FUCK

[baratron]

Don't read this post if you are offended by swearing, because I am too upset to find politer language.

I had a fucking horrible experience this evening. I ran out of Efexor yesterday. Having been for once in my life organised, I had handed in the repeat prescription request on Monday night/Tuesday morning, and therefore expected there to be Efexor waiting for me at the pharmacy today.

HOWEVER. Allegedly, some "doctor" decided in her infinite wisdom that I couldn't have any more Efexor, even though I still had one repeat left before a review was due, because I hadn't had my blood pressure checked in a while. Never mind that I've been on it for, like, 10 years at this point, and if it was going to affect my blood pressure we'd have known that by now. Never mind that it is a drug that you must NEVER stop taking cold turkey because your head will explode. (Look up venlafaxine withdrawal syndrome sometime. It isn't pretty.)

So, this alleged doctor issued the prescription for everything else except Efexor, WITHOUT TELLING ME. There was a post-it note on the prescription to tell me I needed to have my blood pressure checked before more could be issued. At 5.58pm I had to cycle round to the surgery and bang on the door to get them to sort it out.

I say "alleged doctor" because there was a mistake on the prescription too. I'd asked for Flixotide aerosol inhaler 250 micrograms, and had been issued not only that, but also 2 x Flixotide powder inhalers 100 micrograms. Which is a bit of an administrative-type mistake, really. It's true that I have had the same drug in multiple administration methods in the past (e.g. sodium cromoglicate in both eye drops and nose spray), and it's also true that you can get fluticasone both for asthma and for nasal allergies - but these were both asthma inhalers, and surely no one would want the same drug for the same condition in two different types of inhaler? In fact, I have a vague feeling now that I might have crossed out the Flixotide powder inhaler 100 micrograms and written alongside "Please remove this from the repeat".

I am totally and utterly pissed off. If I need a fucking blood pressure check before issuing a medication, then someone at the surgery should fucking well phone me. You have my home number and mobile number. The prescription goes straight to the pharmacy, how was I supposed to see the note? And you, the doctors' surgery, get annoyed if patients order a repeat prescription too far in advance of running out of pills, because "we're not supposed to stockpile". Surely it was pretty obvious that I only had a few days' worth of pills left on Tuesday? A brief check through my medical record would show that I have been depressed on and off for a very long time, and that it's likely not safe to have me manage without even over a weekend.

And then! To top it off - the fucking doctor who I spoke to decided from nowhere to hassle me about the dose of Efexor that I'm on, because "it's very high". Once upon a time, 225 mg of Efexor XL (the extended release form) was the highest recommended safe dose, but that was years ago. Nowadays people can take up to 375 mg in situations of severe depression. Rather shocked to be randomly hassled, I said "actually, it's not that high - I know people on 300 mg and 375 mg, and this is the extended release version". Bear in mind that I didn't even know she was a doctor at this point. She said "Never mind them, you should reduce the dose for the sake of your health. It comes in 32.5 mg capsules". I just... stared. I said "I've been on this dose for about 10 years and haven't had any problems with it". And she replied "Oh, that's a very long time to be on such a high dose. Reducing it even by 32.5 mg is better for your health".

I said "The overall plan is for me to increase the dose of my mood stabiliser and then gradually reduce the dose of the Efexor. But I am not well enough to reduce the dose of the Efexor yet". And she said "Not even by 32.5 mg?". And I said "NO. Actually I've spent quite a lot of the past couple of weeks wanting to be dead, I don't think my depression is controlled enough to come off it." And then I walked out of the surgery without challenging her because I was already in tears, and cycled round to the pharmacy and cried there (which was ok because I know everyone in the pharmacy).

(She is also wrong - the smallest capsule is 37.5 mg, and you can't get those in the UK to my knowledge. Efexor non-extended release pills can be obtained in 37.5 mg, but they also give me terrifying ultra-rapid mood cycling.)

I was just fucking flabberghasted because she had literally met me under 5 minutes ago and knew NOTHING about my mental health. She said she has 30 years experience as a GP. If she has 30 fucking years experience as a GP then she should KNOW that you can't FUCKING change a patient's dosage of medication without knowing what their health is like! And I didn't understand this generic reference to "health" anyway. Efexor is a strong and evil drug, sure, we know this - but my health is a combination of my physical and mental health, and I am willing to endure a fair number of side-effects for improved mental health. Having me able to think and function and work and study is worth the possibility of a medication, say, lowering my life expectancy by a few years. I see it as a tradeoff between having a shorter life that is worth living and a longer life that isn't.

Funnily enough, my blood pressure has been absolutely boring for years, but it's now through the roof. I can't think why.

I need to write an official complaint. If anyone can help with that please do so in comments, I feel too sick right now to deal with it. Random hugs are also okay.

Comments

[ailbhe]

Oh, you poor darling.

You poor, poor darling.

I send you virtual octopuses[podes], and also I will try to help with that letter - if you like you could write a rant letter and I could make it a polite but firm letter, or something.

[baratron.livejournal.com]

It's the out-of-context and generic reference to "health" that gets me most. I'm really not understanding how it will improve my health for me to want to be dead any more often than I already do, nor how several more hours per week of getting nothing done because I'm too busy crying will make me healthier.

Polite but firm seems like the best way.

Honestly - 30 years experience and she thinks that she is qualified to comment on my dosage of a medication without reviewing the evidence?

[hattifattener]

Yeah. Did she think you'd been on it ten years with no one considering the risk:benefit? Did she not flip through her PDR before deciding to mess with your meds? Was she simply on crack? ARGH.

I've experienced a few of those withdrawal effects just from tapering too abruptly. No fun at all. (Though, as side effects go, there are much worse...) I'm glad you did manage to get a refill.

[jackspryte.livejournal.com]

That sounds like a power game. Fucking with these things is dangerous.

[kshandra]

Random hugs are also okay.

How 'bout some very specific designed-for-h-l hugs with octopoid arms? *love*

[ludy]

arrrgh!
*HUGS*

[leback.livejournal.com]

This is the sort of conduct that ought to put someone's medical license in jeopardy. I don't know your system well enough to really know how to approach a complaint letter, but I imagine it ought to look something like:

Dear [appropriate party]:

I am writing to advise you of two recent incidents in which my safety was jeopardized by the conduct of health professionals affiliated with your establishment.

In the first incident, a doctor decided to condition a refill of one of my prescriptions on a blood pressure check, without in any way informing me of that decision. I thus learned that the prescription had not been filled only when I arrived at the pharmacy, on a Friday evening. Had I been only a few minutes later, I would have been unable to obtain my medication until Monday morning -- and because it is your doctors' policy that prescriptions for this medication are not to be refilled until the patient has nearly exhausted the existing supply of medication, this would have forced me to go without the medication (which I ordinarily take [twice?] daily) for the entire weekend.

While suddenly being without a necessary medication is frequently a serious problem, the consequences would have been especially grave in this case, as the medication, Efexor, can be extremely dangerous when abruptly discontinued, even for a short period. The risks to my health would have included [...].

The problem could have been avoided by a simple phone call to me from the doctor's office, notifying me that the doctor had decided to require a blood pressure check before refilling the prescription. I placed the refill order on a Tuesday morning, and would have had ample time to fulfill the doctor's requirements before my refill was due, had I been but notified of them. Absent notification, I had no reason to anticipate any problem -- I have been taking this medication for ten years, and have never previously been subjected to such a requirement outside of a regularly scheduled review (which in this case, would not have been for another [time period]). As such, your doctor's failure to communicate adequately with me put me at serious and inexcusable risk.

Furthermore, when I spoke to [second doctor] on Friday evening in order to rectify the situation, I was astounded by the ill-informed and dangerous advice given to me by that doctor. Although she is not my regular treating physician, or even of the same specialty, and was not familiar with my medical history, she flatly advised me to reduce my medication dosage from that which my regular physician has recommended. My regular physician's dosage determinations are based on my ten-year treatment history, and on detailed knowledge of my health needs. This doctor pressured me to take a lower dosage based only on a generalized awareness that my ordinary dosage is higher than typical, and limited knowledge of the drug's standard usage and side effects. She was in no position to understand the complicated risk/benefit analysis that my regular doctor has performed based on awareness of my particular needs. In fact, my depression, which the Efexor is used to treat, is quite severe, and is only minimally managed at my current dosage. The changes Dr. So-and-so suggested could easily have put me at risk of a variety of harms, up to and including a significant suicide risk. As an experienced professional, she should have known better than to so cavalierly dismiss the particularities of a patient's history when interfering in what can be (and in my case, is) a life-critical treatment regime.

I am naturally outraged by the disregard for my safety manifested by both of these occurrences. I recognize that occasional oversights are inevitable, but both of these errors occurred because of blatant and careless overreaching -- in the one case, varying a usual review regime without obvious necessity and without any effort to inform me; and in the other, casually interfering with a medication that I had been using stably for a considerable length of time. Neither action was dictated by urgent necessity, and there is no justification for their having been undertaken without the exercise of due care.

[Rest of letter depends on what you want to ask for by way of correction/amelioration/apology...]

[flippac.livejournal.com]

I'd mention that the circumstances amounted to duress as well, as the doc was effectively holding the threat of a delayed prescription - any apparent consent to a reduced dose would be questionable at best.

Good letter though!

[tirnoney.livejournal.com]

*hugs* Next time save your strength and don't argue with idiots. Give me a call and I'll write you a prescription to tide you over. I can fax it to the pharmacy of your choice.

[purplerabbits.livejournal.com]

That sounds ghastly! I don't know what to say except *hugs* and bunnies and stuff, but when I'm more with it I'm up for helping read letters if that's any good...

[jinian.livejournal.com]

How un-fucking-believable. I am so sorry that you got not one but two utter idiots trying to fuck with your meds. If you need shins kicked, I work cheap in a good cause (once I get across this ocean). Also, leback is awesome.

[firecat]

[hugs]

That's especially horrible because Efexor is a bitch to withdraw from. It's not one of those drugs you can just skip for a few days without nasty effects. This doctor's so-called concern for your health is putting your health at significant risk.

[taimatsu]

ARGH. How horrible. Many hugs for you. I wish people like that used their brains more.

[moo58.livejournal.com]

Fucking heck! If I miss even one dose of my Effexor I get all moody and down. I'd probably consider harming myself if I didn't become SO apathetic and withdrawn.

Stupid doctor! I now hate her with the fury of a thousand exploding suns.

Please let us know how this all turns out.

[boxofdelights]

Oh, man. Wish I could hug you.

[hiddenpaw.livejournal.com]

I'm confused here, Was that a doctor or a passing sociopath?

*Huggs*

[kyte.livejournal.com]

Oh good *grief*...

Incidentally, both me and G take Efexor, and we're really only a short car journey away. In emergencies like this, feel free to call me and we should be able to sub you a couple of tablets.

[eponymousarchon.livejournal.com]

indeed - you should have numbers for us. If there's an emergency, like that one, phone us for a tide-over. The cheeck of that person! :/

[nitoda]

::hugs:: everyone else seems to have said it all really ... rinse and repeat! ;-)

[mjl]

*hugs*

[erik]

What a horrible experience. *hug*
Doctors should not be allowed to meddle with patients whose history they are not familiar with.

[kixie.livejournal.com]

!

WHAT THE FUCK?

I always manage to deter doctors from fucking with my doses by saying "I have a psychiatrist, he deals with this" - they may not respect me or my opinion, but they'll always try not to step on other doctors' feet.

Are they giving you anything for the blood pressure? And OH GOD, the withdrawals are so godawful.

Write a strongly worded complaint!

[adjectivemarcus.livejournal.com]

That's appalling, you poor thing. I hope the complaint goes well.

[barakta]

What everyone here has said! Good luck with surviving life and hoping you have a spoon to throw at the complaint too.