Three different issues at the moment...

[need2behealthy]

Hi Folks

I have three different issues at the moment (my GP's insistance that I see a Pdoc, fears over BP med level/serum testing and my GP's use of the term "intervention" used in a Psychiatric context). I'll try to address each of these issues one at a time and I would very much appreciate any advice or suggestions you folks could provide.

(ISSUE 1# - THE PDOC APPOINTMENT): Awhile back I was diagnosed with BP by a non-Pdoc specialist and put on meds. Shortly after that, my GP insisted I see a Pdoc. The last time I went to see my GP, he asked me if I had been to see a Pdoc and I told him that I was still looking around. He seemed to understand but also looked at me and rather sternly said "alright now, I need you to see a Psychiatrist". He asked (and I told him) the name of one I had been considering and he wrote me a referral that said I was to be seen by a Pdoc for all of my disorders (including my BP) and for "intervention".

(ISSUE 2# - "INTERVENTION"): When I asked him what he meant by "intervention" he told me that it just meant I would be evaluated for my conditions. A few days later I asked various people what "intervention" (when used in a psychiatric context) meant and was assured that it was nothing to worry about and that it simply meant that my GP wanted to get another specialist involved in my care. A few days after that, I typed "psychiatric intervention" into a search engine and was horrified to see page after page of terms like "crisis stabilization", "emergency commitment", "involuntary commitment" and "crisis management". At this point I was really freaking out. Then, to make matters even worse, I was watching a comedy the other day on TV and someone said that this lady needed intervention and suddenly two men in white coats grab her under the arms and take her away. Yikes, that was the LAST thing I wanted to see...especially after my OWN GP said on the referral that he wanted "intervention" from the Psychiatrist!. When you add all of this with my psychiatric horror story from awhile back, it's enough to make the hair stand up on the back of my neck!.

The place I had been considering is out-patient only. It is a gorgeous building in a very upscale community (think yachts, spas and million dollar homes). I'm actually pretty poor and down-to-earth myself. This just happens to be where I chose to go because it is located in a much nicer area than some of the other places and I figured I'd be treated better. I've called them several times (but not recently) and the procedure is that you call up and get "assessed" over the phone and they line you up for an appointment to get "evaluated" and I imagine, referred for some sort of therapy and/or meds. The wait-time is a few months. I've seen pictures of the place, read reviews and even know the Psychiatrist's name and have read reviews about him. A few complaints here and there but it sounds like a decent place overall.

The big issue now is that according to my appointment schedule, I will see my GP first and then the other specialist who diagnosed me with the BP (not a Pdoc though). With the other specialist, I have left everything open and have plenty of options and wiggle-room as to whether I want her to continue treating what she has diagnosed as BP or use a Pdoc for that. However, my GP is going to want to grill me about whether or not I have seen a Psychiatrist since the last time I saw him, want every single detail about how it all went, see a copy of the records from my visit, diagnoses, medications, when my next appointment is, grill me even more if I haven't seen a Pdoc, etc. He's a bit of a stickler for details - not exactly the type of GP that just says "hi, here are some pills and have a nice day". I really need to do this on my time and when I feel comfortable with it (because of my situation and until I can overcome my fears from a previous nightmare experience) but I'm not sure he is going to understand this and I absolutely can't afford to lose the GP (for insurance reasons). Right now I have an ear infection and I'm even afraid to seem him for that because I'm afraid the whole conversation will immediately turn to me seeing a PDoc rather than simply writing me a prescription for an antibiotic.

I've thought about just telling him that I'm still working it out and exploring all of my options and that it's taking longer than expected (which it definately is), etc but that in the interim the other specialist (not a Pdoc) is treating me for the BP and that I will continue working on it. However, this GP can be somewhat demanding, knows how to apply pressure and can actually be a bit overbearing and over-meticulous at times (even with his staff) so I'm not sure he will want to hear that. I suppose I could make an appointment with a Psych before I see the GP and then, if I continue to feel uncomfortable with it, simply cancel or rechedule but at some point I'm going to see the GP yet again and I don't want him to think that I'm playing games or not taking him seriously because I AM.

(ISSUE 3# - BP MED LEVEL/SERUM TESTING): I understand that Docs are not testing specifically for medication compliance when they test your BP med level/serum and that part of the reason they do this is to make sure that your liver is ok, etc but wouldn't they still be able to tell (by checking the "therapeutic" level of the med in your system) whether you are taking it or not and perhaps, how much you are taking (ie; whether you are taking less, splitting your pills, etc)?. I mean, I'm not thinking about going off any meds or splitting pils, etc - my main fears are that if my levels are either not there or really low she will either think that I'm not being "compliant" or increase my dosage to something that could cause lots of side affects.

How would you deal with these three issues?.I mean...what does one do in this type of situation?. Always seems like everything is one big catch-22 sometimes.

Thanks again for any assistance you can provide and help you can offer. I'm already under a lot of stress and pressure and with these three issues, it's really pouring in on.

[Anneinside]

I don't understand your anxiety about seeing a psychiatrists. They aren't going to prod your stomach, thump your knees, look in your ears. All they do is talk with you and then prescribe medication. They are the least physically intrusive specialty. The first time you see them they ask some questions, encourage you to talk about your history, what is bothering you. From then on you have 10 or 15 minute appointments. They may ask you if you have been having symptoms of your illness, do you think you need a medication change. Then they order your meds or give you scripts and off you go until the next appointment.

As for intervention, and intervention is anything that is done to resolve a problem. In the example above, the intervention is the medicine. Don't worry about getting into a hospital. It is very hard to be admitted. Wards are often full, most hospitals won't admit you unless you are a danger to yourself or others. In my town, if my pdoc sends me to get admitted to the hospital that's all he can do. I have to go through the emergency room. The emergency room doctor evaluates my status and makes the decision of whether I should be admitted. My doctor can't make the decision. If anything, more people complain that they are released too early due to insurance company policies then that they are kept too long.

[Crystal413]

The comments above are great. I wanted to add.....for example if you were prescribed Lithium at a certain dose, you took as prescribed, got your blood work that ck your liver, maybe a few other things and your Lithium level. They can't tell if you took the med as prescribed unless in the case of Lithium you had no level. What they can tell is what your Lithium level is. Based on that they will determine if you are at the correct level, too low and need an increase or too high and you need the Lithium reduced? It's not to be messed with. There are other BP meds that require bloodwork not just Lithium. If the med or meds you take for BP are going to work you need to take them as precribed. The important thing to understand is if you need to make changes to you med, go or call your doctor only.

[jessilb]

Well it is kinda hard giving advise because we don't know what the traumatic event was but I do understand your fears.  Do not believe everything you read on the internet and see on t.v.  Most of it is very over dramatized.  Intervention, especially in an out-patient basis is just talking with the psychiatrist, possibly taking some multiple answer tests, and really getting down to what the problem is and how much it effects your daily living.  And based on that info. the dr. would start (trying) medications to fit your situation.  I say trying because it can take a while to figure out what medication is right for your situation and your body.  If you are having unbearable side effects you are suppose to contact the perscriber right away and let them know so they can give you something else.  Also doses may have to be raised or lowered based on your needs.  It is a pretty lengthy process sometimes.  So, I would try to calm your fears about the word "intervention".  As for the testing that they do they are looking at a number of things.  Do not worry about it if you are taking your pills as perscribed and not on any illegal drugs.  Medication is very tricky in your body.  Some can mess with your stomache, some can give you tremors, any number of things can be happening inside of you and they want to make sure that your meds are right for your body.  I am on a number of anti-depressants, pain killers, antacids, potassium supplements, B-12, lets just say I keep my perscription bottles in a bag so I don't lose any, or forget to put them in my weekly pill organizer.  I also get blood tests about every three months to make sure everything is working right.  As for your appt. with the psych.  I'd say just get it over with.  Once4 you see that everyone is working in your best interest you will feel much better.  I'm sure the hounding you about it because when you are on meds for bp you need to be under the care of a psych. and not some other specialist who does not specialize in bp.  If you have other things, or you want to question my thoughts or experiances in this area please friend me and leave me a message.  I hope this helped and stay strong, it will all work out.

[ILADVOCATE]

   Yes most probably your doctor is just concerned but made that referral because a psychatrist has the specific knowledge to follow up wth mental health concerns. Interventon just means follow up with treatment.  With certan medications they are actually required to do follow up tests for certain health concerns relevant to the medication and the approprate blood level. You could ask them about the specifics depending on what medication has been prescribed. Generally there are not specific tests they can do to determine if a person is takng medication as prescribed. They follow up with that by noting how a person is doing in general and askng them about it. If there is a waiting period for an outpatient clnic you want to go to you could go to another one in the meantime and then be transfered.
   You have very valid concerns and they are all worth discussing with the psychiatrist you will see. Building trust is an essential part of seeking help and gettng the best response from your psychiatrist.