Well, that is a mighty big book you have there--
September 1, 2014 9:13 PM   Subscribe

I have a new doctor. He has many copies of this book in his office (waiting room, examination rooms): The Urantia Book. I really did not think much of it, the doctor has a pretty good reputation (where I live that means jack). Should I be concerned?

I had a preliminary exam with one of his physician assistants. I mentioned I had a prescription for Ambien in the past year (10 tables which lasted over a year) and asked if I could get a refill. I also have severe osteoarthritis and major depression with a panic disorder. Previously, I was required by my last practice to see a psychiatrist to monitor my medication for that (Zoloft) and a therapist for cogitative behaviour therapy. She proceeded to tell me "no way will you get a referral to a psychiatrist," and "no this practice will not prescribe any sleeping pills or anti-anxiety medication," nor would they help with the pain from my osteoarthritis. Sooooo, I got upset asked about the Zoloft, she said that was probably OK.

She then proceeded to tell me that just because the doctor prescribes medical marijuana, it does not mean he is not conservative with drugs or treatment. I had not asked for a lot drugs, I wanted a referral for physical therapy, Zoloft, and 10 Ambien. I had no idea the practice was one of the few in my state that prescribes medical marijuana. I don't use marijuana, never have, nor any other recreational drugs. I don't even drink.


I think a lot of the philosophy is based on the religious aspects of Urantia.

Should I be concerned about the religious aspects of this practice? It is a religion that is very critical of science. I don't have a lot of choice. I live on a remote island (Maui) with very limited prospects. I have very good health insurance, but it is an HMO and there are only a few available primary care physicians. Should the religion and it tenets be a concern?
posted by anonymous to Health & Fitness (19 answers total) 1 user marked this as a favorite
Religion aside, I think you should be concerned that the doctor is unwilling to provide medical care that you need...(?!)
posted by i_am_a_fiesta at 9:18 PM on September 1, 2014 [43 favorites]

Sounds like this doc won't be a good fit, for reasons other than philosophy.
posted by Johnny Wallflower at 9:20 PM on September 1, 2014 [2 favorites]

I would never see a doctor who either owned that book and displayed it in his/her office, or who refused to provide medications for sleep and anxiety. If there is another option, I'd take it.
posted by treehorn+bunny at 9:20 PM on September 1, 2014 [13 favorites]

I would be concerned, but I would also be concerned if I were you doctor.

I think when next you see him you should bring up the book and see what he says about it. For all you know, someone sent him a bunch of free copies and he doesn't know what they are and stuck them in his waiting room. If they buy into an anti-science religion, though, I would do everything possible to get a new doctor.

The prescription issue is separate. I think most doctors (and if I were a doctor), don't want patients coming in with instructions about what prescriptions they want. I think the more typical thing is "I have x symptoms; I've tried X, Y, Z and had experiences M, N, O" with that." and then you and your doc work out together what the best coarse of action is. I imagine doctors are wary of people who come in with a prescription shopping list.
posted by If only I had a penguin... at 9:23 PM on September 1, 2014 [4 favorites]

Well I'm obviously not aware of how many people interact with their doctors. I agree that a doctor who refused to take seriously and treat if necessary your medical issues is a non-starter, but I would think how to treat something is a decision doctor and patient should make in consultation. If patients were just supposed to get pills cause they want them, those pills wouldn't require a prescription.
posted by If only I had a penguin... at 9:26 PM on September 1, 2014

I imagine doctors are wary of people who come in with a prescription shopping list.

Asking for refills of existing prescriptions when changing doctors isn't a "shopping list," though, it's standard care. Which is why I'd be wary of switching my care to this doctor.
posted by jaguar at 9:27 PM on September 1, 2014 [36 favorites]

She proceeded to tell me "no way will you get a referral to a psychiatrist," and "no this practice will not prescribe any sleeping pills or anti-anxiety medication," nor would they help with the pain from my osteoarthritis.

Then, weird culty book or not, they are likely not the best place for you. You need a doctor that is willing to listen to you, and also who is willing to actually treat your symptoms. Try one of the other providers allowed by your insurance.
posted by His thoughts were red thoughts at 9:28 PM on September 1, 2014 [9 favorites]

Oh, I missed "in no way will you get a referral." That's a giant red-flag. Also, having had the same family doctor since I was 10, perhaps I am ignorant in the ways of doctor-switching. My bad. And yeah if he has the book on purpose and won't provide referrals for diagnosed conditions, that's not a doc you want.
posted by If only I had a penguin... at 9:33 PM on September 1, 2014 [2 favorites]

The fact that you have needs and this doctor is blatantly refusing to work with you is seemingly more of a concern than whatever nutjob pseudo-philosophy resulted in them refusing to work with you. It sounds more like they're getting high on their own supply. If this was the only doctor on the island I'd tell you to move, no matter the cost. But you don't have to move, apparently, so that's good.
posted by bleep at 9:40 PM on September 1, 2014 [1 favorite]

Regarding your health insurance: Insurers make frequent exceptions regarding payment of in-network and out-of-network providers. If I were you and I had an preferred local doctor, I'd give my insurance company a call/email and inquire about what steps were necessary to get the ball rolling on a provider exception. The insurance company I work for would be pretty quick to acquiesce with the combo of (a.) limited geographic access to other in-network providers, and (b.) your narrative about your treatment at the new provider. To be honest, just (b.) would be enough to cause a minor investigation at my company, but I can't really speak for other companies.

Fair warning: Bad insurance companies love to just wear people down via endless hoops to jump though. Feel free to meMail me if you need any advice regarding getting heard by the right people at your insurer.
posted by a box and a stick and a string and a bear at 10:00 PM on September 1, 2014 [1 favorite]

I would not have anything to do with this medical practice ever again, even if the next nearest doctor was an enormous inconvenience. The PA showed incredibly bad judgment in her interactions with you; I might go so far as to say rather unprofessional as well. There is absolutely nothing unreasonable about asking for continuing prescriptions of medications you were prescribed by your former doctors. Similarly, an outright refusal to give a referral to another doctor is frankly beyond the pale.

All of that on its own would be bad enough, but taken in consideration with the bizarre cultish books all over the waiting room? That would make me run like hell.
posted by elizardbits at 10:33 PM on September 1, 2014 [5 favorites]

Did you ever talk to the doctor and did he refuse the prescriptions and referrals, or was the PA incorrect?

It could be that he's got an awful PA and he's fine as a doctor. I'd speak with him and explain your interaction with her. He may have no idea this is how she badly treats patients.

Ask him about the refills, the referrals, etc. See what he says and go from there. It may turn out the PA was correct, in which case the weird cultish books are irrelevant because he sucks and you'll get another doctor anyway.

(Another thing: if you took less than 10 Ambien in a year for sleep issues, I can see a medical professional thinking you don't really need them, and since Ambien has increasnigly-known bizarre and terrible side effects, it's possible a doctor won't prescribe them, but I get the Ambien's not the real issue here.)
posted by kinetic at 2:36 AM on September 2, 2014 [1 favorite]

Some PA's work a little separate from the doctor. She may have been running her own agenda. That being said, unless the religious book is a Bible, run screaming. The last thing that you want from your doctor is to be told that your mental illness is caused by creatures from Mars that infected you before you were born, by having sex with your great grandmother Betsy.
posted by myselfasme at 5:36 AM on September 2, 2014

There's a difference between "we don't think Ambien is a good drug to prescribe" and saying "we won't prescribe ANYTHING for sleep."

Even without the book thing, the place sounds like bad news. You need a doctor that's willing to listen and work with you on your medical issues, not rattle off a list of rules about what medical problems they won't help you with.
posted by Kimmalah at 7:31 AM on September 2, 2014 [1 favorite]

The book is a red herring. The doctor doesn't sound like a good fit, but it doesn't sound like it has anything to do with religion/spirituality/metaphysics. It's just not what you're looking for in a doc. You have an idea what has worked for you in the past (CBT, Zoloft, etc.) and want to continue it, the doc won't work with that, that's a problem.

I'd move on.

A lot of doctors are very conservative these days about writing scripts for drugs that can be, in their mind, "abused" or just plain overused (including Ambien and Zoloft), but the not giving you a referral to a psychiatrist is kinda weird. That's unusual in my experience, unless there's some sort of HMO-type cost control thing going on that the doctor is responsible for.
posted by Kadin2048 at 9:04 AM on September 2, 2014

A lot of doctors are very conservative these days about writing scripts for drugs that can be, in their mind, "abused" or just plain overused (including Ambien and Zoloft)

Zoloft is not a drug of abuse and is not on the CSA Schedules. OP was already on it for one of its FDA-approved indications, and having the medicine abruptly withdrawn could cause a number of health concerns. I think not refilling it, in the absence of a medically-justified reason, would be irresponsible.

So, OP, nthing the sentiment that regardless of the religious bent of the practice, you seem to have been treated rather shoddily. If you were spoiled for choice, I'd say just find another practice ASAP. But since you have few choices, I agree with kinetic about talking to the doctor and seeing how that goes.

I disagree with kinetic about the Ambien, though. Ambien is supposed to be used short-term for insomnia, and I think that a patient asking for 10 pills in a year would be using it occasionally, as needed. I'd be more concerned about a patient who wanted 30/mo with refills, because dependency, abuse, and rebound insomnia would be more of a concern.
posted by jingzuo at 4:18 PM on September 2, 2014

GTFOOT. Holy crap. I'd be running like the wind. Won't write a referral? Won't treat OA pain? I swear this is the same shitty GP I have minus the referral (that's all mine seems to do).
posted by kathrynm at 6:04 PM on September 2, 2014

Re: Ambien. I meant that it has received a lot of press about terrible side effects like sleep shopping, sleep driving, sleep eating, etc., and doctors of my acquaintance say they no longer prescribe it for insomnia because it has awful side effects, they instead prescribe Trazodone. I didn't mean 10 pills in a year would have a doctor think you were dependent or abusing them, there are just safer prescriptions to help you sleep. That's why you might not get an Ambien refill.
posted by kinetic at 6:08 PM on September 2, 2014

There are SO MANY red flags in your question. Since you first ask about the book, I'll say this:

First, I would personally not want to see any religious texts in my doctor's office, including the bible. I'm an atheist, so there's that, but more than that, I think a doctor's office should be a safe place for all the patients. Religion has no part in it, and I would hope most doctor's recognize that.

Secondly, you said there were multiple copies which is what takes this from "small red flag" to "major red flag." To me, that's fundamentally very different then just a single copy of a religious text. That screams, I ordered this in bulk because this is a central tenet of my life and/or I'm on the look out for opportunities to proselytize.

But honestly, even if you hadn't mentioned anything about the book, I would have still told you to absolutely go find someone else. Not only are they refusing to prescribe you medications that you've already taken, they're refusing to give you a referral to a psychiatrist. I mean, if you had a PCP that refused to give you a referral to an oncologist when you needed treatment for cancer would you continue seeing them? I'm assuming not.

Also, I'm sorry, but they prescribe medical marijuana but no medications for insomnia or anxiety? I mean, seriously, what the hell?

I understand that this was also delivered via the PA, but I would also not want to go to a doctor who had staff that was spouting this kind of crap.

Any one of these things would be enough for me to seriously consider going somewhere else, but with all of this stuff, I would say find another doctor who move to another island. Seriously, this is nuts. If I were in your position, I would not waste another minute on this practice.
posted by litera scripta manet at 9:52 PM on September 2, 2014 [2 favorites]

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