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Wednesday, March 28, 2012

Bipolar Tip: Winning at Your Next Pdoc Visit!

A lot of us with bipolar disorder think appointments with the psychiatrist rate somewhere between hell and a trip the dentist chair.  Anxiety, trust issues, differences in treatment beliefs, and communication difficulties can interfere with your medication management appointment.

On top of that, in less than 20 minutes you are expected to provide an update of your condition, explain symptoms, address intrusive thoughts, moods, make sure prescriptions get refilled, clearly recall important facts and events, discuss emerging or persistent issues, manage meds and doses, navigate convoluted billing and insurance practices, and maintain good composure.  Whew!

That means no weird laughing moments, tangential comments, or other unusual gestures.  Remember, you are dealing with an individual with the power to have you involuntarily committed to the friendly neighborhood psych hospital!

My Perspective

Okay, I need to say that I do not believe the patient/doctor relationship should be a win/lose or us versus them mentality.  Rather, it is better for all if the patient and doctor work together building a healthy, supportive, and respectful relationship.

Try to consider your treatment successes as wins for your doctor as well.  It should be a win/win partnership as they say.  If lowering your lithium levels made it more tolerable while still keeping your moods stabilized, then it's reason for both of you to celebrate.  Here is a writeup on my last psychiatrist visit back in January.


Because drug treatment can be effective and therapeutic it is in our best interest to make sure it goes well.  Assuming you are on good terms with your doctor, there are three straightforward things you can do that will make you feel like a winner after your next appointment:

Roles.  It is important that roles are understood. Good communication requires each person to know their respective role in the patient/psychiatrist relationship.  My preference is to have the patient take the lead role.  I believe this because (a) you are the best interpreter of the effects from prescribed drugs; (b) you will add value to your treatment program from increased participation; and (c) you will receive higher quality treatment overall.

Responsibilities.  And the winner is, You!  Because it is your life and you are the lead of your patient/doctor relationship, you should be acceptable with being the responsible party for your mental wellness.  You should also acknowledge and remember that you are ultimately responsible for your behavior.  Become committed to better mental health for yourself and be prepared to put forth effort required to do so.  It really is imperative that you take the drivers seat on this.  You should be the lead.

The Plan Man

I have a three step plan for making sure your consultation with your pdoc is effective.  The plan below is the same one I use for my psych appointments.  It is brief and simple, but gets results.
  1. Prepare.  Write down any and all questions/concerns you can think to ask.  Go through them and get rid of the ones that aren't really necessary.  Pick a reasonable number (like 3) that you want to talk with the doctor most about.  Unless this is your initial evaluation with a new pdoc, there won't be enough time for too many topic items.  Think about these questions and concerns ahead of time.  It only takes five minutes to do this.  If you can go further, try to get some time for a quick internet search about each question.  This will make the appointment even more worthwhile.  For more on planning and preparation go to this Mayo Clinic bipolar webpage.
  1. Perform.  Arrive at least five minutes early in a presentable manner.  Play your role as an empowered mental health consumer and think of your pdoc as your personal service provider, which they are.  Be engaged in the conversation.  This is your health at stake here!  Take notes on important items for later review and reminder.  This is where your committment to being mentally healthy will make you shine!  Your doctor will notice this and be more willing to work with you.
  1. Persist.  Do any prescribed follow-on activity from your doc as prescribed.  Remain in contact in case you have any adverse health effects, issues with medication, or worsening of bipolar symptoms.  Be assertive if necessary.  Assertiveness is healthy.  It involves standing up for your rights and respecting the rights of others at the same time.  
  2. Never, never, never quit!  Don't give up on your treatment in between appointments!
Here are some things to consider as you talk with your treatment provider.  You need to be prepared to address these issues and still maintain a good relationship.
  • Is he or she okay with not playing the lead role?  If not, what will you do?  I haven't had problems taking the lead role.  Most doctors prefer a patient that takes an active role in their treatment.
  • Are we in agreement concerning my issues and questions?  How does this get resolved if they are not?  Be prepared not to get everything you want all at once.  There are probably valid reasons why your provider is not in agreement with you.
  • Playing the lead role does not involve being overbearing or contentious.  Simply remain calm and present your ideas, question, and concerns.  Remember, it's supposed to be a partnership!
  • Be reasonable.  Your doctor sees a lot of patients each day and they are human.  Forgive them if they aren't perfect.  But at the same time do not hesitate to change doctors if you no longer receive quality care. 
  • Is this person really looking out for your best interest?   Are you in disagreement with your pdoc about treatment, uncomfortable for whatever reason, or just don't trust your provider.  These are valid reasons to consider changing doctors.

You really need to make sure your medical treatment is as good as it can be.  Medication management is a critical element of the journey to wellness.  Having an effective partnership with your psychiatrist will make your treatment a more positive and worthwhile experience.

Do you have any past visits to the psychiatrist that can shed light into the experience?  Horror story or a good example of a consumer/provider relationship?  Let us know by commenting below (you can do so anonymously).  Remember to have a good day and take your meds.


  1. Hi Jeff,

    Really enjoyed this, needed to hear it. I just discovered your blog and will be putting you on my blogroll.



  2. Hi Olia! Those are kind words. Thank You!