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[quote=Anonymous]I have emailed her psychiatrist--she's a bit snippy about it and I had to calm her down about me second guessing her medical judgement when she ordered a quadrupling of a dose when she newly took her on.  Turns out DD gave her the wrong milligrams from her previous doctor and the psychiatrist thought she was just doubling.  In any case, I agree just being able to email concerns is a great thing.

I am not sure I have done the best job of transitioning, but here are some things in no particular order:

1) Let them know if they are hospitalized they'll be asked for an advance directive--DD freaked a bit when it was explained what it was.

2) If you have a health problem that needs tending here is your order: 1) PCP (or if clearly specialist related, the specialist), 2) urgent care, and 3) emergency room.  If you have any doubts call the nurse's advice line on the health insurance card.  Personally, I always call them first if I am debating whether the ER is appropriate or not.  When to call the ambulance is sometimes obvious but other times not. I've had the insurance nurse tell me to call one and haven't only to get to the ER and have them say I should've called the ambulance.

3) Seven day a week pillboxes are a must (she needs two sided for am and pm).  They should be filled up the same time every week.  (I confess I don't quite trust her to do it right; last time she did it, she put in only one-fourth of her epilepsy medication and had a seizure on the third day.)

4) If they tell you you have a choice of going to the psych ward voluntarily or involuntarily always go voluntarily.

5) If you have two insurances always tell them to make sure they get the primary one right.  She's heard me do this enough times it almost automatic for her.  Believe me, you only make this mistake once.  Also, they should know their insurance lab; again a mistake you only make once.

6) Know the difference between signs and symptoms--doctors trust signs more than symptoms because they are more objective.  Keep a daily record of both (not successful yet). I am slowly educating her that her recounting that she has off and on 104 fevers to the doctor will be far less convincing than a written record.  Something I am going to try--she recently got an Iphone (late technology adoptors) and I am going to have her download Symple Symptom
Tracker into which she can put all her symptoms as they occur.

7) Try to understand where doctors are coming from and what their reactions are to things you say.  Once again a fever example: She has recorded fevers of 105.8.  I have explained that this does not sound credible to doctors and if she's going to say it she needs to add something like "But I think the thermometer gets weird at high temperatures."  She has had the hardest time understanding that what she sees as truth here is not helpful. But we've made progress--the other day I was with her and she recorded a fever of 105.5, which came down in an hour to 104.  When we had to go urgent care because her PCP didn't phone in prescription refill, she told the doctor she'd had a fever of 104 (victory!).  He was seriously concerned and gave her a flu test on the spot.  No need to go to 105 to get their attention!

8) The importance of the presenting symptom.  There have been ER visits that have a mess because she pours out all her various symptoms, along with the one that brought her there, and they conclude she is engaging in drug seeking behavior.  When I take her to the doctor I get her to agree on the top three things for the visit and the one that really bothers her, which will take precedence.  (This doesn't always work; for some reasons doctors always get excited if they find out about seizures and it can be hard to get them to focus on what you want them to.  Her PCP has even told her it'll be hard for doctors to think about treating anything else until seizures are under control.  So take your medicine!)  For the ER, you need to isolate it down to one or possibly two presenting symptoms.  At another ER visit she complained of both severe abdominal pain and back pain and they ended up doing a lumber MRI and found nothing.  A week later she was back with more severe abdominal pain and they found a gynecological problem--which clearly had been present at the previous visit--that needed immediate tending to.)

9) Be upfront that you have a mental health problem and if you get a chance say something like: "I have anxiety and understand it well but what I am coming to you for today feels nothing like anxiety."

10) Know your family medical history.  She can reel off her immediate family and aunts and uncles--not sure she has the grandparents down (all dead long before she was born).

11) Get copies of all your tests and keep in a file.  (I am still doing this one.)

Will let you know if I think of others.  happy to help someone who is less than entranced by HIPPA....
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