PCP: Controlling husbands

Today we saw 30 patients (there were 5 no-shows and several work-ins). Wow. Most of them were med checks, allergies, and colds, but there were, as there always is, a few anxiety cases. One thing that alarmed me was that several of the patients presenting with anxiety were teachers. It made me wonder if my teachers were ever driven to seek therapy because they couldn't deal with the stresses of handling bratty kids or teaching uncooperative teens.

One such teacher was a "Mrs. Smith" who presented with anxiety and depression (she teaches special-ed middle school kids). When I was going through her chart, I glanced through her progress notes and noted that her husband called the clinic several times requesting changes in her medications and, at one point, demanding that Dr. P call him, referring to Dr. P by his first name. Dr. P told me that Mr. Smith was a control freak and I said I kind of figured that out from the progress notes. "Is he in the room?" was Dr. P's next question. I wasn't sure, but as it turned out, he was. Mrs. Smith was a very sweet lady, albeit a bit frazzled, and she commented that her husband wanted her to quit her job b/c it was so stressful. "I'd rather have a wife at home than a..." Mr. Smith said. He never finished his sentence, but we go the idea. And when Dr. P asked Mrs. Smith when she'd like to come back for a follow-up, Mr. Smith said immediately said, "She'll come back next week. She needs it, right?" Mrs. Smith just nodded and said nothing. This lady is just too nice to say no to anyone, even her husband.

Another teacher we saw had stopped taking Lexapro cold-turkey (BAD idea) b/c it wasn't doing anything for her, and since then she'd been prone to fits of crying (which she demonstrated during her visit) and major depression. She can't quit her job or even take time off b/c she teaches Latin (there's only like 1-2 Latin teachers per school nowadays), so Dr. P put her on Cymbalta, a fast-acting antidepressant. Hopefully it'll work.