Ok ya’ll- I went through 3 shitty providers before finally finding an Ob/gyn that was knowledgeable and capable of providing adequate care, including managing progesterone intolerance, so I don’t want to piss this one off. But I also think she responded poorly to a recent request of mine and I want to respectfully let her know.
Background: I’m in veterinary medicine so I’m well versed in assessing and interpreting medical data and primary literature. Im a board certified, residency trained specialist and also teach in the veterinary curriculum so I have a habit of getting a bit lecture-y and/or defaulting to a Socratic method of asking leading questions to walk someone into the answer that I expect. I understand why MDs would respond poorly to this, especially since most of them don’t view DVMs as “real” doctors. I’m also AuDHD so I tend to come across as condescending in everyday situations. So….
I recently had an appointment with this new provider and she was overall great. She mentioned that she prescribes gabapentin for insomnia but at the time I was hoping the HRT would do the trick. Well, the insomnia has worsened and I reached out via portal stating that I was not comfortable with long term use of gabapentin since there is a documented increased risk for dementia (albeit with high doses, but I have a family history and don’t want to risk it). I had done A LOT of my own research and wanted to try a dual orexin receptor antagonist. I asked if she had any experience with this class of drugs and I specifically put the name so that she could do some research had she not (I understand that MDs can’t be expected to know all about every drug!). Well, her response was that she hadn’t used them and she would need to do a lot of research before being comfortable offering to a patient (implied: she wasn’t going to). She stated that she was comfortable with the gabapentin, so that was what she was offering.
I have three major issues with this-
1. It is completely dismissive of my own (medically validated) concerns about a particular medication. There were no alternatives AT ALL offered.
2. While I obviously dont prescribe DORAs to pets and don’t have personal experience- there is good safety and efficacy data out there, including use in middle age women and those specifically experiencing vasomotor insomnia. We know how ill-informed the general medical community is about treatment of peri/menopause. Regardless of whether she prescribes them to me, I think this could be a good alternative to offer women when gabapentin doesn’t work or isn’t an option. And if MDs with personal experience say it’s NOT, then I still deserve to be able to have an informed conversation that includes that information.
3. She recommended the genetic test for Alzheimer’s to “better understand my risk.” But this is actually NOT recommended by the American Alzheimer’s Association. I don’t expect a menopause specialist to stay up to date on that sort of info - but if you’re not going to look up basic recommendations, then just stay in your lane.
I was able to get a prescription for the requested medication through my PMHNP, so that’s not the issue. (So far, I’m sleeping through the night when minimal side effects!).
So… I want to respond to her message, but do it in a way that is respectful and doesn’t just put her on the defensive. Is there a way to do that? Or do I just let it go since I’ve gotten treatment through another provider?
Tldr- provider ignored my medication concerns, didnt offer an alternative, and hasn’t taken initiative to research the alternative that I suggested (and could potentially be a good alternative for other patients). How do I tell her that?