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Red Tape, Department Turnover, and Ineffective Psychiatric Care

Content warnings: Venting, Medical Records, SSI, Psychiatry

Content in this blog represents my own personal opinions and experiences.

So, story time:

I need SSI paperwork completed by my psychiatrist's office immediately, or it could add a whole year to my wait. It's the only office that hasn't turned in the SSI paperwork, yet. They emailed me today and said that they will not do it because I "haven't seen my current psychiatrist 4-6 times," and it is department policy that I do so before paperwork is completed.

I've been with my psychiatrist's office for around 2 years. It's part of a major hospital network in my city, and they've had some turnover in the department during my time with them.

My first psychiatrist, Dr. Vaka, was okay. He didn't really get autism, but he worked with me until we found meds that helped me. He also listened to me, even though I had a lot more trouble communicating when I started to see him than I do now. He was quicker than I liked at the time to prescribe medication, but he was absolutely right that I needed it, both for mental illness and some aspects of autism. I saw him for about a year before he left the practice.

Once he left, I got a new psychiatrist at the same practice. I wasn't bouncing around on purpose; it was just department turnover. The change was stressful and a little scary, but I brought a support person into the exam room with me at my first appointment, prepared to both transition and adjust. However, my experience with the next psychiatrist was awful. I came to my first appointment with him with 2 major concerns outlined in a bulleted list. At first, he refused to read the list, and, only at the repeated insistence of my support person and I did he look at my concerns.

The first of my concerns was about the dosage of one of my medications. I had been experiencing a lot of side effects and wondered if it might be too high. Instead of listening (at all) to the benefits and side effects that were being stated verbally and had been clearly and concisely outlined on the paper I handed him, he just kept asking me what dosage I wanted. What I wanted was a recommendation.

Throughout this process, I was trying to type to my support person on my phone, and the psychiatrist kept telling us off for it, even though we explained that I was using an autism communication app. Then, once I caved and named a dosage between 2 dosages I had tried before, he started repeating again and again that he was changing the dosage to the number I suggested (which he put in my chart as a change I made independently) and correcting us insistently and repeatedly for "not listening to him." Apparently, the issue was that we were not looking at him. This went on for literally half of the appointment, no matter how much we paraphrased and insisted that we were listening. I didn't even try to discuss the other concern on my list after that, even though it was also important.

I saw that doctor twice, 3 months apart, before he, too, left the practice. I might have sought to see him more frequently if my experience hadn't been so awful, but appointments with him were unproductive and stressful.

After he left, there was a 6 month gap before a psychiatrist became available in the same practice at the location near my home. I had to try to handle my medications and things with nurses using IP Relay.

Fast-forward to now, about 6 months after my old doctor left, and I have that new psychiatrist. She seems quite competent and communicative. Her location is also more convenient for me, and I look forward to working with her.

Unfortunately, SSI deadlines have come. Dr. Vaka completed the paperwork for some services but left before my team decided that I should apply for SSI. The next psychiatrist was not with the practice long enough to see me for the department-required 4-6 visits to complete the paperwork, and then, there was a 6 month wait before my new psychiatrist started. I'm not bouncing around or trying to cheat the system, but circumstances beyond my control (department turnover) are making it exasperatingly hard to get the paperwork I need.

On the plus side, though, since it is a major hospital network, SSI should be able to get a lot of the information they need from the medical records themselves, even if the psychiatrist is unable to complete the forms.

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