Doogie, you're making me panic

Sometimes I blog because I want to share something fun.

Other times, it's because I'm really passionate about the topic and I want to throw my two cents in. Today, though, I'm writing because I'm frustrated. Today is the latter.

I'm caught in between two doctors' offices and it's increasing my anxiety. (You'll see below why that's ironic.)

For years, I've had panic disorder. I was lucky enough to find an outstanding psychiatrist in the Houston area, where I lived, who has been treating it ever since. This doctor (we'll call him Dr. S.) has been nothing short of amazing; he is published and well-regarded in his profession. He has seen me every three months (at least) since 2001. And in that time, he has gotten to know me as a person. More importantly, he's been able to tailor my treatment to me, not just a random patient.

So I was more than a little disappointed when I learned this summer that he had hired a physician's assistant to basically take over his practice. Dr. S. had been asked to be the director of a mental health facility, which is a great thing for him, but not so good for me.

You see, in the intervening years, I left Houston and have been commuting every 90 days to his office in Houston just for a 15-minute visit with him to make sure my medications were on track. While the P.A. would continue writing the prescription, I missed the interaction and the specific knowledge Dr. S. has about me.

I returned to Austin after my last visit with a reluctant determination to find a new psychiatrist. My insurance carrier has about 20 psychiatrists listed, but most of them (16 or 17) are all in the same office. A search of reviews for an outstanding physician led to a short list of people who got glowing feedback but who didn't take insurance. So, in an act of bravery and desperation, I set an appointment at the mega-office that accepted my insurance.

I should have known I was going to have an interesting ride when I Googled the new doctor. Turns out he graduated medical school last year. Of course, everyone deserves a shot, but I really didn't savor the idea of going from a seasoned leader in his field, to Doogie who was still in residency.

When I got there, my worst fears were realized. Although Dr. S's office had sent over my diagnosis, medication list and medical history, the new doctor (we'll call him Doogie just for grins) insisted in doing everything by the book. My 15-minute appointment became a 90-minute interview where he asked about any and everything. He asked if I had ever heard my toaster or my TV talk to me; if I had ever been homicidal; if I had ever been in legal trouble. I understand the need for a work-up, but I really didn't need a complete re-diagnosis. That's why I had the existing paperwork sent over.

Doogie ended the interview by telling me that he wanted to change my medication.

You see, I have been on the same regimen, more or less, for 10 years. I take 10 mg of Lexapro a day, and 2 mg of clonazepam three times a day. (Note: This is a high dosage, but it's what Dr. S. and I carefully worked up to and decided would work best for me. Also, you should know that clonazepam is chemically related to Xanax, but is also used for treatment of seizures aside from panic disorder. Recommended max dosage for panic is 4 mg a day, and for seizures, 20 mg a day.)

I was pretty firm that I had found a combination of medication that suited me and treated me effectively. Doogie left the room and returned with more resolve. He told me — in a combination of resolve, tact and intensity — that my dosage of clonazepam was entirely too high. Clonazepam, he said, has a max dosage of 4 mg, so the level I am at is entirely unsafe, and that missing a dose could lead to seizures or death. His plan was to remove the clonazepam (over time) and double the Lexapro dosage.

After telling him that I was aware of any dangers associated with clonazepam and had accepted them after 10 years, he still kept on and wrote a prescription for 20 mg of Lexapro and a "temporary" 30-day supply of 2 mg. clonazepam pills.

I had barely hit the outside of the building before I was on the phone setting an appointment with Dr. S's P.A. back in Houston.

I respect physicians (even new ones), and I know that psychiatric treatment can be subjective. I also know that Doogie was just practicing what he had learned in class and from the book; I know because I have the same Merck manual.

Where I feel disappointed and frustrated is that he didn't even take my specific, individual case into account. He simply was doing what the book told him to, and quite frankly, a computer could have done that.

Now I am forced to make the trip to another city to see a P.A. because a new provider won't listen to me.

At some point, I'll try another local physician, but now I'm scared that I'll end up dealing with the same situation. And that will make me panic.