(reviewed 11/2014: amazingly, I think this is still needed)
Lots of doctors have big egos. Not me of course. Fortunately. Why, I’m perfectly comfortable to just toil away on this website in complete obscurity, etc. etc.
So, you may have already learned that if you’re going to try to convince a doctor of something, something he/she hasn’t already thought of her/himself, you could be in for a challenge.
Fortunately, not all doctors resist input from patients about diagnosis or treatment. If you have an open-minded doctor, who is in control of her ego-needs, you probably don’t need to read any further and can just say to her what’s on your mind. Let me emphasize that a bit, since someone wrote me and said this page was “totally out of date and idiotic” (I’ve added another reader’s related reply below). In answering letters from patients on a bipolar website for the last several years, I have the distinct impression that many patients are effectively “stuck” with their psychiatrist. They can’t switch doctors if communication is not going well. They might get treatment in a public mental health clinic and can’t choose their doctor; or they may live in a location where there are only a few psychiatrists to choose from. If you’re in that kind of situation, then the rest of this essay may be relevant. Here are some thoughts on how you can go about things like:
- asking the doctor to consider a bipolar diagnosis;
- telling the doctor you don’t really believe in her bipolar diagnosis;
- asking the doctor to try a mood stabilizer;
- telling the doctor you really don’t want to take lithium;
- asking the doctor if your wife/girlfriend/mother/brother can sit in on the session to help make sure you understand everything;
- and so forth.
If you’re really worried your doctor won’t like you asking about things like this, make sure you start with something small, like asking for more information about an aspect of your illness. Here are some steps you can try.
First, doctors need to feel valued.
So, start by making them feel valued. But, it’s got to be sincere, so you’ve got to find something she/he has done that you do truly appreciate. Then tell him that: doc’, I really appreciate the way you’ve…” Hopefully this step is not impossible. If it is, you might need to look for another doctor? or you might need to look at whether your symptoms are keeping you from being able to appreciate things, including this doctor, in which case you won’t likely get a better one very easily.
Second, they often feel rushed and fairly overwhelmed…
and act like they haven’t got much time (which, if you knew their schedule for the day, you might very well understand). So, they really don’t want to hear something sounds like it could take a lot of time. Therefore, your second step is to assure her that what you’re asking won’t take much time: I just wanted to ask very quickly about something, and if I need to make a specific appointment to address this, that would be fine”. If you start this at the end of your usual appointment time, you should expect to make another appointment to address it.
Third, they need to feel in charge.
So don’t tell them you’ve found something on the internet that:
- changes your impression of your diagnosis;
- suggests a different treatment approach might be a good idea;
- indicates they’ve missed something, like a lab test they should have ordered; or
- shows they don’t know everything, and you’re going to give them the internet link so they can brush up.
Instead, help them feel in charge by wondering what they think about something, and sounding like you don’t know much about it. Gee doc’, I was wondering what you think of the idea of the ‘bipolar spectrum’? Do you think it might have any relevance for me?” or “you sure have been trying hard to help me get better; I wonder if we looked at my thyroid levels if we’d find anything to help us? or “you have probably seen all this already… I wonder what you think of that data about lithium actually helping cells re-grow in the brain? is that something you think we should consider trying?”
Finally, if you are rebuffed…
(nice word meaning you didn’t get listened to, or got told to be the patient, while she/he is the doctor), you might consider just going along with what you get, as best you can. Oh, I understand what you mean. Treating me surely isn’t easy, I know that”. Hopefully this is just a first exchange along these lines and you’re going to come back and try again. Start with something smaller next time, perhaps?
These steps are usually even harder for families watching a loved one being treated, who’ve been teaching themselves about that illness, and now think the doctor is off course on diagnosis or treatment. You don’t (usually) even have a relationship, however strained, with the doctor. In that case I think all these steps are are even more important, especially if simply getting a second opinion is not practical (can’t afford it; can’t travel 200 miles to get a consultation; doctor wouldn’t listen even if it was the Harvard Bipolar Clinic saying so; etc.). If you’re really stuck, you could try learning about “motivational interviewing“, a technique designed to help someone who doesn’t think they need help — such as this doctor, perhaps.
Perhaps the most important thing to remember, in my view, is that this doctor is human too and there are probably some really good reasons he’s like he is. In any case, good luck to you with all this.
Update 9/2006: A reader responds –
You make many relevant points in this article. However, it could use some perspective. It is the patient who needs to feel valued and they are paying for it. Also, if you saw my schedule you’d understand that I am in a rush too. We’re ALL busy. I don’t really have 3 hours to sit in his office because he can’t charge HMO’s the same amount of money so he takes on too big a case load to make what he thought he’d make when he went to medical school. They
are busy for self serving reasons. Acting too busy under these circumstances is ludicrous. Health care providers will have to update and adjust themselves to understand that patients are MUCH more educated and savvy than they used to be. I don’t want someone who is going to be in charge, I want someone who will act as a partner and when I give them authority to, be in charge.