WHO’S YOUR DOCTOR?
by TOM SMITH
As a kid, I had a doctor and a dentist. The same doctor and dentist that the other five members of my family had, including my parents. Dr. Stencil took care of everything medical except our teeth which were drilled by the kindly Dr. Stubblefield. That was it. Stencil was not a General Practioner; he was a Family Doctor. And the kindly Dr. Stubblefield did not have a dental hygienist; he just smiled and then drilled our teeth.
Today the medical world is very different. Specialists cover the top of my head to the bottom of my toe, all the organs inside or on my body, critical illnesses or cosmetic updates, bones, skin, muscles, or nerves. Every body part has a specialist. My GP is a symphony conductor who also plays the piano.
A similar development happened with mental illness. Social workers, counselors, therapists, nurses, GPs, and psychiatrists divvy up what psychiatrists used to do. My bipolar daughter, Karla, had samples of all of them but right now I want to focus on the psychiatrist.
For the most part, the psychiatrist prescribes and regulates the medications for the mental illness. What I hear in our support groups is that a visit to the psychiatrist today is typically no longer than 15 minutes (with some notable exceptions). The deeper analysis and insight into the mental disorder and behavioral problems are left to the therapist.
Since the psychiatrist, or someone who can prescribe meds, is so critical for the well-being of most people with a brain disorder, it is imperative to find a convenient avenue to those med-dispensers. When Karla first showed signs of major depression and then attempted suicide, she ended up in a treatment center where she was given her first batch of medications. The treatment center recommended a psychiatrist to follow up with her meds. After her first 15-minute visit, she had a prescription for an anti-depressant and a recommendation for a counselor. In due time, both the meds and the counselor worked out well enough but we lived in Tulsa and she was going to college at Oklahoma State University in Stillwater. So, she needed another psychiatrist and a different therapist when she finally got back to school.
That’s the way it goes, especially when a patient moves to another area. It is unnerving enough to search for a physiatrist for a loved one since this kind of specialist is new to most people. Finding one who is available is often discouraging since many of them are booked for a long time. And there simply aren’t enough of them. If it takes a village to support a person with mental illness, many of those villages have no streets with psychiatrists.
When Karla went back to college, she had access to a school psychiatrist who prescribed and monitored her meds. Many people get their first psychotropic meds from their GP which may or may not lead to a psychiatrist. According to support group members and in this age of specialization, many of them feel more confident with the guidance and additional training of a psychiatrist. But sometimes there is no choice.
When a person finds a psychiatrist they like and trust, it is wise to stay with that doctor for as long as possible. If that relationship is working, many other factors are also needed to live a balanced life. Without it, there is a risk of a major disruption. Karla’s main problem with psychiatrists was due to her moving back and forth from Stillwater to Tulsa a number of times and that her insurance coverage was coming to an end because of her age.
Sometimes the relationship between psychiatrist and client does not go well. In that case, be honest and try to work out the issues. If changing doctors is the only and last resort, make sure there is another psychiatrist lined up before leaving. The risk of not having the necessary meds is too great to leave without a replacement solidly in place. Hopefully, your village is big enough to house an alternative psychiatrist.
While HIPPA laws protect the privacy of doctor-client relationships, it is also true that family members can write or email the doctor about their observations of the client. Sometime clients do not share everything with their doctor, and leave out some behavior that can shed light on the symptoms of their mental illness. Besides they only get those 15 minutes. As objectively as possible the family member can inform the doctor of these symptoms. Also, try to work out a way in which the therapist can consult with the psychiatrist so they can be on the same treatment page. But, because of the privacy laws, do not expect any response or comment from the doctor or therapist. However, this information may guide them on what to ask about or how to treat the client.
What we learned later is that family members can participate in the treatment plan of their loved one more than we knew at the time, even if your loved one does not agree to let you be part of the visits with the psychiatrist. After all, we too are part of the village.
If you have comments or questions about these columns, please email Tom Smith at tom.smith@karlasmithbehavioralhealth.org.
To learn more about the services of Karla Smith Behavioral Health go to www.karlasmithbehavioralhealth.org.