When is it reasonable to fire your psychiatrist?

January 18, 2009 2:07 PM

When is it reasonable to fire your psychiatrist? Bonus question: If they can't be "fired", what's the therapeutic benefit to being forced to work with a doctor who you find unprofessional and do not trust?

You're not my doctor, and I'm not looking for medical advice - I am under medical care, medicated and following my med regimen like a superhero.

My psychiatrist, who I've only been seeing for a few months (for a half hour at a time), during one of my last appointments with him accused me of being a drunk and a suicide risk, specifically because "my files" show I was not participating nor making an effort in therapy, I'm obviously an alcoholic and I have no friends or family. He suggested I go immediately into hospital because I'd totally try to kill myself over the holiday, and to get valium'ed to the brim for what would be my inevitable alcohol withdrawal.

Um. I have a kitty at home who I don't want to leave, good friends, and certainly hadn't been thinking nor talking "suicide, yay!"
I fully, totally admit I had an xmas bender, but I also fully and totally admitted my bender to the psychiatrist specifically to ask about any possible interaction with the meds, because I'm not stupid and know that in general, meds+rye=bad. I've never shown up drunk or hungover to therapy or the psychiatrist, nor am I currently drunk, hungover or withdrawing.
I have no idea what could have possibly been in "my files" to indicate that I wasn't working in therapy; I spoke to the group therapist myself, asked if there was anything of the sort in her records, and if so why hadn't she or one of the other therapists brought it up with me directly? Said therapist promised to get back to me two weeks ago, hasn't yet, and has since sent discharge papers from that therapy group to my family doctor.

Anyhow, this whole mess made a bad holiday worse and had me wondering if I was actually delusional - I had friends house-sit me to give me an objective outside opinion to whether I was having alcohol withdrawal, not following through with commitments, misremembering or misrepresenting events, or acting suicidal. The verdict all around: nope, neither drunk nor suicidal, if you have no friends then what the hell are we, and your shrink sounds like a dick!

There is a dearth of psychiatrists in Ontario, and I understand that I may not have a choice to not work with this particular doctor if I get sick beyond what my family doc can treat. I just don't want to put my mental health in the hands of a doctor who doesn't know me, doesn't take my concerns seriously or my words at face value, and makes me feel crappy and wondering if I've gone crazy(er).

posted by grippycat to human relations (28 comments total)

it seems to me that any other psychiatrist, no matter how little they help you, is better than one who treats you like this.
posted by Solomon at 2:23 PM on January 18

The point of having a therapist is to make you better. And this guy isn't making you better. In fact, he's probably making you worse by his actions.

DTMFA, and fast. Any therapist who's looking for this sort of problem in people shouldn't be working with people outside of a fast food restaurant.
posted by theichibun at 2:26 PM on January 18

According to the Canadian Psychiatric Association, if you want to file a complaint about a psychiatrist in Ontario, you contact the College of Physicians and Surgeons of Ontario. The CPSO has a FAQ about the complaints process. They can put you in touch with an intermediary who first tries to work things out between you and your doctor. If that doesn't fix things, they may end up choosing to discipline the doctor (required to take extra courses, losing the right to practice, etc). It would be worth calling to speak to them about your options.

There is a dearth of psychiatrists in Ontario, and I understand that I may not have a choice to not work with this particular doctor if I get sick beyond what my family doc can treat. I just don't want to put my mental health in the hands of a doctor who doesn't know me, doesn't take my concerns seriously or my words at face value, and makes me feel crappy and wondering if I've gone crazy(er).

There is a dearth of pdocs, that's true, but if they are making you more delusional rather than less, there's not much a point of working with them, is there? Depending on where you are in Ontario and how far you're able to travel, it may just be a case of getting on the right waiting list(s).
posted by heatherann at 2:33 PM on January 18

He suggested I go immediately into hospital because I'd totally try to kill myself over the holiday

I fully, totally admit I had an xmas bender, but I also fully and totally admitted my bender to the psychiatrist specifically to ask about any possible interaction with the meds

um, he does have a point?
posted by citron at 2:34 PM on January 18 [1 favorite]

I mean, you went and asked him if there would be a bad interaction with the meds after you already went on a bender which may have had very, very bad consequences? Because if there were a bad interaction you most def asked for advice too late, and going on a bender when you're on psych meds is dangerous.

I have no idea (nor can it be easy for anyone who doesn't know you to be sure) the real situation, but.. Could there be a reason he's saying what he's saying.
posted by citron at 2:38 PM on January 18

How was your interaction with him before this?

I mean, it's possible HE was having a bad day. Perhaps bring someone with you to your next appointment and discuss the situation?

OTOH if this is just the last of a string of bad behavior on his part, I think it's worth the effort to find someone else to see.
posted by St. Alia of the Bunnies at 2:39 PM on January 18

citron:
Don't you have to be suicidal to be trying to kill yourself (I'm not being flip)? Meds+rye= bad is an absolute given and I should be thoroughly spanked, but I'm not much of a drinker in the first place, don't have a history of going on benders, haven't had a drink since, and asked because I wanted to know what was the level of danger I'd put myself in and make sure that my doc knew what could possibly be interacting with prescriptions. Yes I put myself at risk, recognized and admitted it: so why discount what I've actually said and jump immediately to alcoholism and suicide? Should I just accept that as a psych patient every bad choice from now on is fair game to be pathologized?
posted by grippycat at 2:51 PM on January 18

If you don't trust your shrink, he can't help you. Either go to that psychiatrist and talk about your not trusting him, or stop seeing him.
posted by wryly at 2:56 PM on January 18

This doctor either needs to explain himself more fully until you feel you understand from whence he comes or you need to find someone who will. Ask your former group therapy leader for another recommendation for a doctor. Even if he was correct in his assessment, he needs to interact with you better.
posted by JohnnyGunn at 2:57 PM on January 18

He suggested I go immediately into hospital because I'd totally try to kill myself over the holiday

I fully, totally admit I had an xmas bender, but I also fully and totally admitted my bender to the psychiatrist specifically to ask about any possible interaction with the meds

um, he does have a point?

Dumb != Suicidal. Lots of people drink when they're taking medication that you're not supposed to mix with alcohol and lots of people drink excessively at Christmas. That doesn't mean they're trying to kill themselves.
posted by missmagenta at 2:57 PM on January 18

grippycat - can you clarify the timeline.... from the post this is what I'm seeing:

Pre-Xmas - Psych accuses you of being an alcoholic and suicidal and suggests hospitalisation
Xmas Bender
You admit xmas bender to Psych and ask about drug interactions

Is that right?

What was your psychiatrist's reaction to your question about drug interactions?
How many times have you seen your psychiatrist since he suggested you go into hospital?
What have the subsequent meetings been like?

Based on the timeline and taking your word as truth, my first thought was your psychiatrist had the wrong file. In your opinion (obviously we don't know you or how truthful your word is) you don't drink much, have friends and aren't suicidal.
posted by missmagenta at 3:04 PM on January 18

What did the doc say when you responded that you found these allegations shockingly batshitinsane?

After all, just because you're paying him for his medical opinion doesn't mean that everything he says is a diagnosis. (Thankfully!) Ask him why he said the things he did, and tell him that this really damages your trust in his ability to counsel you. Maybe he's a dick, maybe this was a misinterpretation of your behavior, maybe he had you confused with someone else and totally fucked up.
posted by desuetude at 3:10 PM on January 18

missmagenta:
Nope, the bender was first (actually during xmas while his office was closed); I asked about drug interactions nearer to new year's during the same meeting where he recommended hospitalization.

As far as drug interactions, he said that my meds and alcohol could create a Heath Ledger. I've been back to see him twice - the first time he was 45 minutes late for my appointment, stated I'd have to wait for a few hours while he took other patients if I left to put change in the meter (which was ready to expire, because usually, he only spends a half-hour with me). I was too anxious to wait around for the next few hours, so I made another appointment for two days later. Two days later at that appointment, I stated a la desuetude that I found his allegations batshitinsane, and asked if he'd had a chance to speak to the group therapist about the contents of "my file". He claimed he hadn't had a chance to return her phone calls yet. I told him I was upset with his suggestions, reiterated that I was safely not drinking to avoid interactions with my meds, and that I didn't believe he listened to me - he said I must be confused and have misunderstood him and asked (it hadn't even been five minutes!) if I'd been drinking since the new year.
posted by grippycat at 3:30 PM on January 18

Like missmagenta, I'm confused. Here's what I got:

1. Several months ago, your primary physician referred you to a group therapy and a psychiatrist. You began seeing both.

2. You were or were not participating in the group therapy. Maybe the group therapist noted that in your file.

3. Your psychiatrist, looking at your file, suggested hospitalization over the holidays.

4. You spent the holidays intoxicated.

5. You returned to the psychiatrist, telling him about your holidays and asking how the alcohol mixes with the meds.

6. Your psychiatrist [said something negative? and said it was because of something in your file, placed there before the holidays?]

7. You asked the group therapist for an answer, 2 weeks ago, and not gotten an answer yet. The group therapist [forced you to leave the group? told your primary physician that you were no longer in need of therapy?]

Is that even close?
posted by Houstonian at 3:32 PM on January 18

When I was in university I saw a psychiatrist who was adamant that since I had a history of depression, as did several family members, that I must therefore be an alcoholic. At the time I was 18 and had maybe had 5 alcoholic beverages in total in my lifetime. He wouldn't believe otherwise. I'm in my 30s now and have yet to become what he thought I was.

I saw a therapist (psychologist) a while back who was a great help for other reasons and then started accusing me of being shallow in my view on relationships. And I was seeing her to get over an abusive relationship. Uh huh.

My theory about when shrinks or therapists (or even GPs) say stuff like this, they're just projecting their own personal issues on you. Not that they're necessarily alcoholics or suicidal, but maybe they know someone like you who became that way and they assume it for you. Unfortunately they're human too and can't be 100% objective. It is therefore up to you to listen or not listen to them.

If dealing with this doctor is upsetting you, I would suggest avoiding him as much as possible. Can you stay a patient of his without having to have a long talk session with him? Maybe just keep him on to get the meds? I think pharmacists can refill your prescriptions without a doctor's consent now, too (across Canada, I think).

Maybe you can get your GP to put you on a waiting list for a new psychiatrist? I'm not sure how that works, though. Good luck!
posted by sinderile at 3:36 PM on January 18

It's reasonable to fire your psychiatrist until you've fired five of them for the exact same reason. At that point, you'd have to be seriously asking whether it's them, or you.
posted by flabdablet at 3:49 PM on January 18 [2 favorites]

There's a saying that applies re: flabdablet's comment above:

If one person says you're a donkey, you can laugh at them. If two people say you're a donkey, seriously consider it. If three people say you're a donkey, go buy a saddle.

Your psychiatrist's opinion is not borne out by the group therapy or your friends and family's opinions. Or your own opinion. At this point, feel free to laugh at him.

(oh, and three people on metafilter saying 'well, i dunno, you COULD be a donkey...' don't count. This only applies to people who might have some idea.)
posted by Lady Li at 4:25 PM on January 18 [2 favorites]

If you don't trust your shrink, he can't help you. Either go to that psychiatrist and talk about your not trusting him, or stop seeing him.

Yeah, there was this whole book written that reviewed tons of published evidence about what type of therapy helps people. There were surprisingly few factors that mattered. It came down to three (?) things, only one of which I remember, and that one was: a trusting relationship where you view the therapist as someone who can help you. Wish I had all the citations; maybe someone out there does. All I remembered about it was to make sure I found a shrink I liked, respected, and trusted.
posted by salvia at 4:29 PM on January 18

Houstonian:
I'll call the group therapist back in the morning - when we spoke, she agreed that there was nothing in my file to indicate that I wasn't participating in group sessions, agreed that if I hadn't been participating, that one of the group therapists would have/should have told me directly, and agreed that it was reasonable for me to get an answer about what kind of miscommunication could have happened in my files before I felt comfortable returning to group. I'll ask why my family doc received discharge papers before getting an answer back or being told I was being discharged.

This is my first venture into the realm of shrinks and therapists and all that good stuff - and I'm lost. Prior to xmas, there'd been no discussion in therapy or with that psychiatrist about alcohol or suicide, so his suggestion for hospitalization really seemed to come out of left field - but I can understand that hearing about a bender could sound like a warning sign if he already had a miscommunication or misunderstanding about what's in my file. I'd be happy to go back to group sessions after getting back a straight answer, but my trust in this whole process is shot. At the same time, I know my thought processes are also kind of shot, and was just looking for a baseline to see if losing trust in your psychiatrist in this situation is reasonable.
posted by grippycat at 4:32 PM on January 18

For what it's worth, I think you are justified in asking your primary physician for a referral to a different psychiatrist. My reasoning is a bit different, though:

- Reason #1: He thinks you have a drinking problem. He's prescribing you a medicine that will "make you a Heath Ledger" if you mix it with alcohol. To me, this does not speak well of him. Either he really believes you're an alcoholic (and so, prescribing a medicine that will kill you when mixed with alcohol is pretty dumb) or he really doesn't believe you're an alcoholic (in which case, he's just throwing around half-baked ideas), or he is exaggerating the effects of alcohol plus the medicine (in which case, he does not trust you with the truth, and would rather scare you).

- Reason #2: He's really too busy to give you care. He's backed up appointments so severely that he must reschedule them (and does not take ownership of that, but instead gives you an option of having your car ticketed or towed, or rescheduling, instead of doing the reasonable thing, which was to have his receptionist reschedule for him). He does not have the time to talk with the other people engaged in your therapy (the group therapist).

Now, having said that, if you find a similar problem with the next doctor, look carefully at yourself instead of the psychiatrist.

If he's the only psychiatrist available in Toronto, maybe your general physician can prescribe meds, and you can go to a psychologist instead? Or the psychiatrist can provide meds, but not therapy with therapy coming from another source?
posted by Houstonian at 5:14 PM on January 18 [2 favorites]

As a neurologist practicing in an underserved area, I occasionally see psychiatric patients who won't or can't find a psychiatrist. Usually I am treating their neurologic conditions and the psychiatric problems come to the fore and require treatment.

Every so often I recommend one of these patients hospitalize themselves for mental health reasons. They rarely comply. Yet, when the inevitable crisis develops, I am asked to deal with it. Often I am blamed for it - by the patient, by the E/R doc who has to deal with it, by the police, by the family members.

I am quite pleased in those cases when such patients drop me entirely. My feeling is, if you won't take my recommendations, why am I expected to be able to help?

I just don't want to put .. mental health in the hands of a doctor patient who doesn't know me, doesn't take my concerns seriously or my words at face value, and makes me feel crappy

Cuts both ways, partner.
posted by ikkyu2 at 6:30 PM on January 18 [1 favorite]

she agreed that there was nothing in my file to indicate that I wasn't participating in group sessions, agreed that if I hadn't been participating, that one of the group therapists would have/should have told me directly, and agreed that it was reasonable for me to get an answer about what kind of miscommunication could have happened in my files before I felt comfortable returning to group. I'll ask why my family doc received discharge papers before getting an answer back or being told I was being discharged.

Sorry, I find the focus on documentation to be weird. The question is not so much what the file indicated, it's whether or not you were participating. Likewise, it's not whether a group therapist would/should have told you directly, it's whether or not you were participating. If you were participating, then you should ask the group therapist to communicate that directly to your psychiatrist. That would fix the problem going forward.

And I fail to see what communications between the group therapist and the psychiatrist had to do with your comfort level with group therapy - either the group therapy was helpful, or it was not. And with regard to discharge papers, if you want to stay in the group, you should be asking that the discharge be reversed or that papers be prepared to admit you again.

In short, all of this seems a complicated discussion that avoids the questions of (a) whether or not you were in fact participating (not what the paperwork shows); (b) whether group therapy was working for you, or not, and (c) whether you want to have (corrective) facts conveyed to your psychiatrists (as opposed to trying to determine where fault occurred) in the hopes that the psychiatrist will then be more constructive - which gets to the real point of whether he was helpful before this episode occurred, and whether you think he could be helpful in the future.
posted by WestCoaster at 7:20 PM on January 18

WestCoaster, ikkyu2:

Okay, I must have made some sort of mistake here, and I'm sure I'm not explaining anything properly. I'm so sorry. I feel like I've made things worse by posting here.

I was participating and working (to the best of my knowledge) in group. When confronted with the suggestion that my medical records disagreed I first spoke to my therapist, who called my psychiatrist to convey the facts, and who didn't return her calls. My focus on documentation is because I don't trust my own memory; I wanted to confirm with her whether or not I was working in therapy because I thought I was becoming delusional.

I'm not trying to determine fault - I want to know if it's reasonable to want to work with another doctor if I don't trust the level of care I'm receiving, or if I should just suck it up and blindly follow all suggestions (even when they don't make sense to me or seem to be based on misinformation).
posted by grippycat at 7:38 PM on January 18

Yes, grippycat, it's reasonable to want to work with another doctor if you don't trust the level of care you are receiving.

I saw my first-ever therapist at a time of extreme crisis. I had five sessions with him provided free of charge through my employer. It was so helpful to speak to someone who did not know me about my grief and devastation. I could weep and rage without feeling like I was imposing or worrying him. I'm still grateful for the compassionate ear he gave me during my first few sessions. However, when my five sessions were up and he had to refer me elsewhere, I was very happy to move on. See, he had two strong fixations: that humor was a dishonest defense, and I should stop valuing my ability to make others laugh, and that I should run out and buy life insurance asap, even though I was single, in my 20s, with no dependants. The last few sessions we had felt like him just harping at me on those two topics.

I didn't agree with him about either assertion, I felt like they were unrelated to my crisis, and I felt like he wasn't really seeing me at that point, and was instead just running along the track of his little obsessions. I wouldn't have trusted him to work with him further and although at the time I felt strange feeling that (what did I know about therapy, right?) in retrospect I am very sure I was right to feel I'd gotten everything I was going to out of that relationship.
posted by Squeak Attack at 8:27 PM on January 18

You deserve better care than this. It's more than reasonable to fire this guy.
posted by corey flood at 9:55 PM on January 18

Having known a few Ontario psychiatrists, there are some really good ones out there, but then there are some pretty bad ones too. If this happens with the next two dr's then yes, maybe you are the problem. He is not willing to put in the effort to rebuild your trust so you would be better off trying a differnt dr.
posted by saucysault at 3:43 AM on January 19

How is being hospitalized less depressing than being at home, alone?

Mental hospitals are for crazy people. Anyone sane that goes there will likely be driven crazy. They will assure you that they know what is best for you, and you do not, because you are a patient. This is maddening, and you will need medications to counteract that maddening feeling of powerlessness, which they so-carefully instil. And of course, that just proves the doctor was correct in sending you there.

Dump that shrink. File a complaint. If you need one, find a new psychiatrist. But do follow through on that complaint. Focus on it like a Mission. Next thing you know, you'll feel lots better. Might help if you do get a new psychiatrist and seriously consider what medication you take, why, and if you might be better off without it. But seriously, only do that with expert help from a psychiatrist that is actually paying attention.
posted by Goofyy at 6:54 AM on January 19 [1 favorite]

For some reason, your question reminded me of the Rosenhan experiment, wherein staff at mental hospitals could not distinguish sane pseudopatients from genuine mental health patients.

I think the reason why that study popped to mind is that your doctor seems to be coming from a position that assumes certain levels of pathology already exist, and that any and all deviation from perfect compliance is indicative of yet further and worsening pathology: "I mean, he drank alcohol over the holidays!"

That said, I'm no doctor, but if you lack confidence in the ability of any medical provider, especially those that are supposed to help with mental issues, your outcome will tend to be worse. To put it in more neutral terms, say I had a knee injury and went to one orthopedic surgeon who recommended radical surgery and did so in terms that made me feel that I would be a lifelong cripple without said procedure, while simultaneously failing to explain other possible cures and outcomes, I would likely seek a second opinion before undergoing the procedure.

Seeking a second opinion is no sin, regardless of which health care field you seek it in.
posted by palindromic at 10:50 AM on January 19