how to plan ahead for, and make the most of, that 15–30 minute med check appt
Medicated For Your Protection
I Forgot Why I Cake Topamax
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This has nothing to do with talk therapy. You’re on your own for that. This is about making the most of 15-minute medication check-up appointments with doctors. If you’re lucky you’ll get 30 minutes. You’ll see a lot of this in Getting Your Medical Records Together section of the article about applying for SSDI/SSI.
The best way I’ve found to look at this is as if you’re writing a script and the scene is in the doctor’s office. But I’m a bipolar writer, so expect the unrealistic. Think of it as whatever works for you where you’re writing something that involves two people talking for 15–30 minutes, and you’re doing most of the blabbing, or the first letter, email, blog entry, etc. on the subject of your upcoming appointment. It could be notes in the form of an outline. But back-of-the-envelope notes, while vastly better than nothing, don’t have enough detail or order to make the most of a 15-minute appointment you get once every three months.
The format is important to give you a sense of how much you have to cover in how little time1, and to organize what you’re saying. Content is more important, but not so overwhelmingly so that it makes format pointless. People get so worried about what they need to say they end up saying it at the end of the appointment, and doctors hate that. It’s little wonder people get crap prescribed if they leave entirely new symptoms for the last-second “just one more thing”.2
When writing your script you need to:
- Say the most important stuff at the very beginning.
- Generally that takes the form of: what sucks most?, although in many cases it can be: what has improved most!
- Be open and honest with yourself and your doctor.
- When you hide things from your doctor you get misdiagnosed.
- When you get misdiagnosed you get inappropriate treatments.
- When you get inappropriate treatments, that sucks donkey dong.
- And it can contribute to becoming treatment-resistant, where nothing works well, if at all.
- When you become treatment-resistant, that sucks syphilitic donkey dong.
- Try not to exaggerate.
- Be as concise as possible, but bring all, or almost all, your notes (see below), in case your doctor wants more information about something.
- While the appointment is supposed to be all about you, the idea isn’t to fill the entire 15 minutes with you talking.
- You want to write for 1/3 to 1/2 of however long your time is. 5 to 7 minutes for a 15-minute med check, 10 to 15 minutes for a 30-minute damn that’s nice insurance checkup.
- Intake appointments typically last only 30 minutes when they often need to be an hour long. They are usually when you’re in a bit of a crisis, so don’t kick yourself for not having your shit together during your first appointment with your doctor.
- Honestly, you’ll probably need help from someone the first few times you do this.
Now that you know why and how to write down3, we come to the hard part, collecting the data that goes into the script.
Since I wrote the first version of this article 12 years ago4 a lot has changed. Back then the idea of keeping a journal of how your meds affected you, especially online, was a new concept to practically everyone who read it. If you’re not now keeping a record of how the meds make you feel, you’ve probably considered doing so. You don’t have to be keeping one online, but you do need to be keeping a record of the meds you take, if they work or not, and what the side effects are like. It doesn’t need to be fancy, and it doesn’t have to be daily. All you really need is:
- Drug name(s) and dosage(s)
- Event: starting or stopping a drug, changing the dosage, your symptoms improve or get worse, a new side effect happens, an existing side effect goes away/gets better/gets worse/comes back, etc.
You can keep the above information on a notepad, a blog, the backs of envelopes, tweets to your imaginary friends. How you record the information isn’t particularly relevant, just as long as you can show it to your doctor.
In addition to meds you need to keep track of how your condition(s) affects your life.
Here’s what Mouse did - she identified key areas, like depression, anxiety, logical thought and follow through. Your key areas will be the same or different:
- How is your mood?
- Are you experiencing pesky hallucinations? Is there a change in their duration or frequency?
- How bad are those anxiety attacks? How long do they last? Are they more or less frequent?
- How are you able to deal with your life? Are you eating regularly? Are the dishes getting done and is the garbage getting taken out?
- Are you and alphabetical order getting along? How many levels?5
You want to organize the list by what is the most important, but just as long as you get something down, that’s what is critical. It’s best to select the sort of things that you and your family and friends can easily say you’re improving or getting worse. Input from other people would be extremely helpful6. Your opinion is the most important, but you can’t judge how you act from inside of you on a lot of things. Trust me on this. You may think you’re doing just fine on things that are a right mess. Before her appointments Mouse grilled me, her friends and her mom on how she is doing with her key areas.
And when weird stuff just happens to you, anything that triggers you, that freaks you out, that sets you off, that causes anything nasty to happen, record that.
Pile of Pills
Vaccines Cause Immunity
Medicated For Your Protection
There are all sorts of tools available to help you track how you feel for various conditions. There are apps, programs, templates7, and blank mood journals you can buy. After browsing it, that book looks pretty good. While it’s not all that difficult for a basic mood chart to be much better than the templates that are available online, what might be worth whatever it costs you at your local store (if they have it), or the nine bucks + shipping via Amazon8, is their version of everything this page is about: getting your shit together for your doctor’s appointment.
There’s also my twelve-year-old method using a binder with pockets and dividers that also have pockets for your meds and a separate journal for side effects and how well your treatments are working, but I finally moved into the 21st century9. If your phone is as stupid as mine, just get a large notepad10, or whatever you like to use to write in, and record how well your meds are working. Or keep a blog, like members of the Crazymeds community do. As long as you have what and how much you’re taking, or however you can measure your treatment(s), along with how well it’s working, or not as the case may be, and any side effects, that is good enough.
The hardest thing of all: Keep the list, and everything else that goes into the script short, as you don’t want to overwhelm your doctor. Which is why I like keeping to a format where you can judge how long it take for you to say everything you have in 1/3 to 1/2 the time your appointment is. You can chart and document as much as you feel like and are capable of charting and documenting, but you won’t know until you ask, or just do it, how much information really is too much. Doctors can suffer from information overload. And too much raw data can make it difficult, if not impossible, to find anything meaningful.
Another method was posted in the old Crazy Talk forum:
Aside from the tape recorder, you might try keeping a small pad with you as an open log, to wit:
8:15 Head swimming 8:37 Feel like screaming, but other personality says no 9:03 Hyper-focusing on the “2″ button on the TV remote 9:59 At 10:00 I’m going to kill myself 10:01 Well, that didn’t work
etc. You can do the same thing with your tape recorder.
You don’t have to keep it very long; if you just keep it faithfully through a couple of episodes, taking careful observations of your own feelings and behaviors (being conscious of your state and taking note of it is the key), it will give a pretty good sampling of how you are in the throes of it. I took such a log and developed a short multimedia cd for my t-doc titled “7 Minutes In My Head.” It was pretty effective.
Dr. Phelps’ article on the subject. While it deals primarily with mood disorders, the tactics can apply to any mental illness.
Medicine Is The Best Medicine
Vaccines Cause Immunity
Mental Illness is NOT Contagious
Medicated For Your Protection
When it comes to side effects, the general attitude at Crazymeds is: stop being such a baby and take your freakin’ medicine. When keeping a record of your side effects for talking with your doctor and insurance purposes go wild with side effect paranoia and complain, complain, complain. Why?
- It’s cathartic. Not everything is the fault of the meds, but when you first take them everything may as well be. It sure seems that way.
- Most people will blame the meds anyway, so write it down where nobody will see it, unless they need to.
- Who knows what is or isn’t the first sign of something important, right? You don’t want to bug your doctor about every little thing, but if you have a record of every little thing and something turns out to be a big deal later on it makes it a lot easier to figure out.
- It’s so damn therapeutic. No, you’re not any crazier than your original diagnosis. No, it’s not all in your head. That crazy med really does make your ears ring!
- As far as disability insurance is concerned, the side effects of medications are sometimes taken into consideration. As much as I dislike gaming the system, as the system is stacked against the mentally interesting, and it’s socially OK to be prejudiced against us, we need every advantage we can get.
- The same goes for arguing with insurance companies to approve coverage for meds that aren’t in, or are in a 3rd or lower tier of their formulary.
BUT… when it comes time to write the script for your appointment, or when you’re talking with your doctor about the side effects, then you need to be as rational as a crazy person can be about side effects. If you haven’t read it already, here are some side effects of all medications, prescribed for anything, you need to call your doctor about immediately. And these are some you should call your doctor about immediately if you’re taking antipsychotics. Actually if you’re taking any drug for anything, but other than high dosages of SSRIs, it’s really rare to get them from anything else. As for everything else, get the opinions of other people who aren’t going to enable you into rationalizing the decision to stop taking a working medication. I have no idea if talking to your family, friends, anyone you know online, or some random person on the train is a good idea or not. People on some websites will be better than others.
You’d think that putting your medical history on your phone, along with a medic alert bracelet as the backup for a missing or damaged phone, would take care of the need for an emergency medical contact. That works fine for someone whose condition(s)11 and history aren’t complicated.
This may seem like a lot of work, but it is well worth it. Organizing your records in a fashion as described above will really help you understand what is going on in the healing process. You’ll see the progress of the meds working, or if they aren’t working it’s not just “in your head” or a question of impatience, you’ll have documentary evidence that particular pills are worthless for you. You won’t have to spend too much time and energy questioning your own feelings. Even if a friend or family member is helping you with this task it will help you feel more in control of things.
Being in control of things is important. Yes, this seems like a total control freak perspective. I’m autistic, you’ll find my picture in the definition of control freak in some of the finer dictionaries. But so many people feel so out of control during the entire process of trying to get their mental illnesses under control, and you can’t afford to be out of control. If you need to be taking meds you’re managing the symptoms of conditions for which there are yet no cures. How can you expect to manage anything if you’re not in control? Are you going to manage the symptoms or is your doctor going to manage your symptoms? Whose responsibility is this illness? If you do something crazy-bad, crazy-bad enough to get arrested, who goes to jail, you or your doctor? The illness is not your fault, but it is your responsibility, like it or not. Unless a patient is living in a hospital, the illness is somebody’s responsibility outside of the doctor’s office, either the person with the illness or a family member.
What’s it like to be crazy? Part of what it’s like is being out of control all the time.
What’s it like to stop being crazy? To start taking control of your life.
No matter who is keeping the records you can avoid two common pitfalls that sabotage recovery:
- Letting doctors bullying you into continuing a medication that is just not working.
- Giving up on a medication before it has had a chance to work, or upping the dosage on a med to quickly before it has had a chance to work.
You don’t have to be pushed around. Remember, the doctors work for you. But good employees will sometimes require documentation before just going off and doing something.
Take control, get organized and keep taking your crazy meds.
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The Bipolar Disorder Survival Guide David J. Miklowitz, Ph.D © 2002. Published by The Guilford Press. Living Well with Depression and Bipolar Disorder: What Your Doctor Doesn’t Tell You…That You Need to Know John McManamy Bipolar Disorder For Dummies Candida Fink M.D., Joe Kraynak Can Online Consumers Contribute to Drug Knowledge? A Mixed-Methods Comparison of Consumer-Generated and Professionally Controlled Psychotropic Medication Information on the Internet Shannon Hughes, PhD; David Cohen, PhD Journal of Medical Internet Research 2011 vol. 13 (3):e53 Talking to Doctors James R. Phelps, M.D. PsychEducation.org 1 This is why the script format is great, but totally useless for most people. The super-wide margins with the characters' names on top of what they say and so forth equate to one page a minute for dialogue. If you know how your doctor talks you can actually write a script for close to exactly 15 minutes. Extremely few people would be able to use the script format for their appointment "script." But budding screenwriters might get a kick out of trying it.
2 Doctors hate patients who do this. So not only must your doctor make a snap decision, they must do so while being really annoyed. With you.
3 Or say it into your phone prior to going to your appointment. Who needs fancy speech-to-text software, right? Doctors who deal with brain cooties are used to weirder stuff.
4 First published in 2002 on my then bleeding-edge non-anonymous bipolar-epileptic-autistic blog. About a year prior to Crazymeds going up. That's right kids, Crazymeds has been around since November 2003.
5 I discovered this to be an excellent indicator of my cognitive abilities. While I'm usually OK at alphabetizing things by the first letter in their title, when it's down to the second or third I can get very lost. I have lots of books and records. They get rearranged. Have you read or seen High Fidelity? Apply it to books.
6 Which brings up the usual question I have: how does someone with extreme social anxiety/avoidance/phobia get input from other people? Even if you don't have a problem with other people, other people may have a problem with your brain cooties. I have no idea how often I was having short-duration absence seizures at work. I didn't even know I was having them until Mouse asked me about the ones I was having when I was working from home. I'm not the one to ask where the line is when asking people about how crazy you've been acting.
7 All the ones I could find for bipolar disorder suck donkey dong. Most are on a scale of 1 to 3, anything more than that have few, if any other symptoms beside mood. The only one with a 1 to 10 scale had hours of sleep. Among my ever-growing list of things to do: publish my mood chart, which allowed for physical symptoms, mixed states, ultradian rapid cycling, differentiated between euphoric and dysphoric manias, and had metacycles. The truly
self-absorbed self-aware observed physical changes besides how much sleep we needed, and were aware of acute mood cycles within chronic mood cycles.
8 As I write on the Revenue page and elsewhere, if you buy anything via Burning Mind Books or other Amazon links from this site I get a miniscule commission - somewhere in the neighborhood of 25¢ to 50¢ for a $10 book - and prefer you support your local bookstore and buy it there. Ad revenue has plummeted so much that I'll prostitute myself for less than what Jean Genet's whores charged if you can't find the book where you live.
9 Translation: Between the meds and being treatment-resistant I can't even eat consistently, let alone keep detailed records like this any longer. I'm lucky my meds change infrequently, and the only thing I need to keep track of now is dosages adjustments.
10 I prefer using 14-inch long legal-sized note pads. Which are getting difficult to find.
11 "Condition(s)" in this case meaning what you deal with on a daily basis, which may or may not have any bearing on whatever medical emergency you find yourself in.
How to Talk to Your Doctor by Jerod Poore is copyright © 2002, 2014 Jerod Poore
|Last modified on Monday, 18 April, 2016 at 15:53:26 by JerodPoore||Page Author: Jerod Poore||Date created: September 2002|
All drug names are the trademarks of someone else. Look on the appropriate PI sheets or ask Google who the owners are. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of any trademarks may have changed without my noticing.
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Almost all of the material on this site is by Jerod Poore and is copyright © 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, and 2016 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList,
NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Crazymeds is optimized for ridiculously large screens and browsers that don’t block ads. I use Firefox and Chrome, running under Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
Crazymeds now uses a secure server, but it is not so secure that you can discuss anything having to do with nuclear power facilities, air traffic control systems, aircraft navigation systems, weapons control systems, or any other system requiring failsafe operation whose failure could lead to injury, death or environmental damage. Just so you know. So if you’re mentally interesting and have a job that deals with that sort of thing, talk about said job elsewhere. Otherwise feel free to discuss your meds and brain cooties.
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.
* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.