Q:  How to know if psychiatrist is qualified?

Hi Dr. Phelps,

When it comes to a psychiatrist having experience with bipolar disorder, what do you think would be a good benchmark to use in deciding whether this psychiatrist has enough experience to be competent in treating bipolar disorder?  More specifically, what would be a ballpark estimate of the number of patients that a psychiatrist needs to follow, in order for him or her to be getting adequate experience from them to be learning how to treat others well?

I really seem to get the run around when I try to find this information out.  I asked my current psychiatrist (in St. Louis) if there were any psychiatrists in the area who specialize in bipolar; she just laughed at me, and told me that there was no such thing as a psychiatrist who specializes in bipolar.  She is a general psychiatrist who practices part-time, and I feel that she just doesn't have adequate experience to be treating this illness.  I am pretty upset with her.  I am recovering from a horrible flare that started in January, in which I went to the brink of suicide and back several times.  I just discovered that my lithium level had fallen from 0.9 in November to 0.6 in February; my psychiatrist had the labs but she missed their significance--she told me that they were "normal" (I guess because 0.6 fell in the lab's "normal" range, and it was marked as such).  I am doing better now on an increased dose of lithium, but I need better care than this if I am to survive.  I can't watch over my care when I am losing my mind.

Thank you so much for all your efforts,


P.S. I have checked the bipolar referral database from MGH--thanks for the link!  I just am so scared after this incident that I really want to figure out whatever ways I can of protecting myself from ending up with another not-so-good one.

Dear Nini -- 
Well now, that's a perfectly reasonable question, and a logical one to ask.  As I think about it, I'm sort of surprised no one's ever asked something like that before.  And, at the same time, it's one heck of a "bomb" of a question -- because doctors generally don't like and are certainly not used to having someone even wonder about that, let alone ask.  

To tell the truth, when I think back to what I used to know, and what I know now (which generally only makes me all the more aware of how little we really know for sure, enough to be really sure what we're doing; but we have to do the best we can, despite that), it's pretty disturbing.  I think I can see some things now I couldn't see at all then.  I figure in another 5 years, I'll be saying the same thing about how I practice now, like "gee, remember when we used to think that bipolar II could be treated ok with lithium".  Meaning I hope we have something substantially better by then, or at least maybe 10 years from now.  

The point is, you can shop and try to find somebody better.  You could spend a fair amount of time and energy doing that, and you might indeed find somebody.  But much of what we do, we do with unfortunately little clear knowledge.  So, in my view, the most important thing is to have a doctor that listens well and really grasps what you're trying to communicate; who is aware of the general standards of practice of psychiatry, which most are; and who will listen to your ideas and questions and respond by trying to learn more, if you bring in something that she/he is not aware of.  In the process, you create a "team" between the two of you, and that's the most important ingredient in good care.  

It sounds like you're pretty upset with your doc'.  If she can hear that and respond in a way that helps you two get back together as a team, that might be one of the best doc's you can find.  She might well have thought your lithium level was "high enough", as I would if a person's symptoms were well controlled and we weren't seeing repeated breakthroughs of new mood episodes.  

Uh, what am I trying to say here: something like, the absolute amount of knowledge and experience is not necessarily the gauge to use; but rather the ability to create and maintain a process between the two of you where you feel heard and understood, and at the same time the both of you are pursuing continued education about what works for others and might work for you (including the risks, as well as the benefits) -- that's what I'd look for.  Now of course if you can find that kind of practitioner who also knows a great deal and has had a great deal of experience, then wow, that would be someone to try to get in with, wouldn't it?  Problem is, there aren't all that many, and when you find one, you'll probably hear they're full, unless they just moved to town.  So the hunt could be pretty tough.  

In any case, I hope you end up feeling more solid about the person you end up seeing.  Good luck with that. 

Dr. Phelps

Published April, 2001