Kim Palchikoff: How to shop for a doc
When I visited my first psychiatrist, hoping for help with my depression, I was 23 and naïve. I knew nothing about psychiatry, psychiatrists, generic versus name brand medications or the difference between an Ambien and an aspirin. I asked no questions — the doctor was the one who went to medical school, not me. I thought that mental health was something mystical, too complicated for a simpleton like me, a math and science moron who barely passed high school biology.
I knew nothing about him except that he was a big wig at the University of California, Los Angeles, where I went in urgent need of some mental health repair. He mumbled a lot and prescribed me an antidepressant that cost more than $100. When I asked him for another cheaper medication, he had nothing to offer. I was very desperate and very young. I bought the medication. It was so expensive that the pharmacy, located in the back of the store, put the pill bottle in a heavy burlap bag and secured it with a padlock which the cashier up front removed with a key.
That didn’t end well. The medication made me worse, and I didn’t care for the doctor. I didn’t go back.
Thanks to the Internet, these days all patients — and not just those seeking mental health help — can become more informed about doctors before meeting in person.
The website http://www.docinfo.org displays which state a doctor has license to practice, whether any complaints have been filed against them, and if the state medical licensing board has taken any disciplinary action against them. If you have questions about their professional background, you can refer to their website or call their office.
For further sleuthing, here is Nevada’s medical board link: http://medboard.nv.gov.
If you wish to file a complaint against a doctor or hospital, walk you through the steps here: http://www.docinfo.org/report-a-doctor/.
These days most doctors are “board certified,” which means they’ve passed a national exam in their specialty. They don’t have to have passed this test to become licensed physicians, but it’s a good thing to know about them. I’ve gone to doctors who weren’t board certified. They were fine. http://www.certificationmatters.org
To determine whether your psychiatrist is board-certified, go to http://www.abpn.com for the American Board of Psychiatry and Neurology. The site can also provide information about addiction psychiatry and child and adolescent psychiatry.
Is your doctor financially biased in which drugs they prescribe? Check out “Dollars for Docs” (www.projects.propublica.org/docdollars), which verifies how much compensation — down to the dollar, if any — a physician receives from pharmaceutical companies, often in the form of free lunches and dinners provided to doctors as they sit through lectures about the company’s newest name-brand medications that they then hope the doctors will prescribe to patients.
I call these free meals “bribes,” although many doctors would disagree, especially those who often partake in these freebie fancy meals. They’re not getting fishsticks. A Las Vegas restaurant offers drug rep-sponsored four-course dinners for $125 a head.
I’ve never figured out why professionals making upward of $200,000 a year can’t buy their own grub, go to any presentation they want and avoid any conflict of interest.
In 2016, JAMA Internal Medicine — a highly respected medical journal — published a study documenting nearly 300,000 physicians who received free meals from drug companies. In one case alone they found that well-fed doctors were 118 percent more likely to prescribe a particular name-brand antidepressant over comparable generics, just as the pharmaceutical companies wanted.
Patients can’t control what their doctors do. This is what we can control: what generic medications we take. Of the top 10 most prescribed psychiatric drugs, starting off with Xanax, for anxiety, and Ambien, for a sleeping aid, all come in generic prescriptions, at a fraction of the cost.
It took me years to figure out a few things. I used to think name brand medications were more effective than their generic equivalents, kind of like comparing a Mercedes Benz to a Toyota. Now I know they are the same. Now I ask a lot of questions about a physician’s training, experience, and philosophy of medicine. It’s important, if there is a choice of a physician, especially a psychiatrist (and in Nevada there often isn’t). I like to shop for my docs, the way some people shop for a car. And I never hesitate discussing medication questions and prices with my local pharmacist.
These days I see two physicians — a psychiatrist and a primary care doctor. They don’t take pharmaceutical dollars, are well informed, have good bedside manners, and get back to me quickly with answers to my medical questions — either by phone or by e-mail so I don’t have to wait for an appointment.
No, they are not wizards who can wave a happy wand and make depression go away, nor are they genies in a bottle who can grant a medical wish or two, and they’ve never prescribed me medication with side effects that include a well-paying job, friends, a romantic relationship, good credit or a savings account. That’s on me.
But I can be an informed patient.
Kim Palchikoff lives with bipolar disorder and writes “No Stigma Nevada,” a bimonthly column. She can be reached at firstname.lastname@example.org.