The Patient/Doctor Relationship
The BAD!. . .
. . . .AND. . . .
. . . . .
Ask anybody who has had need of psychiatric care of one sort or
the other what it is they find most disconcerting and it's likely they'll
say it's the inability to find that one good doctor.
Below are some clues and tips about what kind of qualities a good doctor
ought to have.
Some signs of a good doctor are:
- Returns calls according to need (emergencies first; routine calls
- Admits when he/she is perplexed by a symptom, but offers to get back
with you on it and does.
- While always the expert, he/she treats you as though you too may know
something about this illness and your own body and mind.
- Doesn't rush you and isn't quick to write out a prescription without
- Never crosses professional boundaries of personal space unless warranted.
- Never uses the threat of institutionalisation to achieve compliance
with drug or psychotherapy.
- Is eager to have significant others form part of the treatment
- Is willing to go the extra mile for you when it's important.
This last is difficult to quantify, but the best example I can give is
one from my own doctor. I had to leave Australia quickly (12 hour notice)
and didn't have time to refill my prescriptions before going. When I arrived
in the states I immediately tried to get a refill, but ran into a multitude
of difficulties since US chemists/pharmacists wouldn't accept the script
from my Australian pdoc without a FAXed authorisation. Since there was
a 12 hour time difference, it took my doctor doing an early, early FAX
(and doing it twice because the US pharmacy gave him the wrong requirements)
to get me sorted out and once again with drugs. Now that REALLY
is a GOOD doctor!
Fortunately for us, this section and the UGLY one will be rather
short. There aren't that many really bad doctors, but there are some troublesome
characteristics that, depending on your personality,
may be more or less tolerable. Here's a few:
- Makes a habit of not returning calls.
- Gives no, or poor, feedback.
- Is unwilling to listen or discounts what you have to say.
- Consistently launches into tales of his/her own personal woes while
There are precious few UGLY doctors, something for which we can all
be thankful. But despite their rarity, the topic does warrant our attention
because of the sheer amount of damage one of these bad actors can do.
Here are some truly crucifiable offenses:
- Using the therapeutic relationship to obtain sexual favours
from a patient under their care.
Should this ever happen to you, report the offender to the
police and their professional association immediately!. Having done
that, make sure you contact whatever support network
you've built so you have some aid in getting through the situation and
in getting a new physician/therapist.
- Misrepresentation and/or fraudulent representation of professional
This is a crime not easily spotted by the layperson. For example, as
of may 1997, there were still no official credentialing procedures for
7 states in the US. At least in those states, anyone
can hang out a shingle claiming to be a therapist. However, should you
become aware of a potentially dangerous or fraudulent situation, immediately
report it to the appropriate authorities for investigation. Make
no effort to confront the deception yourself.
- Coercing and/or cajoling a patient to participate in any illegal
activity by means of blackmail or other duplicitous means.
Should any physician be culpable of such behaviour, then the standard
laws apply and you should report them to the police as soon as possible.
- Violation of patient confidentiality.
Physicians are bound by ethical standards that prohibit them revealing
a patient's medical records and details of their condition without legal
warrant. Any unfounded act of this sort is an extremely serious violation
of patient privacy and steps should be taken to forestall such incidents
and/or to report them should they occur. One area of particular concern
in the information age centres around patient/doctor use of electronic
Admittedly, all of the four possibilities listed above are extremely
rare and one should not be overly concerned about them for the most part.
I mention them simply because they do occasionally occur,
and because mentally ill persons are a particularly vulnerable population.
No matter how tough you think you are, your first visit with your
psychiatrist(s) will be excruciatingly uncomfortable and anxiety-ridden.
Following are some tips on how to prepare for that visit (assuming you
had a choice that is), and things you can do to get you and your doc off
to the best possible start.
How *Not* To Be Terrified...
- First, be sure you've done the necessary homework (like reading
all you can on this site and others) before deciding on a physician.
Remember, this relationship is absolutely crucial to your well-being,
so put the time in necessary to insure a good likelihood of success.
- If feasible, allow yourself plenty of time to make that first
appointment. To feel your world begin to fall from beneath your feet
is to be frightened, but to feel the same way knowing you've no safety
net with a doctor you trust is to be terrified! This is NOT
the time for a panicy walk through the yellow pages in search of a good
- Make your best effort to find a physician relatively close to your
home and/or work. Close proximity leaves you fewer excuses to miss scheduled
appointments (yes, sometimes we just can't be bothered with our health
it seems and so we can't be bothered to go for appointments either.).
Likewise, if you *must* have evening appointments,
then find out if that's even possible before making that first appointment.
- Never abuse the doctor's office staff--make them your allies for they
are the primary link between you and your physician.
- Before your appointment, take time to go through any information about
bipolar disorder you've collected. Organize it by writing down a list
of questions to ask your new doctor. Alternately, you can highlight
passages to ask about if that's a more comfortable option. A bit of
preparation might prompt your memory and prevent your forgetting important
questions in an anxious moment. Your doctor is likely to appreciate
your effort to make the most of both his/her and your time.
- If you are able, write down a list of behaviours, fears, and symptoms
you've experienced. Share these with your doctor in an honest and straightforward
manner. Dishonesty is counterproductive; there's nothing to be gained
by withholding vital, if sometimes painful, information.
- If you've kept a journal of some sort that records your feelings,
thoughts, ideas, poetry etc. take it with you to your appointment. Your
new pdoc may or may not want to take a look at it, but it's a good idea
to have it with you anyhow just in case. And don't forget to mention
you have it with you. If you don't keep a journal already, now is an
excellent time to begin to or to, at the minimum, begin to chart your
daily moods. Learn
a bit more about journals and download a mood chart
in the Living
Well With BP section.
- If you are a confident person, then you may think you already know
what your diagnosis is (this is not unusual among bipolars),
but whether you do or you don't isn't relevant at this juncture. What
matters is that you not charge into your first appointment demanding
a prescription based on your self-diagnosis. Such behaviour
isn't likely to get you off to a great start with your new p-doc (psychiatrist-doctor).
Don't alienate; tread lightly until you've established a relationship.
- Because you've prepared for the upcoming appointment as best as possible,
you can now relax and think of this new person in your life as your
equal and your partner. Careful preparation also gives you the added
confidence of knowing you've done your part and therefore, should the
appointment go poorly, it's less likely you'll blame yourself. Face
it, sometimes we just don't click with another. In that case, you can
either give it one more chance or cut your losses and find another doctor.
Everything I've spoken of is intended to build confidence, alleviate
fear and anxiety, and lastly, to encourage calm assertiveness on your
The Care and Feeding of Your New Pdoc
A few final comments...once you've found a doctor you are compatible
with, extend him/her the following courtesies:
- If you must call between appointments, be sure you tell the office
folks what it is you need. Don't say, "Have Dr. Merlin call me,"
instead say, "Would you ask Dr. Merlin to call me? I am having
severe trembling and nausea and think it might be the lithium."
In other words, the more information you provide, the more likely it
is your psychiatrist will return your call very quickly for serious
problems. If you call and mumble about feeling a bit down, with no further
information, when in fact you are suicidal, you're less likely to get
a prompt call. Of course, often about all we can do when we're depressed
is mumble, but you get the idea here. Try, if you can, (mumble longer
& louder *grin*) to get across as much information as you can, and
if you've cultivated a good partnership with your pdoc, he or she will
probably interpret the mumbled message correctly and call you right
- Give them a break, they aren't mind readers people, but most genuinely
care about their patients. Oh...one other thing to remember is that
doctors are busy, and if you want their attention and respect, NEVER
cry wolf! (yes, some bipolar clients play manipulative non-funny
- If you must break an appointment with your doctor, don't wait till
the last minute. It's rude, inconsiderate of his/her's time and it may
prevent another patient who needs attention from getting it.
- Arrive early for appointments when possible. Yes, you usually have
to wait, but remember that your doctor may be giving another client
some needed extra attention. Be patient, some day that other person
may well be you.
- Lastly, your psychiatrist is as prone to having a bad day and typical
troubles as anyone, so try to be sensitive to where his/her head's at
as well as where your's is. Tough to do I know, but it may save you
from feeling slighted because your therapist is distracted or less attentive
and caring than usual.
Shop-a-Doc Part 2...