAP, like this week, and that in the meantime if he could call in the refill that would be much appreciated, as SSRI discontinuation syndrome is not, by all reports, a very pleasant thing. Plus I'm not thrilled to return to the mental state I was in prior to starting the meds.
He has not returned my calls or called in my prescription. The fact that he declined to refill it without calling me to tell me he did so, forcing me to find out from the pharmacy, is further evidence that I am now assuming he has simply decided to leave me high and dry.
Now, I realize that he is, in part, just covering his own ass, not wanting to simply refill my prescription without seeing me. And I realize that it is my fault for forgetting to set something up a couple weeks ago. I take responsibility for that.
However, I think it's strange that he would simply leave me hanging, knowing that I am now forced to face stopping my medications without so much as the usual tapering-off under a doctor's supervision process that is generally highly recommended. Certainly he is aware of the position he has left me in.
I am, of course, going to switch to a different psychiatrist or PNP, but it could take me several weeks to get in to see one. I do not, at this time, have an internist or general practitioner. I haven't had health insurance all that long, I never really get sick, and I just haven't taken the time to find a personal doctor. I have, on two occasions, gone to the urgent care clinic for one reason or another. This is the extent of my medical relationships.
So my questions are:
1) Not that it matters at this point, but what are the ethical/legal implications here? Is he in the wrong? Or am I in the wrong for failing to meet my end of the deal and this is some sort of punishment?
2) Is there anyway I can get a refill on my prescription from elsewhere (the urgent care clinic??) until I can be seen by a psychiatric professional? Just so I don't have to suddenly stop only to restart, which isn't pleasant.
3) I am currently on day two of not taking my meds, and I'm feeling flu-ish, headache, tired, my muscles feel heavy. If I've gotta do the cold turkey thing, what else can I expect? How bad will this get? What will it be like having to go off for a couple weeks and then try and get back on? I like my meds - they've saved my life in many ways. I don't wish to stop taking them.
4) What do I do about work? If I continue to feel worse and more sick, I won't really be able to function well at the office. What do I say to my boss?
If it matters, I'm in Portland, OR. Mid-twenties male.
Thank you, hivemind.
YANA doctor/lawyer/professional of any sort. However, I know many of you take the crazy meds.
Apologies for the length in advance. Specific questions at the end.
I take 200mg of Zoloft and 150mg of Wellbutrin daily. I have been taking them for about two years. Despite some qualms, they've been extraordinarily helpful.
I am supposed to see my psychiatric nurse practitioner (PNP) every six months to check in, etc. I realize the importance of this. But I forgot to schedule the appointment, and so it has been more than six months since I saw him (it's been just under seven). It was forgetful and irresponsible on my part, I realize, but I've been out of town, it's been very busy at work, life, etc.
Last week, I realized I was about out of meds, so I put in my refill request to my pharmacy online, like I always do. Usually if I'm out of refills, they fax my PNP a note saying I'm out, he calls the prescription in, and it gets filled within a day or so. This time, however, it was several days and I hadn't heard from my PNP or the pharmacy. So I called the pharmacy and they informed me that my PNP had sent in a note that said since I hadn't seen him in six months, he wasn't refilling the prescription. Ok.
So I called my PNP and left a message (as I always do, since he screens his calls). I told him that we need to schedule a meeting ASAP, like this week, and that in the meantime if he could call in the refill that would be much appreciated, as SSRI discontinuation syndrome is not, by all reports, a very pleasant thing. Plus I'm not thrilled to return to the mental state I was in prior to starting the meds.
He has not returned my calls or called in my prescription. The fact that he declined to refill it without calling me to tell me he did so, forcing me to find out from the pharmacy, is further evidence that I am now assuming he has simply decided to leave me high and dry.
Now, I realize that he is, in part, just covering his own ass, not wanting to simply refill my prescription without seeing me. And I realize that it is my fault for forgetting to set something up a couple weeks ago. I take responsibility for that.
However, I think it's strange that he would simply leave me hanging, knowing that I am now forced to face stopping my medications without so much as the usual tapering-off under a doctor's supervision process that is generally highly recommended. Certainly he is aware of the position he has left me in.
I am, of course, going to switch to a different psychiatrist or PNP, but it could take me several weeks to get in to see one. I do not, at this time, have an internist or general practitioner. I haven't had health insurance all that long, I never really get sick, and I just haven't taken the time to find a personal doctor. I have, on two occasions, gone to the urgent care clinic for one reason or another. This is the extent of my medical relationships.
So my questions are:
1) Not that it matters at this point, but what are the ethical/legal implications here? Is he in the wrong? Or am I in the wrong for failing to meet my end of the deal and this is some sort of punishment?
2) Is there anyway I can get a refill on my prescription from elsewhere (the urgent care clinic??) until I can be seen by a psychiatric professional? Just so I don't have to suddenly stop only to restart, which isn't pleasant.
3) I am currently on day two of not taking my meds, and I'm feeling flu-ish, headache, tired, my muscles feel heavy. If I've gotta do the cold turkey thing, what else can I expect? How bad will this get? What will it be like having to go off for a couple weeks and then try and get back on? I like my meds - they've saved my life in many ways. I don't wish to stop taking them.
4) What do I do about work? If I continue to feel worse and more sick, I won't really be able to function well at the office. What do I say to my boss?
If it matters, I'm in Portland, OR. Mid-twenties male.
Thank you, hivemind.
I can't help you on any but 2) but I've been in a similar situation (well, moved from one city to next and ran out before getting a doctor) and I've been able to get refills from a walk-in clinic (and a friend got his at the e.r.). All I had to do was bring all my prescription bottles with me and explain the situation. They frown on it but it was doable.
Good luck. Cold turkey sucks.
posted by beautifulcheese at 10:17 AM on February 23, 2010
Good luck. Cold turkey sucks.
posted by beautifulcheese at 10:17 AM on February 23, 2010
By the way, if it's not clear, PCP = Primary Care Physician/General Practitioner.
posted by Cat Pie Hurts at 10:18 AM on February 23, 2010
posted by Cat Pie Hurts at 10:18 AM on February 23, 2010
Have you tried to contact your practitioner again? If I were in your shoes, I'd be a seriously squeaky wheel. Leave messages explaining that you're concerned about withdrawal symptoms. He's presumably part of a larger office -- call the main number, get a human on the phone. Who's the supervising physician? Contact him/her as well.
He has not returned my calls or called in my prescription. The fact that he declined to refill it without calling me to tell me he did so, forcing me to find out from the pharmacy, is further evidence that I am now assuming he has simply decided to leave me high and dry.
I know you're frustrated and rightfully upset, but you don't know that he's decided to leave you high and dry. Perhaps it's not likely that he's been fired or is burying his grandmother or was in a car crash, but there surely are other explanations besides him deciding to punish you medically. Maybe consider putting this sort of assumption on hold and focus on one problem at a time?
posted by desuetude at 10:26 AM on February 23, 2010
He has not returned my calls or called in my prescription. The fact that he declined to refill it without calling me to tell me he did so, forcing me to find out from the pharmacy, is further evidence that I am now assuming he has simply decided to leave me high and dry.
I know you're frustrated and rightfully upset, but you don't know that he's decided to leave you high and dry. Perhaps it's not likely that he's been fired or is burying his grandmother or was in a car crash, but there surely are other explanations besides him deciding to punish you medically. Maybe consider putting this sort of assumption on hold and focus on one problem at a time?
posted by desuetude at 10:26 AM on February 23, 2010
Best answer: 1) Not that it matters at this point, but what are the ethical/legal implications here? Is he in the wrong? Or am I in the wrong for failing to meet my end of the deal and this is some sort of punishment?
From the position of a layperson with no specific knowledge of medical ethics, I would say that not contacting you back or communicating any other options to you is unethical. I remember a prior AskMe about when and how doctors can drop patients, and I recall that they could not just decline to return a phone call.
2) Is there anyway I can get a refill on my prescription from elsewhere (the urgent care clinic??) until I can be seen by a psychiatric professional? Just so I don't have to suddenly stop only to restart, which isn't pleasant.
I would either walk into an urgent care clinic, or, if you have a good PCP, call them. My PCP has refilled SSRI's prescribed by another doctor based on a phone request, effectively giving a few days worth of pills to tide me over until he could see me for a visit. If you go into anyone's office, bring your last pill bottles to document your ongoing treatment. If you call your PCP, offer to drop that off to verify it. Explain wherever you go that you have been dropped without return call or further info by a treating medical professional. You need immediate attention.
3) I am currently on day two of not taking my meds, and I'm feeling flu-ish, headache, tired, my muscles feel heavy. If I've gotta do the cold turkey thing, what else can I expect? How bad will this get? What will it be like having to go off for a couple weeks and then try and get back on? I like my meds - they've saved my life in many ways. I don't wish to stop taking them.
It will be bad. You should resolve this today. Quitting cold turkey and then titrating back up can be a nightmare. In my experience with antidepressants, most doctors desperately want to prevent their patients going through something like this.
4) What do I do about work? If I continue to feel worse and more sick, I won't really be able to function well at the office. What do I say to my boss?
Today, right now, you need to leave the office early to handle a medical emergency. That's all. I've been through running out of pills where abrupt cessation has severe side effects. The medical profession, generally, does not want you to deal with that. Someone will help. Go to the ER, today, if need be. You will be helped.
posted by bunnycup at 10:27 AM on February 23, 2010 [3 favorites]
From the position of a layperson with no specific knowledge of medical ethics, I would say that not contacting you back or communicating any other options to you is unethical. I remember a prior AskMe about when and how doctors can drop patients, and I recall that they could not just decline to return a phone call.
2) Is there anyway I can get a refill on my prescription from elsewhere (the urgent care clinic??) until I can be seen by a psychiatric professional? Just so I don't have to suddenly stop only to restart, which isn't pleasant.
I would either walk into an urgent care clinic, or, if you have a good PCP, call them. My PCP has refilled SSRI's prescribed by another doctor based on a phone request, effectively giving a few days worth of pills to tide me over until he could see me for a visit. If you go into anyone's office, bring your last pill bottles to document your ongoing treatment. If you call your PCP, offer to drop that off to verify it. Explain wherever you go that you have been dropped without return call or further info by a treating medical professional. You need immediate attention.
3) I am currently on day two of not taking my meds, and I'm feeling flu-ish, headache, tired, my muscles feel heavy. If I've gotta do the cold turkey thing, what else can I expect? How bad will this get? What will it be like having to go off for a couple weeks and then try and get back on? I like my meds - they've saved my life in many ways. I don't wish to stop taking them.
It will be bad. You should resolve this today. Quitting cold turkey and then titrating back up can be a nightmare. In my experience with antidepressants, most doctors desperately want to prevent their patients going through something like this.
4) What do I do about work? If I continue to feel worse and more sick, I won't really be able to function well at the office. What do I say to my boss?
Today, right now, you need to leave the office early to handle a medical emergency. That's all. I've been through running out of pills where abrupt cessation has severe side effects. The medical profession, generally, does not want you to deal with that. Someone will help. Go to the ER, today, if need be. You will be helped.
posted by bunnycup at 10:27 AM on February 23, 2010 [3 favorites]
In the extreme short term, my pharmacist has provided me with an "emergency refill" when I forgot to call my doctor to re-up my drugs. YMMV, I assume this wouldn't work with an oxycontin prescription but, in a bind, it doesn't hurt to ask your/a pharmacist.
posted by stet at 10:33 AM on February 23, 2010
posted by stet at 10:33 AM on February 23, 2010
It sounds like you've only called the PNP once...? I would say you need to at least call him again and repeat your request for an appointment, letting him know you have not heard back from him directly but that you got word through the pharmacy that you can't get the refill. Let him know that you need some guidance as far as what to do from here. He could have thought he called you back but forgot (due to a really huge caseload, etc.), he could have called the wrong number by accident, he may not have your current contact info if it's changed at all, he may be waiting to hear back from someone on a cancellation that he might be able to offer you... it could have been a lot of things. I feel like you're getting a little ahead of yourself, assuming you need to switch to some other provider immediately (although I completely understand that this feels very urgent to you because you're out of medication, and that can be a serious problem, yes). Not saying that any of this excuses the non-contact, but this guy is human too, and there could be a myriad reasons you haven't gotten a message back from him.
posted by so_gracefully at 10:34 AM on February 23, 2010
posted by so_gracefully at 10:34 AM on February 23, 2010
Second the "emergency refill." I've been in this situation before. (for better and worse, I've gone through SSRI "withdrawal" and it sucks). I was out of town, COMPLETELY FORGOT to bring my meds with me. Went to the pharmacy, explained the situation, and got enough to last me for the duration of my trip (for free, too).
Like stet mentioned, they aren't going to do this for powerful narcotics or tranqullizers but pharmacist very much understand what happens when people abruptly stop these medicines and for the most part they know you aren't going to be able to turn this into a drug-abuse situation.
posted by deacon_blues at 10:39 AM on February 23, 2010
Like stet mentioned, they aren't going to do this for powerful narcotics or tranqullizers but pharmacist very much understand what happens when people abruptly stop these medicines and for the most part they know you aren't going to be able to turn this into a drug-abuse situation.
posted by deacon_blues at 10:39 AM on February 23, 2010
The affective disorders clinic I visit has a policy that if you don't come in for 6 months, they automatically drop your case. I had a similar reaction of feeling punished when this happened, but it turned out to be more automatic and bureaucratic than a personal slight. After being quite bitter about my dismissal, I eventually learned that if I wasn't an active patient, my psychiatrist and psych-nurse weren't permitted to return my calls. I had to get a new referral from my GP before I was able to book an appointment--it was a real hassle. Mind you I'm in Canada, and I did receive a letter notifying me of the situation, but it seems realistic that this could be a similar case, whether a letter is forthcoming, delayed, or even forgotten.
posted by domographer at 11:00 AM on February 23, 2010 [1 favorite]
posted by domographer at 11:00 AM on February 23, 2010 [1 favorite]
Response by poster: Thank you everyone.
I can't get a bridge refill from the pharmacy because of the note sent by my PNP stating specifically that he wouldn't refill it.
I'm going to try to keep contacting my PNP, but in the meantime I'm going to take your suggestion and go to the urgent care clinic.
Thank you everyone.
posted by The Pantless Wonder at 11:00 AM on February 23, 2010
I can't get a bridge refill from the pharmacy because of the note sent by my PNP stating specifically that he wouldn't refill it.
I'm going to try to keep contacting my PNP, but in the meantime I'm going to take your suggestion and go to the urgent care clinic.
Thank you everyone.
posted by The Pantless Wonder at 11:00 AM on February 23, 2010
"However, I think it's strange that he would simply leave me hanging, knowing that I am now forced to face stopping my medications without so much as the usual tapering-off under a doctor's supervision process that is generally highly recommended. Certainly he is aware of the position he has left me in."
Don't you think there might be six possible alternative explanations for this? Maybe he got sick, or his mother died, or he had some terrible voice mail glitch. I'm not ruling out the possibility that you're correct, but maybe there's a chance you're a little sensitive / pessimistic here.
Definitely call him again, two, three more times. Yes, you deserve at least an answer, and this guy deserves the benefit of a doubt. Yes, you should pursue other avenues aggressively just in case (maybe he _can't_ get back to you for some reason). Get it taken care of ASAP, before you start feeling so bad you won't feel like getting it taken care of.
posted by amtho at 11:19 AM on February 23, 2010 [1 favorite]
Don't you think there might be six possible alternative explanations for this? Maybe he got sick, or his mother died, or he had some terrible voice mail glitch. I'm not ruling out the possibility that you're correct, but maybe there's a chance you're a little sensitive / pessimistic here.
Definitely call him again, two, three more times. Yes, you deserve at least an answer, and this guy deserves the benefit of a doubt. Yes, you should pursue other avenues aggressively just in case (maybe he _can't_ get back to you for some reason). Get it taken care of ASAP, before you start feeling so bad you won't feel like getting it taken care of.
posted by amtho at 11:19 AM on February 23, 2010 [1 favorite]
Assume there's a non-hostile reason. Maybe he's out of town, had a family crisis, whatever. It would be odd for a provider to not have back-up, but I'd still assume non-hostile until proven otherwise. If a health care provider intentionally dropped a patient in this manner, it would be unethical.
I'd look for a doc-in-a-box type clinic, and explain the urgency. Quitting psycho-active meds in a hurry is a bad idea.
posted by theora55 at 12:02 PM on February 23, 2010
I'd look for a doc-in-a-box type clinic, and explain the urgency. Quitting psycho-active meds in a hurry is a bad idea.
posted by theora55 at 12:02 PM on February 23, 2010
1) Not that it matters at this point, but what are the ethical/legal implications here? Is he in the wrong? Or am I in the wrong for failing to meet my end of the deal and this is some sort of punishment?
If he is actually being hostile, it's wrong. But I agree with others who caution against assuming this is deliberate. You've called once. You should call a couple times a day until you get a response.
2) Is there anyway I can get a refill on my prescription from elsewhere (the urgent care clinic??) until I can be seen by a psychiatric professional? Just so I don't have to suddenly stop only to restart, which isn't pleasant.
Call your regular doctor or go to an urgent care clinic. I've gotten SSRIs from general care doctors plenty of times.
3) I am currently on day two of not taking my meds, and I'm feeling flu-ish, headache, tired, my muscles feel heavy. If I've gotta do the cold turkey thing, what else can I expect? How bad will this get? What will it be like having to go off for a couple weeks and then try and get back on? I like my meds - they've saved my life in many ways. I don't wish to stop taking them.
When I discontinued an SSRI cold turkey, I had headaches, flu-like symptoms, stomach upset, and insane mood swings (mostly sudden, intense bouts of rage and sudden, intense bouts of tears) for about a week and then it started to get better. The mood swings lasted longer than the flu-like symptoms.
4) What do I do about work? If I continue to feel worse and more sick, I won't really be able to function well at the office. What do I say to my boss?
Say you have flu symptoms and take a couple sick/personal/vacation days if you need them. If you can't function at work, and you have sick time, this is what it's for. Does it matter WHY you're sick if you're genuinely feeling sick?
Alternately, plan to get some extra sleep, daily exercise, and plain but basic nutrition. Other than that and your bare basics, give yourself permission to act like you have the flu when you are not at work -- bundle up, sip herbal tea, and let yourself relax. This will pass.
posted by tastybrains at 12:17 PM on February 23, 2010 [1 favorite]
If he is actually being hostile, it's wrong. But I agree with others who caution against assuming this is deliberate. You've called once. You should call a couple times a day until you get a response.
2) Is there anyway I can get a refill on my prescription from elsewhere (the urgent care clinic??) until I can be seen by a psychiatric professional? Just so I don't have to suddenly stop only to restart, which isn't pleasant.
Call your regular doctor or go to an urgent care clinic. I've gotten SSRIs from general care doctors plenty of times.
3) I am currently on day two of not taking my meds, and I'm feeling flu-ish, headache, tired, my muscles feel heavy. If I've gotta do the cold turkey thing, what else can I expect? How bad will this get? What will it be like having to go off for a couple weeks and then try and get back on? I like my meds - they've saved my life in many ways. I don't wish to stop taking them.
When I discontinued an SSRI cold turkey, I had headaches, flu-like symptoms, stomach upset, and insane mood swings (mostly sudden, intense bouts of rage and sudden, intense bouts of tears) for about a week and then it started to get better. The mood swings lasted longer than the flu-like symptoms.
4) What do I do about work? If I continue to feel worse and more sick, I won't really be able to function well at the office. What do I say to my boss?
Say you have flu symptoms and take a couple sick/personal/vacation days if you need them. If you can't function at work, and you have sick time, this is what it's for. Does it matter WHY you're sick if you're genuinely feeling sick?
Alternately, plan to get some extra sleep, daily exercise, and plain but basic nutrition. Other than that and your bare basics, give yourself permission to act like you have the flu when you are not at work -- bundle up, sip herbal tea, and let yourself relax. This will pass.
posted by tastybrains at 12:17 PM on February 23, 2010 [1 favorite]
This is unethical, period. A health care provider is not supposed to randomly cut people off from medication that will cause distress if not tapered-- they can get away with it with "abusable" drugs like opioids for legal reasons but there's no legitimate medical reason to randomly deny someone an emergency refill of antidepressants they have been taking for two years. You are one month late for a six month check-in-- there are all kinds of reasons that this could happen and virtually none of them are an excuse for this person to behave this way.
Imagine if someone harmed themselves or someone else after such a thing happened-- do you think the practitioner, given that abrupt cessation can cause a return of depression, would not be legally liable? IANAL, but I can't see why they wouldn't be.
Go to an urgent care clinic with the pill bottles, get an emergency refill (they should really give you a month's supply, this is not an unusual or strange combination and there's no reason you would suddenly be "cured")-- and report this person to the appropriate licensing/medical board, they are behaving irresponsibly.
posted by Maias at 2:28 PM on February 23, 2010
Imagine if someone harmed themselves or someone else after such a thing happened-- do you think the practitioner, given that abrupt cessation can cause a return of depression, would not be legally liable? IANAL, but I can't see why they wouldn't be.
Go to an urgent care clinic with the pill bottles, get an emergency refill (they should really give you a month's supply, this is not an unusual or strange combination and there's no reason you would suddenly be "cured")-- and report this person to the appropriate licensing/medical board, they are behaving irresponsibly.
posted by Maias at 2:28 PM on February 23, 2010
Response by poster: Hello everyone. I don't know if anyone is still reading this, but here is an (unfortunate) update.
I went to my urgent care clinic. They have a policy of not prescribing any psychiatric medications - so they gave me a piece of paper stating that and sent me to an emergency mental health clinic.
I met with a person at the mental health clinic and was told that, because my PNP had sent a note saying he would not refill the prescription because I was late on my appointment, that they would not refill my prescription. I pressured them a bit, asking what I was supposed to do given that my PNP is awol (and, I should say, it is certainly possible that he has a completely legit reason. But it is clear that he has been in touch with my pharmacy, but has not returned 3 of my phone calls in the past couple days.)
So basically...I'm back at square one.
posted by The Pantless Wonder at 2:43 PM on February 23, 2010
I went to my urgent care clinic. They have a policy of not prescribing any psychiatric medications - so they gave me a piece of paper stating that and sent me to an emergency mental health clinic.
I met with a person at the mental health clinic and was told that, because my PNP had sent a note saying he would not refill the prescription because I was late on my appointment, that they would not refill my prescription. I pressured them a bit, asking what I was supposed to do given that my PNP is awol (and, I should say, it is certainly possible that he has a completely legit reason. But it is clear that he has been in touch with my pharmacy, but has not returned 3 of my phone calls in the past couple days.)
So basically...I'm back at square one.
posted by The Pantless Wonder at 2:43 PM on February 23, 2010
IANAL/IANAD, but that really sounds sketchy to me. Your state (? assuming U.S.) board of nursing probably has a phone number that you can call to file a complaint.
Had you been late on any appointments before? Does your PNP have a "three strikes and you're out" rule, or anything like that? Had you discussed consequences for missed appointments previously, or was this completely out of the blue?
posted by purlgurly at 3:05 PM on February 23, 2010
Had you been late on any appointments before? Does your PNP have a "three strikes and you're out" rule, or anything like that? Had you discussed consequences for missed appointments previously, or was this completely out of the blue?
posted by purlgurly at 3:05 PM on February 23, 2010
I disagree with others, and I say report that PNP to your state's board at this point. Not only has he gone AWOL preventing you from getting medication you need, but you're suffering side effects as a result of it. I don't care if the PNP's mother died, answering machine broke, cat got married, whatever, it doesn't matter. It is absolutely, unforgivably irresponsible to not make provisions for patient care in such a circumstance, especially when he's taken steps ostensibly deliberately done to prevent your obtaining a refill from another practitioner.
When you asked the clinic what you should do, what did they say? If they did not give you referrals for other practitioners, call back and get some. Then call every single one of them explaining you need an emergency/urgent appointment because you were dropped by your own doc with no explanation and with no medication management, leaving you currently suffering withdrawal side effects. Advise you were turned away by an urgent care clinic and a mental health clinic, and have been now (x) hours without prescribed medication. If none of them get you in an appointment, get out the yellow pages, and keep calling.
From the AMA:
"The patient’s right to receive information from his or her physician is a fundamental element of the patient-physician relationship. Therefore, it is important for a physician to make every effort to provide information to patients (see Opinion 10.01, Section 1, Fundamental Elements of the Patient-Physician Relationship). Furthermore, the physician has an ethical and legal obligation not to neglect their patients (see Opinion 8.11, "Neglect of Patient"). However, there is also a long-standing ethical principle of evaluating the medical need of patients (for example in performing triage in an emergency room and seeing patients in order of medical need instead of on a first-come, first-serve basis). AMA Policy in such instances is described in general terms in Opinion 2.03, "Allocation of Limited Medical Resources". Overall, physicians should try to communicate with their patients in a timely manner and should always try to return calls, but their failure to do so does not necessarily result in unethical conduct."
This doc is not triaging. He's just not returning phone calls. How many times have you called him? Over how many days, exactly? What state are you in?
posted by bunnycup at 3:06 PM on February 23, 2010 [1 favorite]
When you asked the clinic what you should do, what did they say? If they did not give you referrals for other practitioners, call back and get some. Then call every single one of them explaining you need an emergency/urgent appointment because you were dropped by your own doc with no explanation and with no medication management, leaving you currently suffering withdrawal side effects. Advise you were turned away by an urgent care clinic and a mental health clinic, and have been now (x) hours without prescribed medication. If none of them get you in an appointment, get out the yellow pages, and keep calling.
From the AMA:
"The patient’s right to receive information from his or her physician is a fundamental element of the patient-physician relationship. Therefore, it is important for a physician to make every effort to provide information to patients (see Opinion 10.01, Section 1, Fundamental Elements of the Patient-Physician Relationship). Furthermore, the physician has an ethical and legal obligation not to neglect their patients (see Opinion 8.11, "Neglect of Patient"). However, there is also a long-standing ethical principle of evaluating the medical need of patients (for example in performing triage in an emergency room and seeing patients in order of medical need instead of on a first-come, first-serve basis). AMA Policy in such instances is described in general terms in Opinion 2.03, "Allocation of Limited Medical Resources". Overall, physicians should try to communicate with their patients in a timely manner and should always try to return calls, but their failure to do so does not necessarily result in unethical conduct."
This doc is not triaging. He's just not returning phone calls. How many times have you called him? Over how many days, exactly? What state are you in?
posted by bunnycup at 3:06 PM on February 23, 2010 [1 favorite]
Firstly, I'm sorry for what you're having to go through. I know it's got to be hard.
Secondly, my SO is often incredibly busy, so doesn't get in to see her psychiatrist quite as often as she should, but as long as she's got an appointment scheduled, there's never a problem getting him to call in a refill to tide her over. Same with her gynecologist who prescribes her BCP.
So yeah, your nurse or whatever is a shitheel and should be dropped. It is incredibly awful of them to force you to quit cold turkey.
This might be a little shady, but you could always try going to a different urgent care place and leave out the part about your doctor refusing to allow the refill. Just say you haven't been able to get in contact with him. If drug seekers can doctor shop to get narcotics, surely you can find one willing to provide you with a week's supply of your SSRIs.
posted by wierdo at 3:27 PM on February 23, 2010 [1 favorite]
Secondly, my SO is often incredibly busy, so doesn't get in to see her psychiatrist quite as often as she should, but as long as she's got an appointment scheduled, there's never a problem getting him to call in a refill to tide her over. Same with her gynecologist who prescribes her BCP.
So yeah, your nurse or whatever is a shitheel and should be dropped. It is incredibly awful of them to force you to quit cold turkey.
This might be a little shady, but you could always try going to a different urgent care place and leave out the part about your doctor refusing to allow the refill. Just say you haven't been able to get in contact with him. If drug seekers can doctor shop to get narcotics, surely you can find one willing to provide you with a week's supply of your SSRIs.
posted by wierdo at 3:27 PM on February 23, 2010 [1 favorite]
I have taken Zoloft in the past and am currently on Wellbutrin. I am also very scatterbrained and have frequently found myself without refills when I needed them. Here is what I would do:
1. Does your PNP work out of an office with a supervising physician? This is typically my experience. Call the office and ask for this doctor or this doctor's answering service. If it is after hours where you are, you may be transferred directly to the answering service, or the PNP's voicemail may have an emergency number for you to call. Get in touch with this doctor if you can. They should be able to help you.
2. If your PNP does not have a supervising physician, get in touch with a primary care doctor. I know you said you do not have one assigned yet, but perhaps you can call around to several offices, explaining the direness of your situation, and get a foot in the door. They can either give you some assistance with the meds or put you in touch with a new psych person ASAP.
3. All of the above may take a few days. If at any time you find yourself entertaining thoughts of hurting yourself or others, go immediately to the ER. Do you have a partner, roomate, or parent you can reality-check with every day? Not to say you're going to lose touch with reality, just that sometimes the bad thoughts can creep up on you even though you know you're experiencing withdrawal.
4. If none of these steps have gotten you new scrips by the end of the week, you'll probably have to resort to the ER.
As for what to expect, you may experience "brain zaps," which many people have reported with Zoloft and other SSRIs. They are more annoying than painful. The fatigue and flu-like symptoms may continue. You may be more irritable than usual.
I found it helped to have a cup of coffee or caffeinated tea in the morning to get started on the workday. Take it easy on yourself in terms of stress and non-essential activities. Get as much sleep as you can, and try to get some vigorous exercise, which may help you feel a bit better.
Once you get back on your meds, you may notice a few days of increased side effects, for example, difficulty getting to sleep or feelings of jitteriness. This has happened to me every time I've gone without meds for more than a few days, but has worn off within 2 weeks.
The advice to have your pill bottles with you is good; I wonder if you could ask any of these people you're seeing if they have any sample packages they could give you to hold you over? Samples don't require a prescription, and your bottles prove that you've taken the medications in the past.
Just remember to take care of yourself and head straight to the hospital if you feel like you're losing control. Do not let your health & treatment be compromised because of a bad provider experience. I hope this is resolved for you very soon. When it is, make sure to get yourself a PCP as quickly as you can, so that if you find yourself in this situation again you have another advocate for your health.
posted by Fui Non Sum at 3:31 PM on February 23, 2010
1. Does your PNP work out of an office with a supervising physician? This is typically my experience. Call the office and ask for this doctor or this doctor's answering service. If it is after hours where you are, you may be transferred directly to the answering service, or the PNP's voicemail may have an emergency number for you to call. Get in touch with this doctor if you can. They should be able to help you.
2. If your PNP does not have a supervising physician, get in touch with a primary care doctor. I know you said you do not have one assigned yet, but perhaps you can call around to several offices, explaining the direness of your situation, and get a foot in the door. They can either give you some assistance with the meds or put you in touch with a new psych person ASAP.
3. All of the above may take a few days. If at any time you find yourself entertaining thoughts of hurting yourself or others, go immediately to the ER. Do you have a partner, roomate, or parent you can reality-check with every day? Not to say you're going to lose touch with reality, just that sometimes the bad thoughts can creep up on you even though you know you're experiencing withdrawal.
4. If none of these steps have gotten you new scrips by the end of the week, you'll probably have to resort to the ER.
As for what to expect, you may experience "brain zaps," which many people have reported with Zoloft and other SSRIs. They are more annoying than painful. The fatigue and flu-like symptoms may continue. You may be more irritable than usual.
I found it helped to have a cup of coffee or caffeinated tea in the morning to get started on the workday. Take it easy on yourself in terms of stress and non-essential activities. Get as much sleep as you can, and try to get some vigorous exercise, which may help you feel a bit better.
Once you get back on your meds, you may notice a few days of increased side effects, for example, difficulty getting to sleep or feelings of jitteriness. This has happened to me every time I've gone without meds for more than a few days, but has worn off within 2 weeks.
The advice to have your pill bottles with you is good; I wonder if you could ask any of these people you're seeing if they have any sample packages they could give you to hold you over? Samples don't require a prescription, and your bottles prove that you've taken the medications in the past.
Just remember to take care of yourself and head straight to the hospital if you feel like you're losing control. Do not let your health & treatment be compromised because of a bad provider experience. I hope this is resolved for you very soon. When it is, make sure to get yourself a PCP as quickly as you can, so that if you find yourself in this situation again you have another advocate for your health.
posted by Fui Non Sum at 3:31 PM on February 23, 2010
Please update again when you can and consider filing an ethics complaint against your PNP.
posted by toodleydoodley at 3:46 PM on February 23, 2010
posted by toodleydoodley at 3:46 PM on February 23, 2010
Yeah, this makes no sense whatsoever. I've heard of this kind of crap around opioids-- obviously, if you go to one doctor after another one has cut you off, you look like a drug addict. But these are not addictive or abuseable drugs and it's completely bizarre for a clinic to refuse you based on someone else's not renewing your prescriptions because you missed an appointment. You are there in front of them and in need.
Keep a diary of this stuff and just go to someone completely different and don't mention the refusal to refill. Then, call the nursing board and the medical board and report these idiots: there's no reason you should be treated this way. And what the heck is wrong with the urgent care place that doesn't refill psych meds? Most of these are provided by GP's anyway.
posted by Maias at 3:51 PM on February 23, 2010
Keep a diary of this stuff and just go to someone completely different and don't mention the refusal to refill. Then, call the nursing board and the medical board and report these idiots: there's no reason you should be treated this way. And what the heck is wrong with the urgent care place that doesn't refill psych meds? Most of these are provided by GP's anyway.
posted by Maias at 3:51 PM on February 23, 2010
I'm not sure what county you're in. You should be able to find your local MHMR office by going here:
http://www.oregon.gov/DHS/mentalhealth/cmh-programs.shtml
They should either be able to help you or put you in touch with someone that can.
posted by GlowWyrm at 4:17 PM on February 23, 2010
http://www.oregon.gov/DHS/mentalhealth/cmh-programs.shtml
They should either be able to help you or put you in touch with someone that can.
posted by GlowWyrm at 4:17 PM on February 23, 2010
Okay, my husband has convinced me that I should say a little more than my vague hinting, in the interest (honestly) of helping the OP. ("Had you been late on any appointments before? Does your PNP have a "three strikes and you're out" rule, or anything like that? Had you discussed consequences for missed appointments previously, or was this completely out of the blue?")
I have been on (comparable) antidepressants for some time and I have never had an issue getting the walk-in clinic to give me an emergency refill if I have been late in scheduling an appointment with my GP or psychiatrist, and I have. These medications, as far as I know, are not viewed as particularly "hard core", so the emergency mental health clinic not giving you at least a short-term script seems inexplicable. Doctors (and counsellors) have also never cut me off with no warning if I was late in booking a follow-up, or missed an appointment. As others have indicated above, either your PNP is being completely unreasonable, or there is more to the story. What I am getting at, is I'm not sure if you are giving us all the details, OP, and it's totally understandable if you have felt too embarrassed to do so. If there are other meds that you're taking, or if there is a longer history with your PNP, I think that that might colour the advice that others are giving you. The last thing you want is to be labelled as a "problem patient" if you go to another medical practitioner and they find out about this whole episode, and you have already experienced the consequences of your PNP contacting the pharmacy and being cut off as a result.
I hope that you're not offended, and if everything is exactly as you have represented it thus far, then going to the licensing board or pursuing other actions, is a completely reasonable course of action. But if not, I hope that you will be able to share any other relevant details, so that we can give you the most helpful advice possible.
posted by purlgurly at 4:38 PM on February 23, 2010
I have been on (comparable) antidepressants for some time and I have never had an issue getting the walk-in clinic to give me an emergency refill if I have been late in scheduling an appointment with my GP or psychiatrist, and I have. These medications, as far as I know, are not viewed as particularly "hard core", so the emergency mental health clinic not giving you at least a short-term script seems inexplicable. Doctors (and counsellors) have also never cut me off with no warning if I was late in booking a follow-up, or missed an appointment. As others have indicated above, either your PNP is being completely unreasonable, or there is more to the story. What I am getting at, is I'm not sure if you are giving us all the details, OP, and it's totally understandable if you have felt too embarrassed to do so. If there are other meds that you're taking, or if there is a longer history with your PNP, I think that that might colour the advice that others are giving you. The last thing you want is to be labelled as a "problem patient" if you go to another medical practitioner and they find out about this whole episode, and you have already experienced the consequences of your PNP contacting the pharmacy and being cut off as a result.
I hope that you're not offended, and if everything is exactly as you have represented it thus far, then going to the licensing board or pursuing other actions, is a completely reasonable course of action. But if not, I hope that you will be able to share any other relevant details, so that we can give you the most helpful advice possible.
posted by purlgurly at 4:38 PM on February 23, 2010
I've been on those drugs. And I have done cold turkey on those drugs.
It isn't recommended, especially with the Welbutrin, which could possibly cause seizures.
BUT it won't kill you.
You do realize that it's important to have those checkups, and irresponsible for your practitioner to refill without seeing you. Also, I don't know where you live but in many areas of the country mental health practitioners are swamped with clients. I don't know why yours isn't contacting you, but there are a number of logical reasons this could happen.
So, yes, you ARE at square one, and are SOL. I'm sorry, been there, done that, it sucks, and I have lots of things I can say about our broken health system.
Do what you can to get back in line to be seen by someone, and this time do what you have to do to remember your appointments. You gotta look after yourself, because, I promise you on a stack of pill manuals, no one else in the system WILL.
posted by St. Alia of the Bunnies at 7:13 PM on February 23, 2010
It isn't recommended, especially with the Welbutrin, which could possibly cause seizures.
BUT it won't kill you.
You do realize that it's important to have those checkups, and irresponsible for your practitioner to refill without seeing you. Also, I don't know where you live but in many areas of the country mental health practitioners are swamped with clients. I don't know why yours isn't contacting you, but there are a number of logical reasons this could happen.
So, yes, you ARE at square one, and are SOL. I'm sorry, been there, done that, it sucks, and I have lots of things I can say about our broken health system.
Do what you can to get back in line to be seen by someone, and this time do what you have to do to remember your appointments. You gotta look after yourself, because, I promise you on a stack of pill manuals, no one else in the system WILL.
posted by St. Alia of the Bunnies at 7:13 PM on February 23, 2010
PS meantime go to Walmart or your local good vitamin store (preferable) and load up on fish oil capsules and flax seed oil. It's not a replacement but it's better than nothing.
posted by St. Alia of the Bunnies at 7:14 PM on February 23, 2010
posted by St. Alia of the Bunnies at 7:14 PM on February 23, 2010
Response by poster: Hello Everyone Again,
First, you guys are so fantastic. Thank you for your time and kindness.
Here is the update: after I went to the emergency mental health clinic (which refused to fill my script as my PNP had written into the pharmacy saying he would not fill it), I got a call back from my PNP. Evidently, the emergency mental health clinic had called him when I left (I had to list him on the many forms I was required to fill out - though I'm not exactly sure they can call him without my consent). In any case, I guess that prompted him (?) to return my call (though the call being motivation is speculation on my part, based only on correlation). Anyway, he told me that the emergency clinic had called him, and he said that he was "very frustrated with me" for having failed to meet him in the requisite time frame, and that this was unacceptable. But he filled my script for two weeks, on the condition that I meet with him immediately.
So I'm going in to see him next week, and hopefully get a prescription filled for enough time to find a psychiatrist, or another PNP, as much trust I think has been lost, and I'm a little sketched out, to be honest.
So I got my meds (yay!! no unwanted SSRI discontinuation syndrome!), so the immediate problem has been solved.
I love you, AskMe. Thank you.
posted by The Pantless Wonder at 9:46 PM on February 23, 2010 [1 favorite]
First, you guys are so fantastic. Thank you for your time and kindness.
Here is the update: after I went to the emergency mental health clinic (which refused to fill my script as my PNP had written into the pharmacy saying he would not fill it), I got a call back from my PNP. Evidently, the emergency mental health clinic had called him when I left (I had to list him on the many forms I was required to fill out - though I'm not exactly sure they can call him without my consent). In any case, I guess that prompted him (?) to return my call (though the call being motivation is speculation on my part, based only on correlation). Anyway, he told me that the emergency clinic had called him, and he said that he was "very frustrated with me" for having failed to meet him in the requisite time frame, and that this was unacceptable. But he filled my script for two weeks, on the condition that I meet with him immediately.
So I'm going in to see him next week, and hopefully get a prescription filled for enough time to find a psychiatrist, or another PNP, as much trust I think has been lost, and I'm a little sketched out, to be honest.
So I got my meds (yay!! no unwanted SSRI discontinuation syndrome!), so the immediate problem has been solved.
I love you, AskMe. Thank you.
posted by The Pantless Wonder at 9:46 PM on February 23, 2010 [1 favorite]
I'm relieved that he ended up doing the right thing, even there was some stupid element of punishment involved. What a tool.
At least now you'll have the chance to find a new doctor without also having to deal with the crazy, as you put it.
If there's not some ethical breach in there somewhere, there should be. He can be as disappointed as he likes, but he handled the situation far more poorly than you did. Sure, you didn't make an appointment soon enough. He put you through a bunch of stress and anxiety for what reason again?
You could try discussing the situation and how it affected you when you meet with him, just to see if there's some method behind the madness that would leave you feeling less skeeved out, but I'm probably just saying that because I'm intensely curious as to what was going through this a-hole's mind when he decided he ought to put you through all this.
posted by wierdo at 10:00 PM on February 23, 2010
At least now you'll have the chance to find a new doctor without also having to deal with the crazy, as you put it.
If there's not some ethical breach in there somewhere, there should be. He can be as disappointed as he likes, but he handled the situation far more poorly than you did. Sure, you didn't make an appointment soon enough. He put you through a bunch of stress and anxiety for what reason again?
You could try discussing the situation and how it affected you when you meet with him, just to see if there's some method behind the madness that would leave you feeling less skeeved out, but I'm probably just saying that because I'm intensely curious as to what was going through this a-hole's mind when he decided he ought to put you through all this.
posted by wierdo at 10:00 PM on February 23, 2010
He may be crazy. I'm tellin' ya, most therapists I've worked with were crazier than me. I'm pretty sure they get in the business to help unscrew their own noggins.
posted by chairface at 10:22 PM on February 23, 2010 [2 favorites]
posted by chairface at 10:22 PM on February 23, 2010 [2 favorites]
Yeah, get your prescriptions, find someone else and get your medications all set-- then call the nursing board and raise hell for this person. What they did was completely unethical and does not meet the standard of care. Someone like that-- who takes their anger and control issues out on patients-- should not be practicing.
posted by Maias at 7:34 AM on February 24, 2010
posted by Maias at 7:34 AM on February 24, 2010
As someone who's been taking antidepressants for more than half her life, I am BOGGLED by how unethical and inappropriate your PNP's behavior appears. From your most recent update, it sure sounds as though this was some kind of power game on his part to punish you for not making your appointment on time. IMO, saying "no refill until you come in" would be one thing, but not returning your phone calls is completely inappropriate.
Get your meds for now, find a new PNP and get things on track with them, then report this bozo to every remotely appropriate licensing board and patient-watchdog agency there is.
posted by Lexica at 7:51 PM on February 24, 2010 [2 favorites]
Get your meds for now, find a new PNP and get things on track with them, then report this bozo to every remotely appropriate licensing board and patient-watchdog agency there is.
posted by Lexica at 7:51 PM on February 24, 2010 [2 favorites]
Thank God you got your meds.
Your PNP is, of course, a complete dick. I hope you will pursue getting him into trouble. I know I wouldn't get it together to do so, but I hope you will.
Just for the record, if anyone else should be in this situation, I found going cold turkey with Zoloft to be disastrous. I basically didn't sleep for two weeks, and it was a bad scene.
posted by Lizzle at 5:12 PM on March 3, 2010
Your PNP is, of course, a complete dick. I hope you will pursue getting him into trouble. I know I wouldn't get it together to do so, but I hope you will.
Just for the record, if anyone else should be in this situation, I found going cold turkey with Zoloft to be disastrous. I basically didn't sleep for two weeks, and it was a bad scene.
posted by Lizzle at 5:12 PM on March 3, 2010
This thread is closed to new comments.
Mind you, I don't know the laws regarding this in OR, so I may be completely off base. I know that here, in MA, a med prescribing psych doc must have followups a minimum of every 6 months to continue prescribing meds.
posted by Cat Pie Hurts at 10:17 AM on February 23, 2010