Talking to Doctors

Medical consensus in psychiatry is critical. Many people do have many opinions, of course, but understanding psychiatric medical consensus is what makes all the difference. If you have 1000 psychiatrists in a room, after all, you can be guaranteed someone is going to disagree on any subject, but who do you believe, the 999 or the one? And is a medical consensus in psychiatry worth more than the opinion of psychiatric patients?
Making doctors listen to you is actually a tall order. I know it seems like it shouldn't be, but it is. If you read my piece last week, "Psychiatrists Won't Listen to Patients -- 8 Reasons Why," (applicable to any type of doctor) then you have an idea as to why. So while last week I focused on the problem, this week I want to focus on the possible solutions. Here is what you can do to make doctors listen to you.
Why won't many psychiatrists listen to patients? Your psychiatrist is supposed to be helping you. Your psychiatrist is supposed to be on your side. You and your psychiatrist are supposed to be a team to fight mental illness together. But this just doesn't always turn out to be true. So many of us have, in fact, experienced the opposite. So why is it that psychiatrists won't listen to patients?
When I was first diagnosed, I went through 18 months of medication trials without success. I initially tried a bunch of antidepressants thanks to misdiagnosis and then I went through mood stabilizers when it was confirmed that I had bipolar disorder. And every medication was pretty much the same. I would take the drug, it would induce horrible side effects, I wouldn’t be able to tolerate the drug and then I would have to try something else. It was unadulterated hell. After 18 months of that, I went to my psychiatrist’s appointment, sat down and looked at my doctor as he threw his hands in the air and said, “I can’t help you. You’re no longer my patient.” My doctor had fired me.
This morning, a girl from the United States (I’m in Canada) contacted me and said she had taken 40 pills in a suicide attempt and now needed help immediately. Please don’t do this. Please don’t treat the internet like it’s 9-1-1. It isn’t. It just so happened that I was checking the comments on my blog three minutes after this girl posted this comment so I caught it in time. (Help was called.) But I very much could have missed it. It could have taken me hours to get to this comment. I get many comments and emails and sometimes it takes me a long time to get around to reading them, let alone responding. I am, in no way, an emergency service. Reaching out to someone is always better than reaching out to no one, but please, if you need mental health help, know who to reach out to.
In psychiatric studies, generally response and remission are recorded for the effectiveness of medications. So, a certain percentage of people positively respond to medications (get somewhat better) and a smaller percentage of people go into remission (get mostly better) from medications. The definitions of “respond” and “remit” vary, but typically it’s a reduction in symptoms, as measured on a scale, to a specified degree. In practice, this means that a medication can still be deemed “effective” even if it only moves you from a 10 to a 5 on a scale of depression. Well, this isn’t good enough.
Recently I went through a nasty bipolar medication change. I stopped one antipsychotic in favour of another. Of course, this was to improve my overall treatment. And as I’ve said before, if you change nothing then nothing changes, and in this case, I had to change medications in the hopes of changing my mental wellness. It did not go well. What ended up happening was a gradual slide into horrific suicidality. The new med was not effective for me. But I learned something from this experience. Before changing bipolar medications, it’s a good idea to put into place a medication change safety plan.
I am a very difficult case of bipolar to treat. Believe me. I have been on more bipolar medications than anyone I know and finding an effective cocktail is akin to walking on water. It’s possible, but it’s pretty darn rare. And recently I made a medication change from one antipsychotic to another. It went very badly in a whole host of ways. In fact, I terminated the medication trial early and went back to my previous medication. I see my doctor this afternoon and now I have to tell him the bad news about how it went. And I feel guilty about failing another bipolar medication. I know he will be disappointed and I feel bad about it.
One of the dumbest things I’ve ever heard is of doctors not giving their patients their diagnoses. That’s right – the patient sees the doctor, the doctor does a full assessment, the doctor reaches a conclusion, but keeps it a big secret like an upcoming birthday party. This is an example of parental doctoring and completely insults the patient.
Bipolar disorder has an approximate prevalence in society of 1% and obsessive-compulsive disorder has an approximate lifetime prevalence of 2.5%. When you put those two numbers together, you should have a very small population that has both bipolar disorder and obsessive-compulsive disorder. However, this turns out not to be the case. Actually, according to a recent study, 50% of people with obsessive-compulsive disorder also have a depressive disorder and 10% have bipolar disorder. In short, if you happen to have both disorders, you’re not alone.