Story Flashcards
1.
First doctor got into a car crash, switched to new Dr.: Dr. Chong
2.
New doctor was extremely friendly, listened to my concerns, didn’t treat me like an idiot:
Explained differences between medications in terms I could understand, didn’t mislead me, etc
3.
Agreed that depression was more severe, treated that first by increasing lexapro dose before switching me to mirtazapine
4.
Mirtazapine was helpful even at the lowest dose, and was the most significant reduction I had experienced in depression symptoms.
5.
Began treating my ADHD next. Said that strattera was helping me, so I could keep it. 50 mg of vyvanse wasn’t working, he said that there was room to go up so I could either try increasing my vyvanse dose or switching to another class of stimulant. Because switching medications worked better with depression I opted to switch medications first. Changed to Concerta then focalin after physical effects with concerta.
6.
Month after we started this, he changed practices and I was at the lowest dose of focalin so he switched me back to my previous dose of vyvanse which was comparatively more effective.
7.
Switch to new doctor, going in with expectation that we would just be continuing previous treatment plan, or switching to something different if it doesn’t work.
8.
Immediately discontinues vyvanse and strattera to start back with focalin, despite me pointing out that
- I found strattera helpful
- It seemed counterproductive to discontinue two drugs and start another as you can’t tell what’s making the difference
9.
Ignores this, new dose of focalin isn’t effective, and starts asking me to prove this. Doesn’t take my feedback seriously and bizarrely starts asking me for proof that it’s less effective.
10.
I don’t want to wait another month to start back strattera, then another to increase focalin, so I asked to just do the vyvanse and strattera option first because that would be simpler
11.
On this dose for 2 months, it’s exactly the same as the past 3 months. Thought that he would just go the same route as previous doctor. Bizarrely says it will take time after 2 months despite me being on this exact same dosage for over a year and a half.
12.
Wait another 5 weeks or so, still the exact same medications, so I go in again. Now he says that 50 mg is the highest formulation of vyvanse. Bizarre because previous doctor had said that I had room to go up on that medication exactly. Literally just pull out phone and google doses of the medication. Lo and behold it says that there are two doses above mine: 60 and 70mg.
13.
He then backpedaled and said that 60 mg wasn’t a significant increase and that the difference between 50 and 70mg doesn’t justify the risk in adolescents. Says there are research studies which support this. Bizarrely says that the algorithms all say my options are exhausted. Obnoxiously asks me if I know what a randomized control trial is.
- Searched pubmed for all studies studying efficacy differences between doses. None supported his claim, and most directly refuted it.
- None of the ADHD algorithms for children said that my options were exhausted.
14.
Brought this up and said that he didn’t remember. Remembered to write down conversation afterwards after he made that sketchy false statement and his later comments seemed like backpedaling.
When I point out that the evidence he had just cited contradicts his claims, he starts getting defensive saying that a sample size of 500 isn’t sufficient.
I ask him what evidence he has and he just says clinical experience without any sense of irony.
15.
Points out that I’ve failed to make any progrsss despite being on the literal exact same set of medications that I started with. Him saying this while doing nothing was infuriating.
