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Preview: Comments on Shrink Rap: My Three Shrinks Podcast 15: POTUS Reading

Comments on Shrink Rap: My Three Shrinks Podcast 15: POTUS Reading

Updated: 2018-03-24T03:59:58.472-04:00


Great podcast guys,I love the format and its more ...


Great podcast guys,
I love the format and its more fun when it is utterly disorganised. I have a few topics for you, I have bee donig research on both DID and Munchausen's but can only find very conflicting information. I know these are controversial issues but that makes it more fun, right?

Lily: your question #3 reminds me of the most absu...


Lily: your question #3 reminds me of the most absurd treatment contract I've ever been told about (by another therapist)--

"My clients agree that I will have to discharge them if they kill themselves while in therapy with me."

I have to say, I wholeheartedly support not seeing dead people.

And don't forget..... Nookooler.... Let's pray fo...


And don't forget..... Nookooler.... Let's pray for a positive change in 2008!

Ohhhhh the same thing as a Bushism! I've never h...


Ohhhhh the same thing as a Bushism! I've never heard someone say "Bushing it up" before, and I thought maybe that was similar to some brit/aussie phrases for "mucking things up" - and just using the word bush, but not connected to GW. Gotya now... ;)

"Bushing it up": to speak in an unintentionally in...


"Bushing it up": to speak in an unintentionally inaccurate or grammatically incorrect manner.

-"And there is distrust in Washington. I am surprised, frankly, at the amount of distrust that exists in this town. And I'm sorry it's the case, and I'll work hard to try to elevate it."

-"Too many good docs are getting out of the business. Too many OB-GYNs aren't able to practice their love with women all across this country."

-"You teach a child to read, and he or her will be able to pass a literacy test."

-"There's an old saying in Tennessee — I know it's in Texas, probably in Tennessee — that says, fool me once, shame on — shame on you. Fool me — you can't get fooled again."

-"Our enemies are innovative and resourceful, and so are we. They never stop thinking about new ways to harm our country and our people, and neither do we."

"Bushing it up"? What's that mean to you? Just c...


"Bushing it up"? What's that mean to you? Just curious!

Thanks Sara - I do sometimes take awhile to write and post my comments! ;)

Lily,No problem. I took your comment in just that ...


No problem. I took your comment in just that way, so I was not hurt by it. Thanks for taking the time to listen again and hear what I said (it's so nice when I actually say what I mean, rather than Bushing it up).

Psych Advanced Directives in Maryland are not really worth much right now. I had a pt with one, which stated "when I get real depressed, the only thing that works is ECT and I agree in advance to it, no matter what I say at the time." At the time, she wasn't saying much at all... catatonic. Hospital attorneys told me we could not use it unless she gave informed consent at the time (couldn't) and no family to help.

Break my heart?? Does not compute. No, the few times I've done this, it has been after serial attempts, and we both agreed that such an arrangement would help provide an additional external locus of control.

if it takes you too long to write a comment, it'll...


if it takes you too long to write a comment, it'll do that, like your original one "expired" or something. More like the system doesn't remember the one it generated when you first loaded the comments.

I do somewhat long comments too, and so that happens to me often. Lol.

Managed care in America was designed to mimic the ...


Managed care in America was designed to mimic the NHS in England, but without the government intervention. Theoretically, people would go to their primary care doc for everything first. They would have a named primary care doc, so that doc would build a relationship with them and really get to know them. They would treat everything within their power, and when things went outside their realm, they would refer to specialists, who act as consultants - not "rush to right away". However, managed care insurance companies didn't play fair, and the reimbursements for this were awful. Plus patients couldn't get things they really needed. In the NHS, patients sometimes have problems getting things they need, but NOT like here in the US. Helen uses liquid oxygen, and I tried to see if I could get that (on my excellent insurance!), and there is no way I can. When I was on the HMO, they didn't cover DME (Durable Medical Equipment), but I didnt' know until I got a bill 2 months into it for $800 worth of oxygen equipment! They also didn't cover like 4 of my meds. They wouldn't cover a dexa scan, even though I was on steroids constantly. (Actually the hospital wouldn't even schedule it for me because of my insurance...) I also didn't get MRIs of my knees because I couldn't get them at my home hospital (where the insurance was based out of...) Because my primary care doc was near my parents' house, I was required to go to a single radiology place out near them, and I was a nursing student living in Philly and the insurance was through my university. So I didn't get it until I was off the HMO - I wouldn't have known I had AVN until even LATER stages had I stayed on the HMO!! Also, the headache center never seems to have the referrals - I don't fault them but it's like they don't receive them or they are constantly misplaced. My family doc would enter the referrals into an electronic system on the computer, and I'd check with the headache center a few days before my appt (because I knew they constantly couldn't find peoples), and they said they have no access to the electronic system. My family doc didn't want to fax it over, but they did - and even then, it got lost a few times. I used to take a train out to my parents' house (hour train ride), pick up the referral by hand and have my parents drive me back in late - all on a weeknight when I should be studying...just so I'd have the referral in my hand when I went to the appts. This is only the corner tip of the hell I experienced on an HMO..... I still feel anxious when I even think about that time!Every time I read the comments on this blog, I feel very lucky about the situation with my psychiatrist. Prior to starting nursing school, I saw the psychiatrist at the headache center, and his reduced fee was $125 an appt, which I could not afford. A good friend of mine was chief resident, and she asked a 3rd year if he would see me for a reduced fee...she told him a little about me, and then said she would never know another thing about my psychiatric care. (She'd actually been my doctor when I was in the hospital once - while she was doing her neuro/headache rotation - but we became friends and still keep in touch!) I originally just needed a doc who could prescribe my concerta. However at my first appt, my psychiatrist asked me how much I could afford to pay so that I could come once a week. And a few months ago, he wanted me to start coming 3 times a week. I cleared it up with him that it wasn't because he was worried that something was wrong with me, but it was more because he felt that more consistent work would really benefit me - and it does. First off, it gives me a reason to get out of bed on my days off. I know that sounds awful, but if I don't have anything, I just stay in bed all day with the lights off and the blinds closed. At least[...]

Rach: I think you are an exception. But $40,000 ...


Rach: I think you are an exception. But $40,000 over 11 years isn't terrible if you have some extra money and it helps. I don't tend to have that much extra money a year.

I'd never met a doctor who was quick to refer, mine have all acted like it costs them personally to make referrals. I know people whose doctors actually send them for treatment though, so I know those doctors exist.

Roy,I would like to apologize to you about what I ...



I would like to apologize to you about what I feel was an unfairly judgmental comment that I made about "contracts."

I listened to the beginning of the podcast again and it is clear to me that you would not terminate the patient *unless* they did NOT give you a chance to intervene.

That makes more sense to me and I do see how the threat of losing your doc can make one tow the line.

I spoke more out of my emotion than reason because I did have a therapist terminate with me after a suicide attempt. We did not, however, have any kind of contract or agreement. I have had three therapists terminate me and although this was many years ago, it still hurts. I did not have a contract with any of them and have never had a psychiatrist fire me.

Last summer I did call my doc after taking 10 times the normal dose of a drug. It was hard to stop and pick up that phone but somehow I did it. Speaking for myself only, of course, when I am suicidal I get into a kind of "zone" and it is hard to interrupt bad behavior like cutting. It is even hard to see my behavior as bad! My life was also saved by a woman at Hopeline and by my doc when I was in possession of loaded weapons.

It is scary, now that I am not in that "zone" to see that by a razor's edge only am I here today( no pun intended!).

So, a couple of questions/things to contemplate.

1) Have any one you used a psychiatric advanced directive with a patient? Unfortunately, one would have to write that up BEFORE the person is/gets in crisis, but it makes sense, being a positive mandate rather than the looming threat of being terminated.

It would seem that if one believes that committing suicide is the act of a mentally ill person, one cannot hold someone accountable for something they did while not sane. Maybe I am getting the legal and medical definitions of insanity confused.

2) Has a patient ever asked YOU to enter into a contract? Yes, I know this is crazy, but I tried to get my doc to "promise" he wouldn't die or leave me (he is 62). He, of couse said "no." I told him to "pretend" that he could promise that and he said "no, because you would get mad at me later for lying to you." (sigh)

3) Does the "I will terminate you if you kill yourself without giving me a chance to intervene" rule come from a desire to avoid a patient "breaking your heart," and if so, is that professional?

Also Roy, I mentioned the lack of aural clarity on the podcast not so much as a complaint as an observation because I know you'd want to know. I listen on headphones which might explain my hearing that which others don't.

I (heart) all of y'all!


I think that unfortunately, people got used to pay...


I think that unfortunately, people got used to paying very small co-pays. Manged care was a good idea at first, but the "managed" part has gotten out of control. However, if there hadn't been so much abuse of the fee-for-service system, managed care would not have been needed. It also hasn't helped that costs associated with medical care have skyrocketed more than anyone could have anticipated.

People are going to have to take responsibility for their health care and how their health care dollar is spent. I think this is a good thing, it's just that we as Americans got lazy.

I have a friend who has no medical insurance yet has a huge house. Other people would rather spend money on SUV's, fancy vacations, and huge houses rather than set aside money for health care expenses. I do not begrudge the $190 per session I spend on my psychiatrist. I am grateful that my therapy is free since I work at a University and my therapist is the counselor. I figure I am still saving money because weekly therapy would add up to more than $190 a month.

When I see my doc, I get about one whole hour. I'd rather have that time with him than the 5-15 minutes I had with my psychiatrists when I paid a cheap co-pay and my insurance paid the rest. I mean, how do you treat MDD and borderline and GAD in 5 minutes?

Also, we all know that the illnesses that are killing Americans are PREVENTABLE! I am saying this and I am overweight, but I am trying to lose weight. Even though I have bee acutely suicidal, I have no desire to meet my demise by stroke or heart attack.

RANT: It has recently started to make me RAGE when I hear of a sick kid with some weird illness or twins conjoined in a weird way from another country come here and get everything free. Yes, I realize that surgeons are learning important things and that they do wonderful humanitarian work, but when so many kids here don't have medical insurance or get inadequate care, I think it's almost a crime. Yes, I know charities contribute to costs, but what about our poor kids here?


Violet,I think part of the problem with Ontario's ...



I think part of the problem with Ontario's health care system is that FD's are quick to refer out a) to take work off their own hands and b) to give other people work. The truth of the matter is that if a person is ill enough they will pay any amount of money to get better.
In the case of my own psychiatrist, I've calculated that it would have cost me about $40.000 over the last 11 years. Am I glad that OHIP covers psychiatry, most definitely. Would I have paid the money if OHIP didn't cover? yes. But then again, I'm the exception to the rule, rather than the rule itself.

Roy, I read this and it occurred to me that my ent...


Roy, I read this and it occurred to me that my entire family's medication out of pocket costs are less for the year than my hairdresser. Umm, much less...all those chemicals. Oh, I didn't figure Max into this, but I think still....
It kind of irks me that I pay a fortune for the hairdresser and am still expected to leave a big tip. And now she has me using some caviar conditioner to compensate for all the chemicals....
Can I get a tax-deductible hair care flex spending account?

Roy - Thanks for writing that comment....when I sa...


Roy - Thanks for writing that comment....when I say medical FSA, I mean HSA. That's what our hospital has.... We also have the ability to use an FSA, which I have not taken advantage of, but should - and perhaps after I meet with this financial advisor (upcoming...once he returns from vacation), I will setup an FSA when the opportunity next rolls around. At our hospital, for insurance we have an HSA, a BC PPO, BC HMO, Aetna POS, Aetna HMO. I don't think I could ask for anything better than those options, aside from working for the government! We have an additional clause on our insurance, however, which is that the copays are different if we go to providers in our hospital system, versus providers that are still in-network for whatever insurance, but not in our hospital system. For hospital stays, if you go to an outside hospital, there is a $2000 deductible and then you have to pay 20%. I had a hospital bill once that was $100,000 (oh....I didn't get that bill - the insurance did!), and if I was at an outside hosp, that means I'd pay my $2000 and then 20% of that - couldn't do it! My AVN doc is in a different system, and now I can't go to him any more. My hospital has the best orthopedics department in like, the world, but they don't have specialists in AVN. I trust them, but I liked my AVN doc - however, I couldn't afford further surgeries at the outside hospital with the current plan. It's a high incentive to stay within the system for major things! I do have a few docs in other systems, including my OB/Gyn (annuals are free with our ins....and when it gets to the point where I need the OB part, I'll have to go high risk anyhow, and will come inside the system), psychiatrist (I pay out of pocket - but a VERY reduced fee...), and rheumatologist (no biggie - don't need hosp care, so it's just $5 more for the copay...).At any rate, thanks for differentiating between regular FSAs and HSAs.Re: payment. It's all about who has to suffer up front, isn't it? If the responsibility is on the patient to pay up front and then be reimbursed, then fine - but they have to be able to afford the up front costs without taking out a 2nd mortgage. And because medical costs are so inflated due to restrictions placed by medicare and insurance companies, the average person cannot afford to pay up front. Until the prices come down to a reasonable level (I'm not blaming docs for the inflation - everybody is at fault on some level...), most people cannot pay up front. One appointment is fine. But for everything? It can take awhile for the reimbursement to happen.I know this is awful, but when the insurance pays, they pay their percent. If you have a kickin insurance like I do, then you don't have to pay the difference. If you don't, then that's unfortunate. (What I will have to do when I go to the dentist in May...) But far better to pay the difference than to have no insurance coverage at all. If I had to pay up front, then the insurance company would only reimburse ME at whatever low percent. What really burns me up is that insurance companies can say they will only pay X% of the costs, but get somebody without insurance, and they can't say, "Sorry folks, I'm only gonna give ya 50% of this one!" Oh no...the hospital/doc/whoever will go after them for 100% unless there is some forgiveness. It's not very fair, is it? I'm talkin people who can't afford insurance - not those who can, but choose not to have it. Those people irritate me because they end up costing the rest of us a lot of money, when they could have afforded insurance but chose not to.Now - why is it acceptible that patients shouldn't have to take the hit up front and docs shou[...]

Thank you for all the comments.I added a filter to...


Thank you for all the comments.

I added a filter to quash Dinah's fridge motor, so it did muffle our voices a tad. Next time, Dinah, we either go to a different room or unplug the fridge.

Lots of thoughts on tx contracts. Thanks. Re: FSA's... here's how mine works. I have a PPO *and* an FSA. I pay my portion of the premium for the PPO, and pay co-pays, which I then submit to get reimbursed by my FSA. Since the FSA money is pre-tax, it's like I am paying 60 cents on the dollar for a copay. Also, since the separate monthly RX premium was $150, and I'd still have to pay RX copays, it would have cost us over $2400/yr for meds (that's AFTER I would have had to make $4500/yr to have after-taxes $2400). Fortunately, our meds are only ~$200/mo. So, I set aside $2400 PRE-tax money, and that is used to pay for our meds. Since my take-home on $2400 would be around $1500, I am only out $1500 for $2400 worth of meds. THAT's the value of an FSA. They are almost always paired with your regular medical coverage (as compared with an MSA or an HSA, for which it all comes out of the account, and catastrophic costs are covered by a high-deductible health insurance policy).

Oh, and paying your doc *directly* would probably improve health care, as your doc wouldn't have to hire an army of clerks to track down the money, thus she wouldn't have to see a pt every 7 minutes just to make ends meet. Also, the closer you pair a stimulus (money) to a response (health care service), the more the response is affected.

Think about it... try this experiment: Tell your hairdresser that instead of paying her full price (and tipping her) after each hair visit, you are going to give her only 50% of what she charges everyone else. But in return, you promise her that you will ONLY go to her for all your hair needs. Also, after each visit, she will have to fill out a form to request her payment, mail it somewhere, and she may have to make a few calls or resubmit it occasionally, and then her money will arrive within the next three months (unless she uses the wrong hairstyling code). Try this experiment, and then tell us how you like your hairstyling visits -- and the results -- over the next 12 months.

Dinah - I think it's called China King, but the me...


Dinah - I think it's called China King, but the menu is in the drawer in the kitchen, and I've already come to my room for the night! I got a small order of sweet and sour pork (with white rice) for $4.19. ($3.95+tax) Not bad at all! :) I think you can look my town up based on sitemeters/google analytics, but if you're ever up in Philly and want a list of new places to try that are a train/short walk away, let me know! There are some very nice ones close by - all ranges of prices. My town is great for me (recent college grad/just starting out) because even though it's smack middle of the Main Line/Lower Merion School District, it has areas that are not reserved for the super-wealthy. My apartment complex is so nice....I pay more than I would like, but it is worth it - they keep the place up well, and it's so close to everything I need. Much better than my commute into the city from Downingtown, which is where I'm from. (Gotta love Downingtown,'s the home of the Blob diner...even though they tore the diner down a few years ago!)I meant to ask - was the lab a qwest diagnostics lab? (sp?) I went there once with a script from the doc, and they got all huffy that it wasn't on their particular lab slip. One thing that annoys me is when I go to the doctor and they automatically fill out the Qwest slip. I prefer to get my labs done at my home hospital so that I have access to my results (and can print if they are not sent to the MD) and can get it done while I'm at work. I also like that all my labs are done at my hospital so that I can see the trends - my doctors don't have to wonder what this level was like a year's in the system. All my radiologic films are done there, too...and because of the AVN, I have a lot of those! With my insurance, I don't pay for bloodwork. I'm not sure if I pay if I go to the "wrong" place once I have a script. I always go to my hospital, and it's free if I go there. It's also free if the doctor draws it in the office. My internal med doc has labs drawn in her office, and I never paid for those via my plan. My health insurance is also pre-tax. I don't use the FSA, but I think when you do that, you have to use that exclusively...can't have the PPO as well...but I'm not sure.I used to run into regional problems when I lived in State College. (Penn State) One of the things that happened was I had a few emergency room visits - one for extreme hypotension on verapamil (60s/40s...woot) and a few for headache, including my first full-out cluster headache. I was on a PPO from my mom's work - and she works for a public school district, so it was good insurance...same thing I'm on now, but cheaper copays. However, the hospital in SC was out of network, but emergency visits are covered. They paid for one headache visit, and then another one awhile later, they did not pay. They said that it didn't qualify as an emergency.This prompted a few hilarious phone calls with reps in a big tall building in Center City Philly...(you know the one...) First, the guy tells me that in the future, I should go to a hospital that is in-network. I tell him that there is only one hospital in Podunk, Pennsylvania, and he says, "Only one hospital? What kind of place is that?" hahaha.....never been outside the city much? mom and I both get on the phone with another rep to continue to try to fix the problem. Now, I will admit that I tend to have a bit of a short-fuse at times when people are giving me a hard time over the phone with things. Not people I know.... Just like, when I have to call the insurance company or the repair people at D[...]

Sorry for the misunderstanding, but I have medical...


Sorry for the misunderstanding, but I have medical insurance (PPO), AND use the FSA for unreimbursed medical expenses such as co-pays or necessary medical stuff that either isn't covered or isn't completely covered. This money is also pre-tax so I don't pay income tax on it.

I use it for co-pays, my shrink, and this year I know I will be using it to get my wisdom teeth removed (yeowch!).

It worked out well last year when I only had $600 taken out, but I used that all up within a couple of months!

You MUST use the money within the plan year or lose it, so you have to be careful. I knew a man who budgeted for lasic, then found out he wasn't a candidate (pupils too large). He had to hurry up and buy glasses and contacts to use the money he had budgeted before the end of the plan year.

I found the list of reimbursable stuff pretty inclusive. I can get my Prilosec, Advil and other OTC reimbursed. Stuff like teeth whitening products and feminine hygeine products are not covered, however.

Once you start the deduction, you can't stop it, just like other changes such as health insurance which can only be changed during "open season" or a life changing event such as marriage, divorce, or birth of a child.

Your human resources department would be the best place for more info.


violet: Oh, I see now. My brother (who's an econ...


violet: Oh, I see now. My brother (who's an economist) has a fancy term for this, but it essentially means that anything provided by society for which the individual doesn't pay their full cost at the time of service will be overused if unregulated. Like how farmers will over-graze public lands if unregulated.

Woo-hoo! I feel special!I suppose, though, that be...


Woo-hoo! I feel special!

I suppose, though, that before I go feeling too special, I should download the podcast. Oh, and maybe also listen to it...

[aside] I would like blogger to give us a bigger c...


[aside] I would like blogger to give us a bigger comment box![/aside]

Hmm patient contracts is an interesting topic. My professional experience with this sort of thing is in relation to methadone contracts at pharmacies - these include clauses on behaviour while in the pharmacy, timing of visits, the deal when scripts expire/patients turn up intoxicated/doses change/payments etc.

These sorts of contracts help us to identify patients who are struggling and also make sure pharmacy staff are protected both legally and (to some extent) personally.

Although all patients sign these contracts before they are allowed to dose at the pharmacy, we only make use of them when we have problems. For example, the contract states that dosing times are 8:30-10:30am and 4-6pm. In practice this is rarely adhered to. In the context, it really doesn't matter to me what time they come in for their dose. I try to serve everyone (methadone or other patient) in the order they come - they just may have to wait longer if I'm busy.

However having a contract that a patient has signed with these times on it is useful for me when an abusive and complicated patient repeatedly turns up 10 minutes before closing, with $500 owing and no valid prescription, blaming me for everything that is wrong in their life - I have a piece of paper that the patient has signed, detailing the behaviour required on our program.

I think the reason it works and we have a mile long waiting list, is that the pharmacists are willing to do what we can to help a patient stay on the program. The contract is a useful standard for when we have serious behaviour problems. It's probably also worth noting that patients who are expelled by us, are transferred to the closest hospital clinic dosing centre. They aren't just left in the gutter.

As a patient... well I think that I can see situations where some sort of contact would not be out of order - my doctors both always have emergency waiting lists - if I can't make it to an appointment at the last minute, that appointment will be extremely valuable to another patient. If I turn up to my appointment in the nude, that may be disturbing to others in the building (not to mention myself!). If I threaten my doctor or receptionist or don't pay my bills or regularly turn up late and expect a full consultation... all these are behaviours that a doctor can reasonably request a patient refrain from.

When it comes to treatment-related contracts... hmmm tricky. I am not a particularly compliant patient. And my honours project was on the topic of compliance (hah!). I think that a certain level of co-operation can be required of patients. But there's a difference between ceasing a medication because the side effects are driving you nuts and simply not taking it because you don't like the idea of taking medicine. When you seek medical help, I think it could be reasonably assumed that medication may be a part of your treatment. The same principle can probably be applied to some branches of therapy.

MWAK: I meant in Ontario, because my (former) doc...


MWAK: I meant in Ontario, because my (former) doctor wouldn't refer me to a psychiatrist. If I had enough money I could go to a psychologist, but no referral to a psychiatrist (who would be free). We have reduced access because it is free.

It depends on the PCP though, because some don't have problems making the referrals. And when I went to a hospital I was allowed to speak to a psychiatrist, but I only got to speak with him that one time. Not that I went back to try to talk to him again, he made some referrals for me, so I'm just waiting.

Since everyone keeps bringing up FSA's, I wanted t...


Since everyone keeps bringing up FSA's, I wanted to set the record straight. The only benefit of FSA's are your tax savings. Whatever you set aside doesn't get taxed. That is why you need to have a good idea of what you are going to spend that year so that you can end up saving hundreds to thousands of dollars of taxes from being taken out. Google an FSA calculator to see what I mean. Being allowed an FSA is a great thing in my opinion.

I really wish I could type!!! Argh!

I wouldn't think that you'd get better care for pa...


I wouldn't think that you'd get better care for paying doctors directly. In my experience, even patients who have Medicare/Medicaid (our government sponsored health insurance for the old/poor/disabled/etc.) get excellent care. I never think about whether a patient has insurance or how they pay when making patient care decisions; we decide what's needed and have the social workers figure out how to get it paid for. Our patients who don't pay get the same medical care as ones who do. People with insurance, people who pay privately, people who can't pay all get the standard of care (often more than the standard of care). The biggest differences are things like you can't have tv and phone service in your room unless you can pay, and our non-paying patients end up getting seen in an inefficent clinic and may have longer waits, and don't see the same doc all the time. I'm not saying that that's right, but it's not as bad as most people from other countries with real health care systems imagine.

This may be easier to do during pregnancy, because it's always easy to find a way to get stuff paid for; and working in an academic institution does free you from the reimbursment chase a bit (although it pus you in the research chase).

Rach: I think we would get better care if we paid ...


Rach: I think we would get better care if we paid the doctors directly. However, I would probably just give up seeing doctors if I had to pay for it, unless it was reimbursed. I haven't seen an opthalmolgist since Ontario delisted eye exams.

I'm not sure why I think we'd get better care, maybe because doctors would probably be more accessible, since there would be fewer of us going to doctors, but I'd likely be one of those people who wouldn't get any medical care anymore.

Anyway, I do like not having to pay, even if it is extremely difficult to get doctors to listen to me. I should just try being more demanding, though the one time I tried that I was told to find myself another doctor. And it's not like I was rude or anything, all I did was tell her that I really was depressed, and I needed help. She disagreed I guess.