Q:  Can't Go to Another Doc'

Dear Dr. Phelps:

I wrote to you in April - "May have Bipolar 2 - Meds". Thank You. The situation has not gotten any better. Now my pyschiatrist thinks maybe I have cyclothymia. I am still on Bupropion (l50 mg) and 3 l0 mg. of Buspar per day. He will not change it. I have not slept thru the night since the middle of February. He perscribed Starnoc - but it did nothing. He will not give me anything to sleep. I have followed the "NO More Sleepless Nights" regime and I also purchased the sleep timer. I go to sleep at ll or ll:30 and wake up at 4am. I am alittle better now, I am awake for 20 - 30 min. instead of an hour or more. But I am very very tired. He keeps saying I am depressed w/mood swings or cyclothymic. Why wont he do anything? The Dr. in the sleepless nights book, says you can suffer sleep deprivation after one night. I live in Canada. We have serious Dr. shortages. I cant go to another Dr. I am very very frustrated. He is sending me to a "Mood Expert" but I wont get an appointment till fall. Any suggestions?

Thanks, again
Dianne
 

Hello Dianne -- 
The Bipolar World folks are really good at this, and pulled up the reply I wrote a while back -- so I can make sure I don't contradict myself!  But it looks pretty clear: your question now is how does a patient "work the system" when she/he thinks she knows enough to want to try a particular approach and yet the doctor either sees it another way or is for some other reason "unwilling" to try that idea.  So, I just want this to be clear: now we're talking about how a patient goes about changing her/his doctor's mind.  Hmmm, pretty tricky territory, eh?  Not all doctors are too keen on the idea that the patient is going to educate him/herself and become an active participant in their treatment.  Another friend of mine has a doctor in Canada and she's facing the same problem: she's educated herself extensively about bipolar disorder and yet her expertise is not "allowed in" to the treatment planning process. 

As you may know, there's a pretty strong movement toward developing a more "collaborative" treatment model, wherein doctors respect the learning that patients can do on their own, even to the point of admitting that at times patients can know more than they do about the illness the patient has.  After all, doctors have to learn about a lot of different things, where a patient has a single illness she/he can become quite an expert about.  So I try to be open to whatever a patient brings me, and in the process talk about "evidence" we can use to evaluate a treatment (benefits, risks, long term effects, etc.).  One of my patients is trying to be patient with me as she teaches me, little bit by little bit, about what some researchers are learning about electromagnetic fields and how they might affect mood disorders.  So far is sounds pretty "way out", but she's very good at this and keeps coming in with little bits of evidence that suggest there is at least a grain of truth to her hypothesis.  

So, in the future there may be a different way of working with doctors where you could walk in and say, "hey, you know doc', I've been trying to teach myself about my symptoms and there's this bipolar approach -- i.e. applies to cyclothymia -- that I'd like to pursue, and here's some information on it (information that you've picked because it is very concise and  highly referenced to authoritative articles from the medical literature).  

In the meantime, what do you do?  This really depends on the particular doctor you're working with and why she/he is relatively resistant to paying attention to your inclinations: too little time?  angry at being told what to do by patients?  has an ego thing about who's in charge?  doesn't know enough to recognize you've got important information?  just exhausted and doesn't care enough anymore?  Just as I couldn't tell a patient what to do because I can't diagnose at this distance, I can't tell you what to do about this either.  

However, in general what I've been doing is encouraging patients to use the "dear doctor" letter, and refer doc's to my site.  If you haven't tried that yet, maybe some approach like that would help get things going.  Good luck to you. 

Dr. Phelps