![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 44. Go back in thread:
Posted by JadeKelly on January 13, 2009, at 3:41:28
In reply to Please be sensitive » JadeKelly, posted by Deputy 10derHeart on January 11, 2009, at 23:45:13
My apologies 10nder Heart
~Jade
Posted by Phillipa on January 13, 2009, at 3:41:28
In reply to Re: Seriously What's Happened To Meds Board???? » Phillipa, posted by fayeroe on January 12, 2009, at 8:23:51
To clarify educate them on new meds. And of course this is only what several drug reps I've talked to have told me some waiting to see docs and the other I corresponded with. As for dispensing I used used the word from another post as pharmacies dispense meds nurses follow docs orders and medicate the patients with the prescribed meds. Phillipa
Posted by Partlycloudy on January 13, 2009, at 3:41:28
In reply to Re: Seriously What's Happened To Meds Board???? » fayeroe, posted by Phillipa on January 12, 2009, at 10:45:57
> To clarify educate them on new meds. And of course this is only what several drug reps I've talked to have told me some waiting to see docs and the other I corresponded with. As for dispensing I used used the word from another post as pharmacies dispense meds nurses follow docs orders and medicate the patients with the prescribed meds. Phillipa
So you don't dispense per se, but distributed following a doctor's dispensing orders? Just to be clear.
pc
Posted by Phillipa on January 13, 2009, at 3:41:28
In reply to Re: Seriously What's Happened To Meds Board???? » Phillipa, posted by Partlycloudy on January 12, 2009, at 11:52:29
PC that's a tough word isn't it? As giving the meds as presciribed is kind of dispensing also. I think I'll google the definition how's that? Love Phillipa
Posted by Phillipa on January 13, 2009, at 3:41:29
In reply to Re: Seriously What's Happened To Meds Board???? » Phillipa, posted by Partlycloudy on January 12, 2009, at 11:52:29
PC oh wow this is getting complicated with new technology. I think have one more reply can use before three posts in a row used up. Here's an interesting one. Then will use Miriam Webster's definition. Phillipa
Posted by Phillipa on January 13, 2009, at 3:41:29
In reply to Re: Seriously What's Happened To Meds Board???? » Phillipa, posted by Partlycloudy on January 12, 2009, at 11:52:29
PC seems according to dictionary definition nurses do dispense. For a bit more clarification a nurse is responsible for dosing errors as nurses are responsible part of job to know acceptable doses of all meds for safety. Hence charts are reviewed and med orders checked for acuracy by all three shifts and signed off on doc's orders that indeed the amount and med was safe for the particular patient according to med dose guidelines. Gets complicated.Especially since the pharmacy checks also. But not so if working in the system just part of the job description. Ulitimately the nurse is responsible for wrong doses being ordered as docs make mistakes just like anyone else and sometimes in a hurry. Phillipa
Posted by Partlycloudy on January 13, 2009, at 3:41:29
In reply to Re: Seriously What's Happened To Meds Board???? » Partlycloudy, posted by Phillipa on January 12, 2009, at 12:31:16
Let's say that dispensing has a connotation - that you are recommending that a medication be used.
That's my interpretation.
Also, a pharmacist dispenses what my doctor has prescribed.
A nurse distributes what the pharmacy has dispensed.
But I would NOT want my nurse to dispense any medication based on education and experience with what my knowledge of drugs are, since my own mother was a nurse for 40 years and thought that an aspirin was good for sleeping, decongestion, and pain. (One out of three? Not very good odds. I'll go with the pharmacist or the doctor, thank you.)
That's pretty scary. Kind of like you offering to put an IV into another poster. Yikes.
Posted by Phillipa on January 13, 2009, at 3:41:29
In reply to Re: Seriously What's Happened To Meds Board???? » Phillipa, posted by Partlycloudy on January 12, 2009, at 12:45:07
Oh no argument from me. I agree hence one of the reasons decided not to fight not working again. I must say that my endos nurse does dispense my thyroid meds to me. hands them to me no doctor present and I've never seen an order? Well have endo today so got to go. Oh the field of nursing is changing so quickly. Now with proper training and further education nurses are nurse anesthisists deliver anesthesia under supervision of head anesthesiologist who is present in faciclity somewhere in or near OR you might be in. but not present in Or just checks on things or intervenes if problem. Too many surgeries going on at once. Cost is less for nurses but they do have high salaries. Phillipa
Posted by manic666 on January 13, 2009, at 3:41:29
In reply to Re: Seriously What's Happened To Meds Board???? » Partlycloudy, posted by Phillipa on January 12, 2009, at 12:31:16
MASS HYSTERIA,beam me up /ucking hell
Posted by Sigismund on January 13, 2009, at 3:41:29
In reply to Re: Seriously What's Happened To Meds Board???? » Phillipa, posted by fayeroe on January 12, 2009, at 8:23:51
>I beg to differ, Phillipa, on your statement that drug reps teach doctors.
I think the sad truth is that they do much too often.
Posted by yxibow on January 13, 2009, at 5:51:12
In reply to Re: Seriously What's Happened To Meds Board???? » Sissy35, posted by Phillipa on January 13, 2009, at 3:41:28
I'm probably going to be shot down but is this yet another circuitous anti-psychiatry skeptical thread ?
I mean everyone is entitled to their own opinions, but this comes up every fortnight, defying the idea that I thought the "meds board" was supposed to at least theoretically support psychiatry and help people with their medication issues and what experiences people have had with medication and what they face in life.
-- just my 2c, no personal attacks.
-- Jay
Posted by Garnet71 on January 13, 2009, at 6:28:26
In reply to Re: Seriously What's Happened To Meds Board???? » Fred23, posted by fayeroe on January 13, 2009, at 3:41:28
> 7. Doctors get most of their "education" via drug salespeople.
>
> 8. Doctors aren't trained in statistics enough to be able to interpret even real studies.
>
> So, there is very little *real* info for doctors or patients to go by for what the drugs actually do.
>
> 7.Where are you getting that information. My ex rarely, if ever, allowed a drug salesman into his office to talk.
>
> 8.Tell that to my ex and a friend of mine who works ER.
>
> 9.I disagree on what doctors know and don't know. The doctors that I know wouldn't prescribe something that they didn't know how it worked.
>
> I feel that making assumptions concerning medical professionals and posting it here isn't exactly fair to the physicians and patients.
>
> Fayeroe------------------
For those of us who suffer from anxiety/depression...SSRIs weren't invented or commonly used when some of my psychiatrists were in medical school. Two of my former psychiatrists appeared to know little about general medicine and also the use of SSRIs--they relied upon what the drug company reps. told them. I would find contradictory information on a drug and ask the pdoc, and they would always repeat what I'd find on the drug co. website.
Posted by Vincent_QC on January 13, 2009, at 7:17:14
In reply to Re: Seriously What's Happened To Meds Board????, posted by Fred23 on January 13, 2009, at 3:41:27
> I've read several books over the last few months, after having begun actually taking an SSRI, and wonder if people here know such "basics" as (off the top of my head, rather than a thorough review of what I've learned):
>
> 1. Most/many drug studies submitted to the FDA are biased, often having been done by those with financial ties to the drug maker.
>
> 2. Most/many so-called research papers are ghost-written for the drug companies.
>
> 3. For FDA approval, new drugs don't have to be better than old drugs, just 51% better than a placebo.
>
> 4. Most/many new drugs are "me-too" re-hashes of older drugs that the company just wants to extend the patent on. (E.g., Prilosec vs. Nexium.)
>
> 5. Legitimate studies show that SSRIs don't have a very high rate of actually working.
>
> 6. Science doesn't actually know *why* SSRIs do work, when they are successful.
>
> 7. Doctors get most of their "education" via drug salespeople.
>
> 8. Doctors aren't trained in statistics enough to be able to interpret even real studies.
>
> So, there is very little *real* info for doctors or patients to go by for what the drugs actually do.
>
> So a board like this is the ideal place for that type of info to be discussed.
>I'm not surprise...and I think everyone with a minimum of awareness and knowledge already know all of this...but thanks to point this out!!! That's why we found quality in all members of this website here no? ;-)
My 2 cents on all of this... the medicine is not very advanced in the domain of psychologicals problems...I'm so not surprise to see that the FDA only approve product with a low minimum of efficiency.
For the patented drugs...I think a lot of the people here know this also...Celexa VS Cipralex, Effexr-XR VS Pristiq, PAxil VS Paxil CR... If someone have a minimum of IQ, he will be able to related the pharmaceutical compagnies VS the financial side of them...They don't produce and promote drugs just to help the peoples, they exist because they want to make money...like we want to make money too...Can we blame them? I think some of them have to be blame...but not all of them either. We have to remember that without some pharmaceutical compagnies, this board would not exist...(Thanks to GSK who make the good Parnate, thanks to Pfizer for the Nardil...and many others...)...
For what I also read on books and from TONS of years surfing the web, is that for MY MAIN problems (Social phobia), Nardil and Parnate + Rivotril are the only 3 drugs with more than 60% of success rate 60-85% I think...
Only 15-25% of people on a SSRI's or SRNI's drugs will see some improvements of the social phobia or achieve a remission state, the TCA's are completely innefective to treat the social phobia, even the popular imipramine, a CTB make also a big difference...and tend to make the remission state last longer...And many others factors and things that I read but don't remember...
One thing is sure...when a Doctor or a PDOC absolutely want to prescribe to me a NEWER drug (I had several doctors like this) and I teel the doctor I can't afford to paid the price of the new drugs and he talk about the fact that I can be sponsored by the pharmaceutical compagny and when I hear him talk about the futur visit of the sales representative of this compagny next week and about SAMPLES box of the NEW DRUG, I take my legs and just want to run out of his office...that's not a good sign!!! Hahaha
I keep very bad memories about my experience with the so unfamous CIPRALEX drug...I have a beautifull 45 pounds of FAT also that I keep as a souvenir...everytime I see it in front of the mirror, I remember the so GOOD CIPRALEX...and how it was suppose to be aMAGICAL drug in comparaison with the Celexa, also from the same compagny but now not patented...
Anyway...we canno't do anything against US (pharmaceutical compagnies)...
Posted by fayeroe on January 13, 2009, at 8:13:34
In reply to Re: Seriously What's Happened To Meds Board???? » fayeroe, posted by Garnet71 on January 13, 2009, at 6:28:26
I don't know where people are getting the notion that physicians quit learning after medical school. An endless array of information is available and if you ARE a doctor, you receive publications on a monthly basis that are very informative about new drugs and new surgical techniques (surgeons)> OB/gyns even get the informational literature (that doctors have reviewed) concerning Pmeds drugs. Doctors are privy to drug trial results. Doctors and nurses take part in drug/placebo studies frequently.
My ex's evenings were spent reading up on meds and studies. How do you think he knew what to prescribe when a patient was combative and/or having a psychotic episode? The doctors that I knew had enough knowledge about Pmeds to prescribe in a crisis and refer to a Pdoc immediately. They also consult asap when it appears that the patient needs Pdoc intervention right away.
I, personally, am not very comfortable with all of this speculation concerning the "lack of" training and continuing education that doctors can avail themselves of.......Hold your hand up if you've gone to medical school or worked in a medical environment where a wide variety of meds are prescribed on a daily basis. Having been married to a doctor certainly doesn't make me a professional but we discussed his practice for 16 years and I learned much from the man. I saw every med under the sun while working in ER. The doctor that I worked with went out of his way to explain the drugs that he prescribed to his patients.
Painting the medical profession with such broad strokes seems to be condemning all because someone has had a bad experience with their doctors.
I recommend surbscribing to something like "The New England Journal of Medicine and trying to reading through it. It is a very informative publication.
p.s. my ex did not keep boxes full of samples that he handed out like candy. he prescribed the med that he knew would be appropriate for the situation.
Posted by Garnet71 on January 13, 2009, at 8:56:35
In reply to Re: Seriously What's Happened To Meds Board???? » Garnet71, posted by fayeroe on January 13, 2009, at 8:13:34
Fayeroe,
My experience with physicians over the past 25 plus years is much different than yours.
Have had some great physicians. Emergency medicine is much different than non-emergency medicine. Mostly--primary care physicians and pdocs spend 5 minutes with me so how can they possibly know what's wrong? This happens more often than not.
Nice to hear your ex kept up on the research. Like I said in a previous post, when I ask a doctor if they keep up on the current research, I get a deer-in-the-headlights look. Not all doctors spend their evenings reading the journals.
I've also been told many Pdocs are more likely to have been at the bottom of the class in medical school, so they enter the profession not by choice....although I know some of the brightest choose psychiatry as their first choice and are very good, caring doctors, such as Dr. Bob.
Posted by Partlycloudy on January 13, 2009, at 9:32:26
In reply to Re: Seriously What's Happened To Meds Board???? » fayeroe, posted by Garnet71 on January 13, 2009, at 8:56:35
> I've also been told many Pdocs are more likely to have been at the bottom of the class in medical school, so they enter the profession not by choice....although I know some of the brightest choose psychiatry as their first choice and are very good, caring doctors, such as Dr. Bob.Now THAT'S interesting... have you actually been under his care?? Because he makes it quite clear that he doesn't give advice here on the boards.
Do go on!
PartlyCloudy
Posted by Justherself54 on January 13, 2009, at 9:58:47
In reply to Re: Seriously What's Happened To Meds Board???? » fayeroe, posted by Garnet71 on January 13, 2009, at 8:56:35
I was in my pdocs waiting room and when he came out of his office a guy jumped up and started going on about a new med. You could tell my doc was very irritated and kept saying to just leave the literature. Anyway, when we were in his office he told me he has trouble listening to them, just wants to read the literature and then do his own research. Made me feel a whole lot better about my pdoc!
Posted by Phillipa on January 13, 2009, at 10:45:04
In reply to Re: Seriously What's Happened To Meds Board????, posted by Justherself54 on January 13, 2009, at 9:58:47
Justherself Now that's in my opinion a great doc!!!! Love Phillipa ps did ask my endo's nurse who educates him with his meds a different type of course and this is second hand info but she said a combo of reasearch himself, patient response, and drug reps. Covers all the bases.
Posted by Garnet71 on January 13, 2009, at 11:23:33
In reply to Re: Seriously What's Happened To Meds Board???? » Garnet71, posted by Partlycloudy on January 13, 2009, at 9:32:26
>
> > I've also been told many Pdocs are more likely to have been at the bottom of the class in medical school, so they enter the profession not by choice....although I know some of the brightest choose psychiatry as their first choice and are very good, caring doctors, such as Dr. Bob.
>
> Now THAT'S interesting... have you actually been under his care?? Because he makes it quite clear that he doesn't give advice here on the boards.
>
> Do go on!
>
> PartlyCloudy
>
-------------------
That wasn't a very nice thing to say. No I have not been under his care but any doctor who takes the time to maintain a website that is designed to help people like us is in my book a caring doc!!
>
>
Posted by Partlycloudy on January 13, 2009, at 12:02:38
In reply to Re: Seriously What's Happened To Meds Board???? » Partlycloudy, posted by Garnet71 on January 13, 2009, at 11:23:33
> >
> > > I've also been told many Pdocs are more likely to have been at the bottom of the class in medical school, so they enter the profession not by choice....although I know some of the brightest choose psychiatry as their first choice and are very good, caring doctors, such as Dr. Bob.
> >
> > Now THAT'S interesting... have you actually been under his care?? Because he makes it quite clear that he doesn't give advice here on the boards.
> >
> > Do go on!
> >
> > PartlyCloudy
> >
> -------------------
> That wasn't a very nice thing to say. No I have not been under his care but any doctor who takes the time to maintain a website that is designed to help people like us is in my book a caring doc!!
> >
> >
>
>I didn't mean it to be unkind. I don't think you can imply that Dr Bob is a caring individual because he pays for running a website yet doesn't offer any support himself, IMO. Actually, there are some members here who have felt, at various times, that we are part of some vast experiment, lab rats, if you will. Not really part of a doctor's care, but perhaps under one's scrutiny.
I don't share that particular view, but I do think Dr Bob takes great pains to remain as impartial as possible and let the posters take care of each other - and he stays out of it, by design, and by stated policy. This is a place for peer to peer support, not a place where we are under his compassionate care.
That's all I'm saying. I thought you were saying that you were his patient, and that really, really intrigued me.
pc
Posted by polarbear206 on January 13, 2009, at 14:35:44
In reply to Re: Seriously What's Happened To Meds Board???? » Phillipa, posted by fayeroe on January 13, 2009, at 3:41:28
> I beg to differ, Phillipa, on your statement that drug reps teach doctors. Medical schools and life experiences teach doctors.
Agree, 100%
Posted by Jay_Bravest_Face on January 13, 2009, at 14:42:53
In reply to Re: Seriously What's Happened To Meds Board???? » Phillipa, posted by fayeroe on January 13, 2009, at 3:41:28
Nurses (RN's) can prescribe some meds as well. Many people don't know that.Jay
Posted by fayeroe on January 14, 2009, at 8:26:36
In reply to Re: Seriously What's Happened To Meds Board???? » fayeroe, posted by Garnet71 on January 13, 2009, at 8:56:35
> Fayeroe,
>
> My experience with physicians over the past 25 plus years is much different than yours.I am confused about your knowing that my experience with my physicians has been much difference than yours? Are you talking about the doctors that I know or the doctors that I've gone to for DXs?
How old are you? I've had primary care physicians since birth. Since birth I've seen ob/gyns, orthopods, internists, neurologists, lots and lots of surgeons, an oncologist and Pdocs. Lots of care in my 65 years.
>
> Have had some great physicians. Emergency medicine is much different than non-emergency medicine.Which emergency meds are difference from non-emergency meds? I am very curious about that.
Mostly--primary care physicians and pdocs spend 5 minutes with me so how can they possibly know what's wrong?
You have never had an extensive evaluation?? That is surprising, considering you've had 25 years of experience with physicians. Perhaps you could ask about that when you see your doctor.
This happens more often than not.I think a new doctor might be in order.
>
> Nice to hear your ex kept up on the research. Like I said in a previous post, when I ask a doctor if they keep up on the current research, I get a deer-in-the-headlights look.I would get that look if my doctor asked me if I had a license to drive to get to his office. I would ask if he meant a CDL or ordinary...Are you clear on which research you are talking about?
Not all doctors spend their evenings reading the journals.My ex spent an allotted amount of time in his study, and spent the remainder of the evening with his family. Doctors have their families and friends to spend time with.
I still maintain my position that some doctors are getting a bad rap. As patients, are we not responsible for some of our health issues? We can do research on our own. It is my body and head, after all.
>
> I've also been told many Pdocs are more likely to have been at the bottom of the class in medical school, so they enter the profession not by choice....I am stunned by that statement! I'll ask my Pdoc how his grades were in school? I know that he went to Harvard and did some special study at Duke.
I think it is hilarious that a person would become a Pdoc because they were too dumb to be a dermatologist.
although I know some of the brightest choose psychiatry as their first choice and are very good, caring doctors, such as Dr. Bob.
I had no idea that you were acquainted with Dr. Bob? How did you come to meet him?
Posted by fayeroe on January 14, 2009, at 8:42:38
In reply to Re: Seriously What's Happened To Meds Board???? » JadeKelly, posted by Phillipa on January 13, 2009, at 3:41:27
> Educated as they were old ones no longer used and I never dispensed to a patient an MAOI as the docs in the various hospitals I worked at didn't use them. Phillipa
I forgot to post this about when we were all in a tizzy about the "dispensing" of meds.
-------
*Physicians, dentists, and nurse practitioners with prescriptive
authority are the only individuals, other than pharmacists, that are permitted
to dispense prescription drugs (providing patients with prescription drugs for
take home - self administration) in a medical setting.* Dentists may only
dispense prescription drugs for their dental patients. Nurse practitioners may
only dispense those prescription drugs that they are authorized to prescribe.Nursing personnel may administer a dose (orally, by injection, etc.) of a
prescription drug to a patient after receiving a written or verbal order from
the prescriber for that patient.
"Prescription drugs that have been dispensed by an individual
who is legally authorized to dispense may be delivered to (handed to/taken to)
the patient by a responsible, authorized
staff member" who has
been instructed to refer questions related to patients' medications to
appropriate individuals.A dispenser of a med has to have prescriptive authority. Nurses do not
write prescriptions, at least not legally.p.s. This is not to say that many doctors do not rubber stamp their signatures on script pads and allow their staff to write out prescriptions. That is illegal.
This information could protect a patient who doesn't understand how important it is to know where the prescription originated.
Posted by Garnet71 on January 14, 2009, at 11:35:53
In reply to Re: Seriously What's Happened To Meds Board???? » Garnet71, posted by fayeroe on January 14, 2009, at 8:26:36
> > Fayeroe,
> >
> > My experience with physicians over the past 25 plus years is much different than yours.
>
> I am confused about your knowing that my experience with my physicians has been much difference than yours? Are you talking about the doctors that I know or the doctors that I've gone to for DXs?
>
> How old are you? I've had primary care physicians since birth. Since birth I've seen ob/gyns, orthopods, internists, neurologists, lots and lots of surgeons, an oncologist and Pdocs. Lots of care in my 65 years.
> >
> > Have had some great physicians. Emergency medicine is much different than non-emergency medicine.
>
> Which emergency meds are difference from non-emergency meds? I am very curious about that.
>
>
>
> Mostly--primary care physicians and pdocs spend 5 minutes with me so how can they possibly know what's wrong?
>
> You have never had an extensive evaluation?? That is surprising, considering you've had 25 years of experience with physicians. Perhaps you could ask about that when you see your doctor.
>
>
> This happens more often than not.
>
> I think a new doctor might be in order.
> >
> > Nice to hear your ex kept up on the research. Like I said in a previous post, when I ask a doctor if they keep up on the current research, I get a deer-in-the-headlights look.
>
> I would get that look if my doctor asked me if I had a license to drive to get to his office. I would ask if he meant a CDL or ordinary...Are you clear on which research you are talking about?
>
>
> Not all doctors spend their evenings reading the journals.
>
> My ex spent an allotted amount of time in his study, and spent the remainder of the evening with his family. Doctors have their families and friends to spend time with.
>
> I still maintain my position that some doctors are getting a bad rap. As patients, are we not responsible for some of our health issues? We can do research on our own. It is my body and head, after all.
> >
> > I've also been told many Pdocs are more likely to have been at the bottom of the class in medical school, so they enter the profession not by choice....
>
> I am stunned by that statement! I'll ask my Pdoc how his grades were in school? I know that he went to Harvard and did some special study at Duke.
>
> I think it is hilarious that a person would become a Pdoc because they were too dumb to be a dermatologist.
>
>
>
> although I know some of the brightest choose psychiatry as their first choice and are very good, caring doctors, such as Dr. Bob.
>
> I had no idea that you were acquainted with Dr. Bob? How did you come to meet him?
>
>---------------------------------
Fayeroe,
Sarcasm reflects anger; I think you are directing your anger at the 'wrong person' (me). I wonder why you are directing your anger at a stranger on a psych message board, but if you care to share or talk about it I will be supportive. If you choose to further be condescending, sarcastic, and rude, please do not post to me anymore. As I implied with my previous post, you have your experiences and I have mine. As I said, I have had good docs, but my experience with primary care physicians and pdocs is terrible. For OBGYNs, Pdocs, and general practioners, most of my visits are under 5 minutes. This is intolerable. I am not the only one who feels this way; even doctors who blog on the NY Times health blog say they cannot adequately treat their patients because they have to see so many a day just to stay in business. (These same doctors will also contend psychiatrists and dentists are often, but NOT ALWAYS, the one's who were struggling in med school which is common knowledge in the medical field itself.) I don't believe our health care should be a commodity, but that is just my opinion and perhaps a topic for another discussion.
It's obvious you think your experiences and opinions count more than those of us who were not married to a doctor. Clearly, you don't know much more than the average patient here as indicated in your denial/disbelief that nurses prescribe medications.
Nurse practioners, who are increasing their role in our health care, write prescriptions every day. In fact, for over one year of psychiatric treatment at a facility I used to go to, I met with the psychiatric nurse, who wrote all my prescriptions on a regular basis--I saw the doctor-the psychiatrist-only once during that time period.
You are not the authority on this subject. This does not mean you can't discuss this, but please don't act as if you are 'in the know' and the rest of us are clueless. Please be civil and respect others' opinions rather than discounting our experiences and implying we are making them all up or are lying.
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