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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