I'm frustrated, & seeking your thoughts & guidance.  I'm not dumping=0Aco=
mplaints on you; rather, I'd like suggestions for next steps.

A couple years ago I began seeing doctors at a large research hospital.  =
I=0Achose this hospital & these docs because of their excellent reputatio=
ns.  I've=0Ahad many appointments with a movement disorders neuro. for PD=
, a neuro. for=0Alifelong severe migraines, a psychiatrist for antidepres=
sants, & an internal=0Amed. doc to hopefully pull it all together.  I'm t=
he type of patient who takes=0Aresponsibility for my life & health, so be=
sides seeking the best care I could=0Afind, I keep excellent records & ed=
ucate myself as much as possible.  My=0Aexperience has been very disappoi=
nting.

My problems overlap in that they all involve brain chemistry - the PD, th=
e=0Amigraines, lifelong problems with insomnia, as well as anxiety & peri=
odic=0Adepression.   At the first appointment, I gave each doctor I saw a=
 concise=0Awritten history of these problems, & requested that they consi=
der all of them=0Awhen diagnosing, prescribing, etc.

I'm very satisfied with the individual competence of each doctor, & I rea=
lize=0Athat there is much that medical science doesn't understand yet abo=
ut brain=0Achemistry.
However, after evaluating what has occurred over the past couple of years=
, I=0Athink that the frustrations which I've  persistently felt are legit=
imate, and=0Athat the causes are fragmentation of my medical care, togeth=
er with inadequate=0Atime allotted to (or by?) doctors for patient contac=
t, and perhaps a=0Amisunderstanding on my part of how that type of system=
 works.

I'm trying very hard to figure out how to word this post in a concise way=
,=0Awithout burdening you with a lot of facts, & feelings, & examples, al=
though I=0Awish I could so you could really understand.  Perhaps it's ade=
quate to say=0Athat I began with those docs a couple years ago, telling m=
yself & them that I=0Aneeded people with much knowledge, high intelligenc=
e, high creativity, and the=0Atime & interest to investigate, integrate, =
& extrapolate so that they & I=0Acould gain an understanding of my chemis=
try & bring me to the highest level of=0Afunctioning possible.  Pretty hi=
gh expectations, but I do believe this is=0Apossible, given the right (an=
d rare) set of circumstances.

What ultimately happened is that, 2 yrs later, I still have the same need=
.  I=0Athink that I have found doctors with knowledge & intelligence.....=
....and that=0Athe other attributes remain unfulfilled, thus leaving me w=
ithout the crucial=0Abenefits which would come from a synthesis of inform=
ation about my medical=0Ahistory, a close look at details from this histo=
ry  and today to discover=0Aelusive insights, and then an orchestration o=
f treatment so I'm taking the=0Aleast amount of the safest mediations to =
address my problems as effectively as=0Apossible.

Each doctor I see has mentioned that my situation is very =93complex=94. =
 No one,=0Ahowever, has moved beyond that to do what I mention above.  I'=
ve tried to take=0Athis on myself by studying Stahl's psychopharmacology =
book, a book on=0Abiological psychiatry, etc. etc.  I have wonderful deta=
iled logs of my medical=0Ahistory, and have kept great day-to-day records=
 of symptoms, medications, etc.=0AI think that someone with the time to l=
ook at these would be thrilled to have=0Aa patient who is this conscienti=
ous.

Despite my efforts to learn, I simply don't have the medical sophisticati=
on to=0Apull off what I want on my own. Each of my doctors focuses on a n=
arrow slice=0Aof me, and only on what's going on during the 20 minutes I'=
m with them every=0Afew months.

There are a couple of reasons I'm persisting in my efforts.  I believe I=
=92m=0Aseeing signs that one of my sons is following me chemically, and I=
 want him to=0Ahave appropriate medical intervention much earlier in his =
adult life than I.=0AI'm also concerned that perhaps I'm losing many func=
tioning hours=0Aunnecessarily. I can cope, if an improvement in functioni=
ng cannot be changed.=0ABut I must know that this is so. My next attempt =
to get some sense of=0Aresolution is Mayo.

I'm writing all this to ask for your insights and knowledge.
=09--Is there some way I could have, or still can, handle my involvement =
with my=0Acurrent medical providers more effectively to have my concerns =
addressed?  I=0Asee my internal med. doc. Mon. to update her.  How do you=
 suggest I discuss=0Athis with her?
=09--How can I make sure that Mayo is not a repeat of the fragmentation I=
've=0Abeen experiencing?  I'm certainly willing to see as many docs there=
 as they=0Awant to have me see, but how do I get someone to look at detai=
ls & integrate=0Athe findings?
=09--I don't know what else to ask you, but would be grateful for any ide=
as or=0Athoughts on any aspect of my situation you'd be willing to send m=
e.

Thanks so much for caring enough to read this through.  I'll be looking=
=0Aforward to your replies.

M.Dawn   56/6=0A