19 April 2011

Finding a doctor / therapist

by Nia
Reflection on Depression's 3/20/11 post on choosing a mental health professional gives a good outline of the various types of practitioners — psychiatrists, GPs and nurse practitioners, psychologists, mental health social workers, and licensed counselors/therapists — and their strengths and weaknesses (based on the blogger's experience).

I would like to emphasize your right, and the need, to shop around. I realize your ability to do this depends on insurance coverage, finances, childcare, and work hours, never mind your mental and physical energy. But if at all possible, if the practitioner does not display compassion or good communication, or if he does that thing I call "denying you your own experience," or automatically contradicting your observations and conclusions, dump his ass and move on.

Some statements I've heard from doctors that made me sense I was in the wrong place:

"You just need to go to more parties."

"There is no such thing as nutritional deficiencies in America."

"Insomnia is almost always caused by anxiety."

"I think [the chest pain] was just a muscle pull."

"Why do you not wear makeup? Don't you want to get married?"

If you are interested in pursuing a particular line of treatment (medications, cognitive behavioral therapy, leeches, etc.), here are What My Body Wants' Rachael West's comments about what she learned about communicating with doctors as she investigated the cause of her extreme exhaustion. (This is from her pdf What My Body Wants: Part Two (Getting Help). A link to it is on this page.)

"While the medical profession is continuously evolving, we do know that the system as it is currently set up is more helpful if you want to know whether you are sick or not, rather than how to be well in a greater sense of the word. My relationship with doctors improved greatly when I accepted how they operated and changed my way of asking for what I wanted. I recognise that time is short for them and that if I’m clear about my expectations and needs it will make it easier for them to help me.

...It’s a bit like I might approach a meeting with a very expensive consultant I have hired to work for me – you prepare for the meeting ahead of time, approach the discussion methodically and before leaving check that everyone is happy with what has been discussed and what happens next.

...To see [a certain chronic fatigue specialist], I needed a recommendation from my GP so I trundled off to an appointment at the local surgery and asked for just that. I didn’t ask if my GP thought I SHOULD see this physician, I simply told him what I wanted."

Finally, if you're like me you might have worried that your morose affect has influenced the way doctors treat you, and that unless the doctor is extraordinary you won't get decent care unless you act like a trained monkey. And you're right! To wit:

Doctors Often Don't 'Get' Their Patients, Study Finds
ScienceDaily (July 26, 2010)

'Difficult' Patients More Likely to Experience Worse Symptoms
ScienceDaily (Jan. 27, 2011)

Image: detail of 18th-century French illustration of trepanation (trepanning); from Wikipedia entry on trepanning. {{PD-old}}.