Claudia asks…

Could you talk about the best ways to handle working with the frequent turnover of psychiatrists when getting services at a community-run health center?

I have been going to the only place in town where I can get mental health care at no cost. While I greatly appreciate their services and commitment, they have a steady turnover of doctors. I’ve been going for close to three years now, and I think I’ve had 5 (?) doctors.

The problem is that my file is pretty thick. I’ve been going there for so long. I know they haven’t read it, yet they base opinions about my care on what sometimes seems like a cursory glance.

There isn’t enough time to really go into my history in these sessions (usually 15 minutes). Basically, I had a complete psychotic break in 2003 and was practically catatonic for a year before I could slowly rebuild my life (and my mind) piece by piece.

Yet, recently, I had a doctor, who all she would do is look at my file and say disapprovingly, “You’re too young to be on this much medicine.” Her words verbatim.

I’m almost 40, but that’s besides the point. I had to calmly state to her that it is a regimen of drugs that has been developed over 6 years under close doctor supervision. I can’t tell you how hard it was to hold my tongue. She practically scoffed at me.

Now, I have a new doctor. And I feel like he’s dismissing me as well. It’s not just personal perception. I brought all of my pill bottles with me and told him exactly what I was taking and in what strengths. When I left, I realized that he gave me scripts for the wrong dosage on one medicine and a script for only one month on another when I only see them every three months.

I know this is long. I guess it boils down to: How can I handle these situations without being rude but conveying that this is a serious disease that I have. It’s completely ruined my life once, and I don’t want it to happen again. How do I get them to listen? And how do I effectively ride out this constant change in doctors?

Dr. Fink answers…

This is a common problem in teaching and clinic settings. These facilities offer care at reasonable or no cost, but they tend to have a lot of turnover.

My first thought is this: Because you presented your own history so eloquently and clearly in this post, I might suggest keeping a written version of something like this – a brief, to the point summary – to share with any new doctors or therapists. Carefully examining your entire file may not always be possible for them. Your summary would introduce the key points in your history and send a clear message that you’re an active participant who expects to be a part of the conversation – not just on the receiving end of their suggestions.

Include in the summary a list of current medications and all of your contact information, including your pharmacy’s phone number. This is actually a huge help to the new prescriber because the charts are often a mess, and summaries of history and treatment plans are hard to find. This is a good place to start a conversation with a new doctor and to improve communications. (If you have notes about medications you’ve used in the past and their effectiveness, or lack thereof, and any side effects, that information can be very valuable, as well.)

If you continue to feel that the doctor is being dismissive, not being an effective listener, or seems to be bothered by your your desire to play a more active role in your treatment, consider asking to speak to the doctor’s supervisor. In a clinic setting, this is often the Medical Director or the Clinic Director. In a teaching hospital and some teaching clinics this person may be the Attending Physician who is supervising the Resident or Fellow who is taking care of you.

Many clinics rely on “doctors in training,” either as part of their training or as “moonlighters,” so they aren’t always the most experienced docs. This is okay as long as these trainees are willing to get supervision and guidance when needed. It is also why some of these docs may be a bit insecure and not sure what to make of patients who bring their own summaries. However, most of them will be grateful for the information and for your participation – it helps them do the best job that they can for you.

You can always ask a doctor for clarification of something if you hear something that seems to be out of line. To the doctor who suggested you were too young to be on so much medicine, it would be totally appropriate for you to ask her to clarify what she means by that and what her specific concerns are.