Imaging walking up a hill that seems to have no summit. Your life depends on making it up the hill but you can’t remember why you are making the trek. Social pressure encourages you to keep going up but sometimes sitting down to rest makes the hill too steep to maintain without rolling down and crashing so as tiring as it is you just move up the hill one step at a time.
This is what I call the bleak. Doctors call it depression but I have yet to find a psychiatrist or counselor who understands half as much about depression as they think they do. The one’s who have experienced it don’t usually see patients or have a really long waiting lists and the rest of the well intentioned bunch seem especially prone to misunderstanding all the great things licensure requires them to learn.
I read a great pamphlet as I sat outside my psychologist’s office several years ago: Improve your care- Talk to your doctors” it said invitingly.
The following week I ran across a great article entitled “Communicating With Doctors” and then I received an automated phone call informing me that my next appointment was cancelled.
Following the recorded message’s advice I waited until the next business day and called the appointment line to reschedule.
“I’m sorry but Dr. Nameless is no longer with us.” The bland voice on the other end of the line recited.
“I don’t know… there is nothing I can do because that doctor is no longer with us and none of our other doctor’s are accepting new patients” was the most information I could get.
Looking at my pill bottle I figured out that I had enough pills to get through 78 days and I went on with life planning to call the insurance referral line the next day.
70 days later I was on 4 waiting lists and the insurance company continued to insist that Dr. Nameless was accepting new patients and I should contact his office. His office of course continued to insist that Dr. Nameless was no longer with them and that none of their other doctors were accepting new patients. They recommended I call my insurance company how also insisted that when the computer stated that a town 140 mile from my house was 14 miles from my house it was I who was mistaken.
On day 71 my general physician explained to me again that while she is an MD and has sympathizes with my situation it is policy to leave psych meds to the psychiatrists. “I’m really sorry that there is not more I can do but it really is a matter of liability” she explained.
“Isn’t it a liability to have one of your patients abruptly stop anti-psychotics?” I asked with what I thought was a great follow-up question “could you refer me to someone at least as a stop gap method until I can get an intake appointment with someone who is accepting new patients?”
“Absolutely, tell the receptionist to give you the contact number for our referral psychiatrist and tell them we referred you for a med check.”
The receptionist then proceeded to give me Dr. Nameless’ disconnected private practice line along with a piece of paper listing 3 of the 4 doctors whose waiting lists I was already on.
The following day I called the doctors who had wait listed me and after phone tag, disconnection and name dropping discovered that there still are were no appointments available and everyone would contact me as soon as something became available.
“In the meantime you should continue seeing you regular doctor” one cheerful receptionist reminded me. “It is very important that you continue to take your meds. A lot of patients have trouble with that but you are on your pills for a reason!” she encouraged.
Another helpful admin assistant told me that if I felt it was an emergency I should go to the emergency room but there was no chance of getting into see that psychiatrist before my prescription ran out. “You should have made an appointment months ago” she told me obviously forgetting that the conversation began with “hello, I am on the waitlist for an intake appointment”.
It was the last day of my existing prescription when my husband joined the band wagon of people with great advice to me about what I needed to do. Exasperated I took a deep breath and told him that since this was so easy he could take care of it.
The next month I listened to him vent about how infuriating these people are and finally one of the waitlists had a cancellation.
After a mountain of paperwork I was taken through a small hall to the doctor’s office and the intake began. Remembering the pamphlet and the article about choosing a new doctor I was prepared to be compliant, honest about my medical history and begin a new therapeutic relationship.
“So what brings you here today?” Dr. Newguy asked looking directly at me.
According to the pamphlet doctors should make good eye contact. Check!
“I am bipolor, diagnosed for about 5 years now. My former psychiatrist abruptly disappeared and I am here for an intake. I’ve been on the waiting list about three months. Also, I’ve been off my meds for about a month because I have not had a doctor” I responded. Trying to maintain good eye contact as Dr. Newguy peered at me.
“Why did you leave treatment?” he asked.
A little confused I tried to clarify, “I didn’t leave treatment. I went to an appointment and then shortly after received a phone call that my doctor was no longer seeing patients.”
“Why didn’t this other doctor want to treat you anymore?” Dr. Newguy asked. The good eye contact was beginning to feel a little uncomfortable.
“He didn’t refuse to treat me… he just disappeared and the appointment line said that he was not there anymore.” I answered.
“And you say that you are bipolar?”
Making a few notes on his pad Dr. Newguy paused.
“Have your previous doctors considered Borderline Personality Disorder? Bipolar and BPD are often mixed up. People with BPD often feel abandoned.”
I thought for a moment before responding. I didn’t know exactly what to say. “I don’t feel abandoned”, I finally uttered.
“You just said that your previous doctor wouldn’t let you make another appointment. Do you have a habit of missing therapy?”
“No, I think you misunderstand.” I stated flatly but I’m sure that my brow was beginning to furl.
I sensed this intake was going south when the doctor said “You stated that you have been off your meds for about a month.”
I knew we were failing to develop what the brochure had called a positive patient-doctor rapport when Dr. Newguy commented on my change is posture and explained his firm policy on terminating treatment after the second no show. He continued to impress upon me the importance of my respecting his authority as an expert in regard to my mental health. I needed to be back on my meds and he held the power of the script pad so I held back my growing opinion of the arrogant, idiot now controlling my life.
The session ended abruptly with Dr. Newguy promising to be back in a few minutes and returning quite a while later.
“I have spoken to your husband” he said “and I think it’s better that you come back in a few days with him. Until then I would prefer not to prescribe anything. I’m sure that you will be fine until then.”
“What?” I managed.
“I called your husband on the phone and I feel that in order to treat you I need a reliable source of information so make an appointment with the receptionist and I will see you both next week.”
The eye contact was gone and so was my patience.
I returned to the waiting room where the receptionist sat behind a sliding glass window talking on her cell phone to someone about the new kitchen theme in Lindsay’s apartment. After a few minutes she put a new piece of gum in her mouth and opened to the sliding glass door to attend to my annoying desire for attention.
A week later I returned to the doctor’s office with my husband who was as confused as I was about why he had been summoned and despite the appointment card written seven days before the gum chewing receptionist informed us that we were mistaken and did not have an appointment scheduled. As she closed the sliding glass door I noticed a new stack of literature on the small counter entitled “Successful Therapy”.