You could cut the irony with a knife

I’ve been off my Lexapro for a month and it turns out that’s bad.

Sometimes my patients have crippling anxiety.

When they do, I’ll take a few minutes to rule out other causes, report it to my preceptor, and they’ll breezily tell me “Fine – write a prescription for Zoloft, Lexapro, or Prozac – whatever you feel comfortable with. Do you know the dosing?”

Lady, you have no idea. By the way, I would also like a refill for myself.

… but for the life of me, I can’t find someone to take 10 seconds to write one for me.

I don’t feel it’s alarmist to say this is a problem.

I’ve been pretty open about my anxiety / depression. It’s been a non-issue for the last 4 years because my med school had outside psychiatrists.

But I’m not in med school anymore, and there are only a certain number of times you can refill a prescription from out-of-state without a visit – and I’ve gone way beyond that.

So now what?

I could set up an appointment at my current hospital, but I have to do a psychiatry rotation with these same attendings, so that seems… short-sighted.

I could call around at one of the competitor hospitals, but they’re all far enough away that I’d have to ask off work for “medical reasons”, which is a bit of a death knell. And why would they even accept our health insurance?

They probably don’t.

(Or maybe that’s just me making lame excuses? I honestly don’t know. My anxiety has ramped up to the point where the thought of just finding a phone number and calling someone is so mentally and emotionally exhausting that it’s impossible to tell.)

The thing that kills me (and the reason I’m writing this blog post at all) is that I know I’m not the only resident with this problem. I can’t be. Depression and anxiety are way too common – and the 80-hour work week and infeasibility of accessing your own hospital’s psychiatrists have to make this a global problem.

In the mean-time, there I am: taking a total of 10 seconds to jot down a prescription, then sitting in the corner anxiously twirling my pen and grinding my teeth.

Medicine sure can be stupid.

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23 thoughts on “You could cut the irony with a knife

  1. Action Potential, please take care of yourself. I believe that I can speak on behalf of your fans and say that we are concerned about you. Despite your integrating humour into this condition (which I believe is a strong trait for any health professional), this is serious (you know) and just ask for help from the attendings at the psych department.

    If you’re worried about having a rotation there after being one of their brief ‘patients’, then you can ask before hand, “hey Dr Psych, do you think anything strange of a resident coming to you for help and follow up this visit as a non-patient (actually employee) person?”

    I’m SURE this situation has been dealt with before. Like you said, anxiety and depression in the medical profession IS extremely high. My understanding is that female doctors in general suffer from anxiety and/or depression 200-400% more compared to females in other work professions (Aus stats). The point is that it is verrrrry high and you know it! So you’re obviously not alone, and most likely not the first to have this happen (i.e. having a rotation at the same place as seeking medical advice/attention, whatever).

    Again, please take care of yourself! This may sound selfish, but I REALLY love your blog. It’s inspiring me and motivating me through uni – and hopefully then into med as well.

    • Thanks. I mean, it’s a weird situation – I just dislike the idea of mixing my personal and professional lives to the degree that I’d be working with someone who 1) has to evaluate me professionally and 2) knows I have anxiety / depression. (That psych rotation I have to do.) It just seems… short-sighted.

      But you’re right. And thanks so much for the comment – that makes my day. I always feel like I’m sending these posts out as messages in a bottle, haha – somehow I’m always surprised to hear people say they’ve been following it! 🙂

      • I totally (Aus spelling) understand what you mean. And okay then, I’ll improve on my responsiveness if it means that you’ll continue sharing your journey. By the way, please excuse that awful grammar and spelling. I really need to start proofreading my writing.

  2. Obviously I think the best thing is for you to get a new psychiatrist but I totally understand your hesitation. Can you ask another resident “hey I’ve been on a stable prescription of lexapro x mg that just ran out. Can you write me new script?”. They’d know it was for depression and/or anxiety but you don’t have to go into details. Do you have another resident you can ask and trust? Another option is to get a pcp to renew. I know you’re in a pedi specialty so an adult doc is less likely going to be evaluating you in the future. Please take care of yourself.
    Sophia

    • Interestingly enough, we don’t have paper pads – our hospital is 100% EMR (some prescriptions still have to be done on paper, but they can only be ordered through the EMR).

      I accept that this is both an objectively very prudent, good idea… even though it happens to be detrimental in my particular case. (If we had paper pads, it’d be easy! I can think of a few different people who would’ve done it without hesitation.)

  3. I had read your posts about mental illness when I was in college and didn’t think much of them (because I was FINE and just needed to try harder), but I’m an overwhelmed and unhappy medical student now, and hoping to see a psychiatrist soon. I really needed to re-read these posts right now. Thank you for being so open – you have no idea who you might be helping. As others have said, please take care of yourself! You are worth it.

  4. You raise some really interesting points. Thank you for being brave enough to share them. So can we access the help we will need as junior doctors, in small towns, without being afraid of awkwardness with the treating team during our future rotations? Isn’t it seen as responsible and resourceful to seek treatment for our ailments, so we are better able to focus our energy back on our patients?

    • As is usually the case, the ideal goal and the practical reality are separated by about fifty miles of roadblocks. You’re right though, of course. It was just so much easier in medical school when they had an easy phone number for us to call to get hooked up with someone who took our insurance but didn’t use our EMR. I just don’t understand why residency programs wouldn’t want to make this kind of thing easy to do – it’s in their best interest!

      But you’re right.

  5. Hey Action Potential, ugh that really sucks. I’ve been there too, wanting to avoid the psychiatrists affiliated with your hospital. But you should really look into the psych attendings, they’ve probably dealt with a similar (if not the same) situation before. Sure, it’s awkward, but it’s better than trying to survive with nasty anxiety 😉

    Do take care! Wish you the best!

  6. How about a general practitioner/family doctor. No potentially awkward encounters in the hallway or on rotation and you get the ongoing care and prescriptions you need. Please please don’t write the script yourself or get another junior colleague to do it – you know that’s a risky move for both of you. I hope things improve soon. 🙂

  7. Not the same situation but something to think about. I’m an OB/GYN resident. The health insurance for residents where I work makes it essentially free for them to receive prenatal and delivery care at our hospital. Not surprisingly, I have done lots of exams/delivered babies of lots of residents and wives of residents. Most people consider that area pretty sensitive and “private.”

    Honestly, I have not thought twice about anyone that I have ever seen as a provider and then worked with them as a co-resident in the OR or on a rotation. Sometimes I even forget that I ever checked their cervix in triage or did an ultrasound on their baby. I never see someone and think “she was such a terrible pusher” or “her baby came out with a cone head.” It’s pretty easy to separate my interactions with people in the two different settings. I feel confident that any psychiatrist at your hospital would feel the same way.

    Good luck with intern year. It is a tough year but gets better all the time. Take care of yourself.

    • This was very helpful to hear. Seriously, thank you. You’re right; I don’t really remember any of my walk-inpatients in that sort of detail. (I guess it’s both a blessing and a curse.)

  8. I’ve read your blog before and just saw it pop up on the AMSA email. I’m surprised how much this mirrors my situation so I had to chime in. I’m a medical student and just switched to the school’s insurance because i’m now too old to use my dad’s. Meanwhile my lexapro (yes same thing…just shows you you’re not the only one right!) is going to run out in a few weeks and like you i don’t know how to refill it. The lexapro has been a godsend to me in the last few months and I’m so glad I got the courage to seek help and start taking it. I’m actually about to start my psychiatry rotation and am considering going into psychiatry so I’m currently trying to figure out how to get a refill without ending up on the school’s EMR/seeing a future colleague. Like you said its so ironic how medical students/residents/doctors can have so much difficulty finding time and resources to take care of their own health. And then there’s the other issue that my privacy is only the least of my worries since I also can’t just skip out on a few hours of my day to go to a doctor’s appointment.

    • it’s also really ironic how much I’m rooting for you to get the refill despite everything. Meanwhile, I’ve been hesitant for the same reasons. We always know the right thing to do; but doing it is much harder than advising others… I do hope you have helped yourself the way you would have helped others in your situation. I know that’s the only thing that made me seek help for myself.

  9. Hi there! I am an LMSW in NYS, a social worker, credentialed as a mental health counselor. I would advise from personal experience not to go to your hospital psych docs. There is a lot of stigma with mental health providers having mental illness. I am a social worker and I struggle with bipolar disorder. I currently work in a “peer” run agency and identify myself as both a social worker and a peer when I work with both clients and other professionals. However, I was basically fired from a job as a counselor after telling a coworker I had bipolar disorder. I have been restricted from the psychiatrists I can access because I already have a professional relationship with majority of docs in the area. I am going to a psych in private practice who is very well respected and very professional about serving providers who need care. I suggest that you ask around (perhaps ask social worker/ discharger planner?) for a name of a good doc in private practice. You can then call to make an appointment. There is such a shortage of docs in psych that 4-6 months before an appointment can be made. I would tell the secretary that you are a resident at the local hospital and that you stable, but seeking assistance due to confidential issues. I bet the secretary would talk to the doc for you and get you in right away. You can also go for the primary care route and access whatever primary care that you could normally get…and then try to get a written script. There is not a lot of stigma in using antidepressants… so even if you use the hospital pharmacy you should be okay. My bucket list of meds? My meds scream crazy: Effexor, Lamictal, Seroquel, and Klonopin Lexapro….you will do okay, I promise 🙂

  10. Seriously, good luck… I totally get it. Ironically, I did my clinical fieldwork for social work at the hospital here with the biggest residency program. They had some random clinic for employees so I bet the residents were able to access that for primary care. I bet that if you went through that route for a primary visit, and if they even sent it to the hospital pharmacy, no one would notice. Now if you walked up to an attending and asked for a script? They would notice.
    It was funny that I did my fieldwork for social work at a huge teaching hospital. I was in grad school, was broke, and used my huge universities student clinic for medical care, My university was huge and had counseling center too. I ended up seeing a psych there. He was the head psych attending at the hospital. I saw him in elevator all of the time. Now I work on a special project with that hospital.
    I also went to the counseling center where my classmates were interning, Thankfully my school was so large it had multiple counseling professionals (social work, psychology, student counseling for education, mental health counseling) and they had policies about your classmates not having access to your files.

  11. Pingback: Happy pills | physician

  12. Two possible solutions: what I did in residency was find someone with a small private primary care practice that took cash and she did my meds. Other friends named other residents as their PCPs and wrote for each other, legitimately. Hope it works out.

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