Who should have a bigger influence on treatment decisions: the bipolar patient, or the psychiatrist?
Should it be equal?
If you’ve been reading this blog lately, you know I am firing my psychiatrist currently looking for a new one.
Brief synopsis: I’ve been seeing her for a long time. Our medical relationship has grown uncomfortable. She thinks she knows what is right for me, and I do not feel she respects my input. We disagree about my treatment plan, and she, as the clinician, refuses to budge.
Listen, I know that psychiatrists know psycho-pharmacology and general medicine much more than I do, in terms of studying and clinical practice.
I am not suggesting that I don’t need a doctor.
However, I know myself better than anyone. My psychiatrist has not observed every single day over the course of my now-13-year-illness.
Because I live with bipolar every day (without fail!), I have spent hours upon hours studying medication, general psychology, theories of psychotherapy, and research papers and scholarly articles on mental illness.
I have certifications in the field, and I have studied these subjects in universities.
I also have personally taken an estimated 10-15 different medications (I lost count) in the course of 13 years, and I know what generally works and what doesn’t.
Practical experience is invaluable.
I want to find a psychiatrist that will finally include me in the treatment plan, negotiating with me on how I am going to agree to live everyday.
I need to agree to have certain side effects, deal with medical challenges in the future. I think I should have a say in feeling tired, bogged down.
In the last four months, if I have been able to find a new, higher-paying job, get promoted at said job, get elected to volunteer positions, with no (major) psychiatric issues, why should I be taking thousands of milligrams of medication a day? Nine pills a day?
I know that might be necessary when I am going through a severe episode, but if I am doing well, I think it is worth a try to cut down.
And that should be up for discussion.
I know myself better than anyone.
As I mentioned, I have been seeing my current doctor for a long time. I think she has become accustomed to telling me what to do.
But like my consumer friends say, I have the right to hire and fire. I do not need to be afraid to get a second opinion.
As a consumer, my advice to psychiatrists is that they empower their patients to have an interactive role in their treatment plan.
Within reason, and especially when doing well, patients should be able to discuss treatment openly, have an influential say in treatment, and an awareness of what impact their medications may have and what their options may be in the future.
In my opinion, feeling helpless in your treatment plan leaves the client to make their own choices, which may be largely unguided by a professional.
Keep that openness in your relationships with your patients.
The educational expertise of psychiatric medicine must at least in part coincide with a patient who has the clarity to help make their own health decisions.
How much say do you have in your treatment plan? Do you think you should have more of an input in your medication dose levels and choices, or do you leave that to your doctor?