Having a Good Relationship with Your Psychiatrist

Having a Good Relationship with Your Psychiatrist

I have underlined the title of this post because this is potentially a life-saving tip for someone with any mental illness, especially for people with Bipolar because we experience such extremes that are not always present when in a doctor's office. I have listed some things below that I have found helpful in having a good relationship with the person who will perhaps be as most involved in what's going on in your cranium as you are.

Step 1: Finding a psychiatrist

It is vitally important that you find a psychiatrist you both like AND trust. If you don't have either of those things, switch and keep looking. Trust me. Having Bipolar Disorder is serious business, and you need a doctor who is going to be on the same page as you. Your relationship with your psychiatrist is kind of weird. They hear your most bizarre symptoms and try to sort it out, prescribing serious medications with serious side effects. Like and trusts are essential components in a good doctor-patient relationship. Once you find a good psychiatrist, it's important for you to stay with them as long as you are able to because it will make your life easier than bouncing around from doctor to doctor.

Step 2: Maintain regular appointments 

Once you have found a good psychiatrist (and it can take some time), you need to uphold your end of the doctor-patient bargain by scheduling and showing up to appointments. Doctors will often drop patients if you are a chronic no-show. I understand that sometimes it's difficult to remember or get out of bed. My current psychiatrist almost dropped me a couple of years ago for multiple no-shows. I would forget in bouts of Mania when I become super, disastrously disorganized. I explained my problem to my doctor's office. They now do phone call reminders 24 hours in advance. I also invested in a $1 pocket planner that I keep in my purse to write appointments. When your doctor sees you showing up for appointments, they are going to see that you are honestly trying to be a good patient and recover from your illness. This will help establish a good doctor-patient relationship.

Step 3: Be Compliant with Your Medications

This is very important. It is necessary for you to be compliant with your medications. I know, it's hard to manage all the meds you can be taking for mental illness, especially bipolar disorder. If you are abusing your medications or not taking them as prescribed, your relationship with your doctor will suffer, and your life in general will be more stressful. I can't tell you how much easier my life is as a bipolar patient because I am medication compliant. When I wasn't med compliant several years ago, my refills were not done unless I was in an office visit, I had blood tests, my refills on medications were limited to none or 1, causing more frequent visits. Now, when I feel a mood issue arising, such as severe anxiety or sleep changes, or a stressful life event is occurring, I am trustworthy enough with my medications that my doctor will trust me and call in a needed medication to my pharmacy without a visit. I have heard many stories of people who were not medication compliant, and when they were in an unexpected situation, such as a mood shift, their doctors would not call in a prescription until they were seen in an office, which could mean days or weeks of suffering. I have been there. I am sure there are bad psychiatrists out there, and everyone is different. But I have been med compliant for several years and it has made that aspect of managing my Bipolar disorder easier.

Step 4: Speak Honestly and Be Detailed About Everything

Be honest and descriptive when speaking with your psychiatrist about anything from symptoms to concerns to medication side effects. Don't be vague and general. Be as detailed as you can.

 For example:

Patient: "I'm having trouble sleeping."

That could mean anything from having trouble falling asleep, having trouble staying asleep, waking up too early, and so on. A better response would be:

Patient: "I am having trouble falling asleep at night. My heart starts to pound and I have a lot of anxiety as I am trying to fall asleep. It usually takes me several hours to fall asleep if at all. It has affected my work performance and I am too tired to spend time with my family. My life is suffering from this problem and I need help."

This will tell the doctor about your quality of life and that you are distressed by your problem.

Another example:

Patient: "The medication makes me feel tired and I've gained some weight."

That could mean anything from feeling a tad sluggish and gaining 5 pounds to something more serious. I made this mistake over the past years as I piled on the pounds. Finally, I had to speak up and be detailed. My revised response was:

"I can't get out of bed in the morning to take my daughter to school because I am afraid I'll wreck; I am that tired. I can't do anything because the medication makes me too tired. I've gained 20 pounds in the past two months on this medication. I can't go on like this." When I used this response, my doctor lessened the dosage of the medication I am taking, and it made a big difference in the mornings. So you've got to communicate properly with your doctor.

So, you ask, when is it time to move on from your psychiatrist?

This is really a subjective issue. I recommend getting a second opinion from your (non-psychiatrist) therapist/counselor (if you have one) or a trusted family member or friend who is familiar with you and your condition before quitting one psychiatrist to leave for another. We can easily get frustrated with our psychiatrists because our condition is distressing. We can quit one to leave for another one in a bout of mania, or get dropped by one for the same reasons.

Some questions to ask yourself about if you should stay with the same psychiatrist, or move on:

- Do I feel rushed in the appointments, as if I don't have enough time to explain symptoms and concerns?
- Does my psychiatrist seemed genuinely interested in helping me recover or stabilize my Bipolar disorder?
- Do I feel comfortable talking to my psychiatrist about distressing symptoms?
- Have I improved under my psychiatrist's care (assuming you are taking your meds as prescribed and keeping appointments, etc)?
- How easy is it to get appointments (i.e, does it takes months or days to get into see your psychiatrist, or do they have an emergency line if the wait is long for an appointment)?
- Does my psychiatrist seem to take me seriously, or does he/she brush off concerns or symptoms that I deem significant?

If you have struggled with the above questions, you might think about switching to another psychiatrist. There may not be many options in your area (there's not a lot in mine unless I am willing to drive 45 min or more), and therefore you are assigned to the one you've got. In that case, make the best of the situation if you can, or make improvements even if it means inconvenience. For me, the most annoying situation I deal with is the appointment issue. My psychiatrist is overloaded with patients due to being one of the top in the region, so it takes months to get into see him. They have set up a nurse hotline for emergencies, which I use, but sometimes I would like an in person visit and that isn't always possible. Another issue I have struggled with is have I improved under his care over the past 6 years? I think so. I have been able to work (although, not consistently) a fair amount while under his care. So I suppose the correct answer is "yes."

If you have any suggestions for finding and maintaining a good relationship with a psychiatrist, please feel free to leave comments below.