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Comunication Between Dr.'s

Question:

I have a question about communication between health professionals. I have been to see a social worker, and a psychiatrist over the past year and I have never been told any diagnosis for what I am struggling with. I also had some tests by a psychologist done at a hospital but I still feel confused as if even they have no idea why I feel the way I do or why I am still struggling. I think I may have some type of bipolar/ mood swings and also major anxiety. I have not fully been able to commit to the idea of medication because I’m not told what I am dealing with so I feel scared that they don’t fully understand me. I also can’t seem to get lined up with a regular mental health doctor or therapist. At this point I have given up trying but I know I am not fully ok and I feel like it is just a matter of time before I struggle again. The low points, reactive or not, to my life are really bad and it is only when my mood is better that I see how bad I get. I guess what I was wondering is how doctors go about communicating to each other or to the GP what they think. Do Psychiatrist or Social workers have to tell the GP what is going on or what is talked about? Thank you for your time.

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  • Dr. Dombeck responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
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Answer:

In between asking your question about doctor’s communication are some details about your condition(s). It is clear that you are having a hard time managing. You mention anxiety and mood swings, but also allude to "lows" that are perhaps depression. All of these symptoms can be considered in the depression spectrum. While anxiety disorders can occur independently of depression, they are also kissing cousins to depression. Co-occurrence is common.

You have a right to know your diagnosis, I think. Ask your treating doctors and/or therapists what they think is the problem, and how they have diagnosed you. They may not be hiding this from you so much as (in their minds) shielding you from the bureaucracy of health care. You already know there is a problem so it is unlikely that anything you hear will leave you worse off than you are now.

Keep in mind that different doctors sometimes diagnose the same person differently even though the person clearly only has one set of conditions. Diagnosis is much more of a science (e.g., a defined procedure) than it used to be, but some conditions can be looked at in more than one way, and different doctors will typically see things a little differently. A good case in point is schizoaffective disorder, which contains symptoms from both depression (or bipolar disorder) and schziophrenia. Some doctors will diagnose two conditions (e.g., major depression and also schizophrenia), while others will diagnose only schizoaffective disorder. In most cases of this nature, the labels are not that important, because the underlying treatment strategy is the same.

Keep in mind also that some non-psychiatrist therapists resist the idea of diagnosing their patients, and do so primarily because insurance companies demand that it be done. I think this is a poor way to proceed (because treatment strategy should come from a solid understanding of diagnosis), but there are many competent therapists out there who see it differently.

You’ve said that you are hesitant to address your conditions with medication because you don’t know what you are dealing with. Fair enough. So – ask what you are dealing with. If there are medications out there that can help, please don’t shy away from them. Medications are tools that people can use to help themselves feel better. If you are in need of some fixing, and you refuse to use the tools available that might help you do that fixing, then you are getting in the way of your own recovery.

There are good non-medication evidenced-based psychotherapies available today for treating major depression and most anxiety disorders. Psychotherapy alone is not recommended for treating bipolar disorder. These useful psychotherapies are typically cognitive behavioral in nature – so ask your therapist to use a cognitive behavioral approach with you, or find a new therapist who can offer you that approach (if you have major depression, an anxiety disorder or some related condition).

Last but not least, your question concerning doctor-to-doctor communication. At least in America, doctors (psychologists and I believe psychiatrists as well) are not supposed to communicate with one another without first obtaining your explicit written informed consent that this communication occur. This is because there are privacy laws that exist to shield doctor patient communication, and also ethical principles that uphold a patient’s right to privacy expectations. A good mental health doctor will explain all of this upfront during an early session. The typical drill is that you have a right to expect that what you say to the doctor will be confidential as provided by law. Typically the states provide cases where a doctor must break confidentiality so as to inform authorities and affected persons, including cases where there is suicidal or homicidal intent expressed on the part of the patient. Doctors should disclose this to patients early in their relationship. Things get a little more complicated when you are a patient within a healthcare system, rather than directly a patient of a specific doctor. In such cases, in practice, there may be implicit permissions for doctors within the healthcare system to discuss your case as proves necessary for furthering your care. In practice the paperwork requirements for maintaining privacy are burdensome and some doctors don’t do a good enough job keeping up with them.

As I don’t know where you live, I don’t know what rules apply to doctor-to-doctor communications. Your doctors and therapists will know, however, so feel free to ask them what the rules are where you live. In an important way, they are working for you (even if you are not their supervisor in any way shape or form) and they ought to be up front with you about how they are sharing information.

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