Afraid that I may lose access to treatment

The psychiatrist who oversees my care, prescribes my medications, and referred me for ketamine treatment, is closing her practice. Finding a replacement, however, is proving to be extremely difficult.

Most clinics and doctors that I can get to from the rural area where I live have a waiting list of months to years, or have stopped taking new patients all together. Worse, even when a clinic or a doctor in private practice is willing to schedule an initial appointment, they refuse to work with me once they find out that I am going for monthly ketamine infusions. So far:

a) Many just said they won’t provide me services  — without offering me any explanations, alternatives, or resources in case my treatment needs were urgent. Both irresponsible and cruel, individuals responding this way to someone who is trying to access treatment by a psychiatrist should not be working in the mental health field.

b) Others have apologetically said that they don’t feel that they have enough knowledge/experience with ketamine treatment to effectively work with me. It really is time that these psychiatrists start learning about the treatment and rethinking whether refusal to work with ketamine patients is really in the best interest of these patients as they seem to assume. After all, what level of expertise with ketamine are they thinking they need to have? These doctors probably already have plenty of patients receiving chemotherapy and other specialized medical treatments — and though they aren’t experts in the specifics of those treatments, they monitor their patient’s mental status and consult with his/her other doctors as necessary to coordinate care. Why should ketamine patients be any different? Of course it would be advantageous if all my healthcare providers could have advanced training and experience with all my disorders and treatments, but I’m in no position to hold out for unrealistic ideals. Isn’t a psychiatrist who lacks expertise with ketamine still better for me than being left without a psychiatrist?!! Because seriously, living where I do, those may be my only realistic options.

c) One psychiatrist that I spoke with said that by receiving monthly ketamine treatments from a specialist while having my psychiatric care and medications overseen by someone else I am inappropriately splitting my treatment and seeking drugs from too many doctors at once. This doctor really needs some basic education about ketamine treatment. First, it is entirely standard for ketamine infusions to be provided by a specialist who is not the patient’s primary psychiatrist. Few psychiatrists administer ECT themselves either – they refer their patients to a team of specialists to provide the electric shocks and anesthetic drugs, but they don’t accuse their ECT patients of inappropriately splitting their treatment by pursuing this arrangement. Second, ketamine treatments for depression are not illegal, they are simply off-label. If a psychiatrist is comfortable prescribing other treatments off-label, they really ought to ask themselves why they are so unusually judgmental about this one, and keep that personal bias in check when talking to patients.

Finally, I wish all of these individuals could understand that I have provided informed consent to receive this off-label treatment. If any psychiatrist is afraid to work with me because they think I might sue them for letting me exercise my right to receive a potentially life-saving experimental treatment, I’d say: Let me sign a waiver. I’m not asking you to give me ketamine infusions, just to allow me to receive them under my own volition. The risks are mine, and the decision to take those risks should be mine. For me and other patients like me, the risks of not having this effective treatment are worse.

I need to have a psychiatrist. And unfortunately, both my difficulty finding one and my fears that this will soon prevent me from continuing ketamine treatment are really starting to take a toll on me.

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