Q: Can't Go to Another Doc'
Dear Dr. Phelps:
I wrote to you in April - "May have Bipolar 2 - Meds". Thank You. The situation
has not gotten any better. Now my pyschiatrist thinks maybe I have cyclothymia.
I am still on Bupropion (l50 mg) and 3 l0 mg. of Buspar per day. He will not
change it. I have not slept thru the night since the middle of February. He
perscribed Starnoc - but it did nothing. He will not give me anything to sleep.
I have followed the "NO More Sleepless Nights" regime and I also purchased the
sleep timer. I go to sleep at ll or ll:30 and wake up at 4am. I am alittle
better now, I am awake for 20 - 30 min. instead of an hour or more. But I am
very very tired. He keeps saying I am depressed w/mood swings or cyclothymic.
Why wont he do anything? The Dr. in the sleepless nights book, says you can
suffer sleep deprivation after one night. I live in Canada. We have serious Dr.
shortages. I cant go to another Dr. I am very very frustrated. He is sending me
to a "Mood Expert" but I wont get an appointment till fall. Any suggestions?
Hello Dianne --
The Bipolar World folks are really good at this, and pulled up the reply I wrote
a while back -- so I can make sure I don't contradict myself! But it looks
pretty clear: your question now is how does a patient "work the
system" when she/he thinks she knows enough to want to try a particular
approach and yet the doctor either sees it another way or is for some other
reason "unwilling" to try that idea. So, I just want this to be
clear: now we're talking about how a patient goes about changing her/his
doctor's mind. Hmmm, pretty tricky territory, eh? Not all doctors
are too keen on the idea that the patient is going to educate him/herself and
become an active participant in their treatment. Another friend of mine
has a doctor in Canada and she's facing the same problem: she's educated herself
extensively about bipolar disorder and yet her expertise is not "allowed
in" to the treatment planning process.
As you may know, there's a pretty strong movement
toward developing a more "collaborative" treatment model, wherein
doctors respect the learning that patients can do on their own, even to the
point of admitting that at times patients can know more than they do about the
illness the patient has. After all, doctors have to learn about a lot of
different things, where a patient has a single illness she/he can become quite
an expert about. So I try to be open to whatever a patient brings me, and
in the process talk about "evidence" we can use to evaluate a
treatment (benefits, risks, long term effects, etc.). One of my patients is
trying to be patient with me as she teaches me, little bit by little bit, about
what some researchers are learning about electromagnetic fields and how they
might affect mood disorders. So far is sounds pretty "way out",
but she's very good at this and keeps coming in with little bits of evidence
that suggest there is at least a grain of truth to her hypothesis.
So, in the future there may be a different way of
working with doctors where you could walk in and say, "hey, you know doc',
I've been trying to teach myself about my symptoms and there's this bipolar
approach -- i.e. applies to cyclothymia -- that I'd like to pursue, and here's
some information on it (information that you've picked because it is very
concise and highly referenced to authoritative articles from the medical
In the meantime, what do you do? This really
depends on the particular doctor you're working with and why she/he is
relatively resistant to paying attention to your inclinations: too little
time? angry at being told what to do by patients? has an ego thing
about who's in charge? doesn't know enough to recognize you've got
important information? just exhausted and doesn't care enough
anymore? Just as I couldn't tell a patient what to do because I can't
diagnose at this distance, I can't tell you what to do about this
However, in general what I've been doing is encouraging
patients to use the "dear
doctor" letter, and refer doc's to my site. If you haven't tried
that yet, maybe some approach like that would help get things going. Good
luck to you.
Published July, 2002