Inside Bipolar Podcast: Losing Your Provider: Navigating the Therapeutic Relationship from Beginning to End

Inside Bipolar Podcast Episode Transcript:

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.

Gabe: Thanks for listening everyone. I’m Gabe Howard and I live with bipolar disorder.

Dr. Nicole: And I’m Dr. Nicole Washington, a board-certified psychiatrist.

Gabe: Before we jump into the topic, I want to let everyone know that Dr. Nicole and I love to get your questions and feedback. You can email us at show@psychcentral.com or you can follow us on TikTok and Instagram. Dr. Nicole is @DrNicolePsych and me, Gabe Howard, I’m @AskaBipolar. Trust me, we are great follows. Now, today we’re going to be talking about finding and replacing your Dr. Nicole. We’re mostly going to be talking about it in terms of your Dr. Nicole, your psychiatrist, but it can also include your therapist or your psychologist or even support groups. And a lot of people think that finding the right medical providers is easy. But the reality is, especially when you get the rug pulled out from under you, it can be very difficult and not as obvious as people think.

Dr. Nicole: Change is definitely not easy and definitely changing your psychiatrist or your therapist after you’ve been with someone for a while. Yeah, it can be really hard because I think a lot of times people underestimate how strong that relationship with your therapist or your psychiatrist can get.

Gabe: I think a lot of people are familiar with how hard it is to find an initial Dr. Nicole.

Dr. Nicole: Mm-hmm.

Gabe: Or an initial therapist, right? You’ve got to kiss a lot of frogs to find the right one. But I don’t think people realize that once you’ve established that relationship and then for some reason, it needs to end. Either your provider moves on, your provider retires, your provider passes away. I mean, all of these are possibilities in managing a lifelong illness. Then it becomes really difficult because you’ve got the ghost of provider past. You’re not just looking for a provider anymore, you’re looking for a provider who was just as good as your previous provider.

Dr. Nicole: Yeah. And good, good could just be good for you. So it’s not that the new one isn’t a good doctor or isn’t a good therapist. They just might not be as good of a fit for you as the one that you love so much. So that’s where the problem can come in for some people, because they’re trying to make everyone be that person, which is really, really difficult.

Gabe: And yet when we’re trying to replace our providers, people are like, oh, well, you liked your Dr. Nicole just find another Dr. Nicole who’s just like her. And that that’s sort of impossible, right? Because there’s always going to be something and I’m going to disclose a little bit. When I was first diagnosed, I was really, really scared. I was terrified, and my very first psychiatrist was a man. And frankly, I was afraid of him. He was, he was a mean looking dude. It’s not his fault, right? He wasn’t a mean guy. He was a mean looking guy. And the first thing that I did is found a female Dr. Nicole. Because, I don’t know, I just, I felt more comfortable. I have a lot of strong women in my life. People who listen to this show have heard me talk about my grandmother. My mother was interviewed on the show. I just felt more comfortable with a woman. But then all these years later, my Dr. Nicole retired and I had to go back out in the world. And the first one they assigned me to was a man, and my knee jerk reaction was, nope, don’t like men. All male Dr. Nicole’s are bad, but clearly I realized intellectually I can’t make decisions on this. And what got me personally over the hump is that my previous Dr. Nicole recommended who I’m now lovingly calling new Dr. Nicole. But where all this is going is my knee jerk reaction was not to give him a chance because of a feeling that I had 20 years ago when I was newly diagnosed, and I can imagine that resting that on him would have been very difficult for him. That’s sort of where I’m going with this, Dr. Nicole. What do you do? What do you do when a patient comes into your office and they’re like, well, you’re not like my last Dr. Nicole. And you’re

Dr. Nicole: Mm-hmm.

Gabe: Like, okay, what personality

Dr. Nicole: Mm-hmm.

Gabe: Trait am I lacking that you like so much?

Dr. Nicole: Oh, I think you bring up a good point, because I while I do agree that it is important in relationships, whether that’s with your doctor, your therapist, friendships, that you have deal breakers, we all have deal breakers. We all have things that are very important to us. So it’s okay to have some level of standard. I think you don’t just go into any of these relationships all willy nilly with no standards at all in place, but I agree with you not being so strict and so tight. I mean, the reality of it is most of us come into all of our relationships with all the stuff from our previous relationships, and so sometimes they’re going to be things about our past that sneak into every single relationship, even with your psychiatrist, even with a new therapist, even with the leader of a support group that you choose to go to, there’s always going to be things from your past that eek into these other settings. So being aware of those things is very, very helpful.

Gabe: So one day, your mind and your own business, you’re talking to your Dr. Nicole everything’s going well. And she says, hey Gabe, now that we’re at the end of the session, I’ve refilled all your prescriptions. I’ve heard everything that you have, and I want to let you know this will be our last session and I’m moving on because I’ve taken another job. I’m retiring. I’m moving to another city. Now that my kids are grown, I’m doing XYZ. I’m moving into research. Dr. Nicole’s and therapists have all kinds of reasons for moving on. What do you do? How do you even begin to prepare for that moment?

Dr. Nicole: First, we’re thankful if you get a moment to prepare, because we know that sometimes things happen abruptly. Sometimes you just automatically find out, oh, my Dr. Nicole left the practice and I had no idea. Sometimes your therapist, your psychiatrist, they may die, and these things happen. And so it’s it really it really depends on how you lose them. I think that that’s important.

Sponsor Break:

Gabe: And we’re back discussing suddenly changing providers and things you can do to smooth out the transition.

Dr. Nicole: So if there is a death, you lose your therapist, your psychiatrist to death. I hope that you take the time to grieve I hope that you take the time to be okay with the fact that you need to grieve.

Gabe: I think that a lot of people downplay this, though, maybe in a way that they shouldn’t. There’s this general attitude that why do you care if your provider died? They weren’t your friend? Or why do you care that your provider is moving? They weren’t your friend. They’re not your loved one. Why are you putting so much onto this basically business relationship? And I think that people don’t get the support that they need. I want to say it. It’s a business relationship from doctor to patient. It’s not so much a business relationship from patient to doctor. So I understand it. But I think that a lot of times people like me who are out there trying to get support when their Dr. Nicole’s, you know, leave for whatever reason, are just generally met with, who cares, get a new one. And I don’t think that that serves people, Dr. Nicole.

Dr. Nicole: Yeah, sometimes it’s the individual who struggles with why. Why do I care so much? Why do I care? This person was not my friend. It was my psychiatrist. Why do I care? Well, you care because you see them monthly. You. You see them routinely for years sometimes you mentioned, I think you said you have seen your psychiatrist 20 years. That’s a long time. You’ve seen that person more than you’ve seen some family members, some of your closest friends. You’ve probably shared more with this person than you have at times with some family members and some closest friends, they become a very valuable part of your system. You think things like, oh, I wonder what Dr. Nicole thinks about this. Oh, I wonder what my doctor so and so is going to say about this thing that happened to me. Patients come to me all the time and they say, oh, this thing happened and I swear I could hear you on my shoulder saying, blah, blah, blah, blah, blah, because we become very valuable. And you’re right, it does not reciprocate in the same way. So I know that as a psychiatrist, I have a very. I have a lot of responsibility. Because the relationship that that person has with me is often stronger than the one I have with them, because I have hundreds of patients to take care of. And I love each and every one of them. And in whatever amount of time we have together, whether it’s an hour, whether it’s 15 minutes, in that moment, I’m locked in. It’s all them. But when that visit is over, I can’t still be thinking about them. I got to move on to the next person, and I got to give them 100% of my attention. And that shifts all day long for you. I’m the only person that feels that that space for you.

Gabe: Yeah, we think about you all the time. Like you said,

Dr. Nicole: No, no, don’t say that.

Gabe: We’ve got our little Dr. Nicole’s on our shoulder. Well, okay.

Dr. Nicole: [Laughter] Yeah, please don’t say that. Don’t say that.

Gabe: [Laughter] Not all that I meant. We think about our doctor. Nicole’s. Like you said,

Dr. Nicole: Yes,

Gabe: When we’re making decisions,

Dr. Nicole: Yes.

Gabe: When we’re practicing coping skills, when we’re trying to decide what to tell you in our visits,

Dr. Nicole: Yes.

Gabe: We’re singularly focused, whereas you are not. And I think that’s

Dr. Nicole: Yes.

Gabe: Important for both sides to understand.

Dr. Nicole: It is. It’s important on my end for us to realize why I think people get so upset with us sometimes and are so passionate about things. And it’s also important on your end to realize their my Dr. Nicole has hundreds of me to focus on in a, in a given week, in a given month. So if there’s a month between our visits, I’ve seen hundreds of people I may not remember small, small details about things, but in those moments I’m locked in to you in that moment. And that’s what’s important. But it is hard on your end when you when you, when you think you’re thinking about your Dr. Nicole and you don’t feel like it reciprocates. But I do think, though, when it comes from other people, it can be demeaning. And that’s where it gets frustrating. When your loved ones are saying, well, why are you so upset? I mean, she’s old, of course she’s retiring. Why? Why are you so upset? You should have known it was coming. Like she’s just a psychiatrist. Go get another one. Get a younger one. Maybe they know more. You can get all kinds of opinions from people, but they don’t understand because most people don’t see their primary care doctors that often. They see them, you know, annually, if they’re healthy, they don’t understand the strength of that relationship and how strong that bond can get for you. And they just don’t know what they’re talking about. So we just don’t listen to those people because they have no clue about how strong this relationship can be and why it’s such a big deal. Show yourself some grace. Allow yourself to grieve that loss if that’s what you need to do.

Gabe: I really noticed when I was diagnosed with bipolar disorder for the first time that I was sort of assigned people the, you know, because I came from the inpatient unit and they assigned me as a psychiatrist and they assigned me a therapist. There wasn’t a lot of decisions that Gabe got to make, and I thought that I was sort of I don’t want to use the word stuck with those people, but I just thought that that’s how the process worked. I was really surprised to learn that you’re allowed to interview your Dr. Nicole. You’re allowed to interview your therapist. You’re allowed to go to different support groups. You don’t have to stick with the one that you’re assigned. And now I know that not everybody gets that general privilege, but many people do. And even if it’s harder for you to switch, you’re not necessarily locked into the person that you’re given. Even practices sometimes have more than one doctor. Nicole I what are what do you think about all of that process? Because I, I think a lot of us were assigned to person, and that’s

Dr. Nicole: Mm-hmm.

Gabe: Just the person that we sort of imprinted on. But now, maybe later in life, later in our recovery process, we’re in a position where we can, I don’t know, shop around for a for a Dr. Nicole or a therapist.

Dr. Nicole: I okay I don’t I don’t like shop around. We’re not we’re not shopping around for our therapist and our psychiatrist. So. Interview is I’m getting stuck on interview. I think I would think of it more as a trial run than an interview

Gabe: Okay. Okay. Fair.

Dr. Nicole: Because waiting lists are so long. Taking the time to, oh, I’m going to interview this one, and then I’m going to interview that one. It may take you months to find somebody and then what’s happening in the meantime? What’s happening with your meds in the meantime? What’s happening with your therapy needs in the meantime? I mean, there are places where therapists and psychiatrists have 8-12 week waiting lists. Interviewing may not happen. Some people who are in private practice may have the ability for you to do a quick little call with them, to just meet them and see if you feel like you jive. But even then, I don’t feel like that gives you a great picture of what that person’s going to be like in a session. So you may see someone a couple times. If you just don’t feel like it’s a fit, then you can look into switching. But again, if it takes you two months, you still have another two months with this person while you wait to get in with a new person that can be very sticky. That can also bring into play the appearance of it looking like your doctor shopping and doctor shopping is never a positive term, so I don’t want to use shop around, because the connotation in the medical community is when a person is doctor shopping, it implies that a person is just looking for someone to tell them what they want to hear.

Gabe: They’re answer shopping. They’re not doctor shopping. They’re answer shopping.

Dr. Nicole: Or to give them what they want. And sometimes that’s not a bad thing, right? Like, sometimes it’s not a bad thing that I know what I’m looking for and I’m trying to find it desperately, but it can give off the appearance that something shady is going on, because most people don’t just switch doctors every couple of months or every few months. So when a person comes in and I say, oh, who have you seen up until now? And they name five different people in the last year, red flags start popping up because you think, oh my gosh, like what’s going on here? So we do have to be a little careful and I want you to get your needs met, but I want you to be aware of what that can look like. And I don’t want that to negatively affect your encounter when you finally find the right person. So I don’t know if any of you are shopping around, but yes, if you are at a multi physician practice or a multi therapy practice and you don’t feel like one is working for you, I think there’s a way to ask for somebody new. You just ask, can I see a different person? I don’t feel like this is a good fit. One of the things that I don’t think people do enough of is talk to the person about why they don’t feel that they are a good fit.

Dr. Nicole: So come to me and say, Dr. Nicole, I have seen you for about three months now. I’m a little bit concerned that this may not work out and this may not be a good fit. Is there any way that I can look into a different psychiatrist in this practice? Is there anybody you recommend? At that point, I will find out, what is it that you feel like is not working for you. And sometimes it just doesn’t work. And that’s okay. And I will gladly send you to somebody else. I can’t tell you that the person you say this to may not get hurt and get upset, but I do think how you say it is the most important thing, because I have had people say this to me in very, very unpleasant ways, and it always goes better when they just matter of factly say, I don’t think this is working out. Do you have any recommendations on what we should do next? So I think having conversations, because it’s so hard to find people in general and to get on somebody’s schedule, I think it’s worth trying to figure out can this relationship work and being open about what it is that is not working, and see if there’s something that that can be changed or can be helped?

Gabe: I really think you hit the nail on the head. I want to talk directly to my people living with bipolar disorder. She rubs you the wrong way. He doesn’t like the same sports teams that I like. I don’t like the decorations of their office. These are, these are not good reasons to switch, considering how difficult it is to find a good, competent provider. But. But let’s dig a little deeper. I’m not getting my way is probably also not a good reason to switch. You want your doctor to tell you the truth, the cold, hard facts so that you can reach recovery. The reasons that you might want to switch a Dr. Nicole out is because you feel so uncomfortable you’re not able to share. But like Dr. Nicole said, you might want to explore that, maybe even with a therapist. That could be something to bring up to your therapist and say, hey, look, when whenever I sit in Dr. Nicole’s office, I clam up and I can’t tell her the things that I need to tell her to get help. And I don’t know why. Because again, that may and probably has more to do with you than it does with your chosen Dr. Nicole. Now, that’s not a lock. I don’t want people to hear. You should never, ever, ever switch. It’s

Dr. Nicole: Mm-hmm.

Gabe: Always your fault. There’s no reason to change. I think that there are really good reasons to change. But I got to be honest, I think that there’s a lot of reasons that people want to change, that frankly aren’t good reasons to switch out. And it’s really important that people understand that, because, again, you don’t want to be perceived as answer shopping because that’s going to impact your care. And I don’t mean it’s going to impact your care, because Dr. Nicole’s going to notice it and think oh, red flag. Like she said, it’s also going to impact your care because you have to start over each time, every single time you have to start over. And that brings us back to our subject of it’s terrifying to start over, and especially when you don’t get any warning whatsoever. What

Dr. Nicole: Mm-hmm.

Gabe: Should you tell the new Dr. Nicole, the new therapist, the new support group, as to why you’re here suddenly? And I’d also like to bring up Dr. Nicole that one of the reasons that you could find yourself suddenly needing a new Dr. Nicole is because of something that happened in your life. You decide to take a job in another state. You decide to get a promotion. You decide to move across town and driving an hour and a half to see Dr. Nicole is no longer in the. Your insurance changes suddenly because you

Dr. Nicole: Mm-hmm.

Gabe: Took a new job. There are a lot of reasons on us as well. I just want to point that out there, because we’ve sort of been painting it like your Dr. Nicole or your therapist just up and left you one day, but we up and leave you all the time. We

Dr. Nicole: [Laughter] Yes, yes you do.

Gabe: We just feel less finicky about that.

Dr. Nicole: Yes, you do. Yes, you do. And it makes sense because it doesn’t feel bad to you because it’s usually a move on your end, you’re understanding. There are things we can talk about, about whenever you go to a new psychiatrist, like what are some things you can do? And I think that would be a valuable conversation to have. But, the two hardest situations that I encounter is when someone is terminated by their psychiatrist and they need to see a new one, or if they have a death of their psychiatrist and they come to me for that reason. Those are two of the more difficult transitions that people tend to make with me. Usually if the person retires, if the person moved, if the person leaves the practice, there is typically enough notice that that person has time to transition them to someone new. And so the person doesn’t feel kind of left out in the cold or left high and dry. There’s a lot of negative, sad, unpleasant emotions that come into the situation when I’m seeing someone after their psychiatrist either dies or if they’ve been terminated. So when there is a death, there is a lot of sadness. Oftentimes when a person comes to me after their psychiatrist dies, they’re very resistant to medication changes.

Dr. Nicole: They are so resistant to wanting a change, even if things aren’t going well, even if they’re having lots of symptoms, even if things are not going well for them and their bipolar disorder, they’re like, oh, but doctor so and so put me on this. And so there’s a sentimental attachment to that regimen. And almost in a way, I think people, whether they realize it or not, are feeling like they’re somehow abandoning that person or they’re disrespecting that person in some way by wanting to change their medication regimen. So I have to be a little more gentle and less of my direct self in those moments, because I am sensitive to the fact that you really cared about this person. You valued their opinion. You trusted them. But. Ultimately, I think any psychiatrist who has a great relationship with their patients and who cares? We want you to be well, regardless whether I’m alive or dead, I want you to be well. And if that looks like changing my medication regimen or doing something different, that’s okay. But it is it is difficult sometimes for people to be okay with changes when they’ve lost their psychiatrist to death.

Gabe: I think it’s the without warning that gets us. If you’re handed off, if you’ve got six months, if you know that it’s going to happen, I think that’s easier. But you’ve got somebody sitting in your office, Dr. Nicole and their previous Dr. Nicole has passed away. Or and I’m really curious about this one. Their previous Dr. Nicole fired them for some reason. Now, I want to be clear. I think people here, they were terminated from their previous Dr. Nicole and that that leads this idea that they did something wrong. But I’ve heard tell I’ve heard tell that

Dr. Nicole: [Laughter]

Gabe: Psychiatrists that go from full time to part time will have to get rid of some of their patients, or their psychiatrist stops taking a certain insurance panel, and that that means they get rid of all the people who are on that insurance panel. But of course, there is also a number of people who their Dr. Nicole decided, I can’t see you anymore. So

Dr. Nicole: Mm-hmm.

Gabe: Being terminated from a practice also carries its own trauma and challenges.

Dr. Nicole: Mm-hmm.

Gabe: Whether it’s your fault, not your fault, whether it’s nobody’s fault. However, it happens, one minute you had a Dr. Nicole and the next minute you don’t have a Dr. Nicole.

Dr. Nicole: She is gone, gone, gone, gone. It’s hard when you get terminated from a practice. So I fully recognize anyone out there listening who’s ever been terminated from their psychiatrist office. I know this is not a pleasant feeling, and I’m not talking about my insurance is no longer being accepted by that practice. I am talking about, you receive a letter that, for whatever reason, you are no longer welcome to receive services from this particular practice now.

Gabe: You just ripped a band aid off right there, didn’t you?

Dr. Nicole: [Laughter]

Gabe: Didn’t you? I tried to make it nice, but you’re like, whoosh. No, you gone.

Dr. Nicole: No, you get a letter. You get a letter that you are terminated. So what are some of the reasons that you might find yourself being terminated from a psychiatrist practice?

Gabe: That’s my question.

Dr. Nicole: One, it could be because of no shows or late cancellations. We talk all the time about how there’s waitlists and it’s hard to get in. And psychiatrist schedules are loaded. It puts a real strain on the system. If you have people who no show frequently. So that is a reason that a lot of practices will terminate you if you have so many no shows in a row if you have late cancellations and it’s usually in their policy, nobody springs this on you. It’s usually in that new patient paperwork. It’s usually listed somewhere in the office. It’s not usually a surprise, but most people don’t read all that little print on all those forms. But it’s usually in there that if you miss so many in a row. So I’ve worked places that would send you a notification after your first missed, like, hey, you missed a visit. Second miss, you missed a visit. We’re not going to schedule you again. Third one you missed. It’s a wrap so you know you’re out of there. This is not uncommon. Some practices may terminate you for behavior.

Dr. Nicole: So if you are in the in the lobby and if you are cursing out the staff or you are being aggressive or have difficulty getting your opinion across without yelling at people, that will be a reason that a practice can terminate you from their practice, because they are keeping the safety of their staff as a priority, and they can’t have that. So your behavior could be a reason. And, you know, one more that we don’t always think about. If you are somebody who is not. How do I even say this? If you are a person who is not following the recommendation of your psychiatrist, and if your psychiatrist feels like that puts you at so much risk. And also puts them at so much risk they may choose not to be able to treat you. Which sounds like that doctor is just trying to force me to take medicine and they don’t respect my decision. But this doesn’t happen a ton. I’ve only done this a couple times in very, very, very severe, very scary circumstances. But it can be a reason.

Gabe: Do you find that people have a hard time listening to the new Dr. Nicole, when they’ve suddenly lost their old Dr. Nicole? And how

Dr. Nicole: Yes.

Gabe: Do you help them understand it? And what would you like people to know from your perspective? Because believe me, I think everybody listening to it understands it from their perspective. It’s your perspective they don’t understand this from.

Dr. Nicole: Yeah. So I personally think after you’ve seen somebody for a long time, there can be some value that comes with seeing somebody new. It’s a new set of eyes. It’s especially if let’s say you’re older. I won’t say older. Your previous psychiatrist was someone you’ve seen for a while, and let’s say maybe they are further along in their career. They’re going to be just by nature of the way life goes. They’re going to be very comfortable with certain drugs. They’re going to they’re going to have they’re things that they know have worked for them and their tenure as a psychiatrist. And then you go to somebody new and let’s say they’re younger. They may have a whole different perspective about psychiatric medications because they’ve trained under new medications and newer meds, and they may be much more comfortable with newer medications that your previous psychiatrist never even thought about because they’re like, are those new meds? We don’t need them. We’ll keep with the old stuff that’s been working well for decades. New eyes can be good sometimes. Your new psychiatrist can hear something that your previous one had heard so much, it didn’t. It didn’t spark anything in them. So new eyes can be good.

Gabe: But, new eyes can be scary.

Dr. Nicole: It can be good though, because the new person can step back and see you in a way that your other psychiatrist couldn’t see you because they had seen you for so long. They need they need the new eyes. So that can be good. But it can be scary because I won’t lie to you. It can. It can also not be good because you’re a new psychiatrist may say, well, you’re a previous psychiatrist was giving you this med, and we don’t even hardly use that med anymore. It’s so old. So I’m gonna change your medication regimen. That’s also not a good plan.

Gabe: That’s exactly what happened to me, though. I you have set me up beautifully. Dr. Nicole as my psychiatrist after 20 years retired. As I already indicated. And I got a brand-new psychiatrist who is much younger than I am. And he was so super excited to say you recognize that the medication that you have been on, you would never be prescribed today because it’s fallen out of favor. The side effects aren’t as fantastic. Would you consider trying this new medication that’s come out in the last couple of years? It has a much sexier side effect profile than the medication that you’re on and why you are stable. You are reporting that you’re having side effects that you don’t like. And I think that this would clean it up. Now, I was sort of excited to get rid of the old side effects. And I still have this sort of mentality that the newer TV is better than the older TV, even if they both have the identical resolution. So I approached it from that perspective. I was like, hey, if you’re telling me that I can have a better level of stability than I have now, I’m kind of excited to to get in there and see what can happen. But then it was sort of terrifying to carry that prescription to the pharmacy. I was like, well, wait a minute, it could also get worse.

Dr. Nicole: Yeah.

Gabe: Like I was super excited about getting better, but then all of a sudden I became super terrified about it getting worse. Now. Now I want the listeners to know I my my story is not finished yet. I’m still going through the tie, trading down the tie, trading up the I’m still learning all of this. But it doesn’t matter how I turn out, the part that I want folks to focus on is that suddenly, after 20 years of being on the same medication, I’m now on a new medication. I personally see that as potentially exciting, but I think that Dr. Nicole looks at it as potentially like, well, wait a minute, you were stable. I’m just curious, is that how you see it? Wait, you were stable in somebody messing with it?

Dr. Nicole: [Laughter] It depends. I mean, it really does depend on a lot of things. If you were stable with no side effects and you said life is 100% great, then I then maybe I’d question it and I probably wouldn’t change it. But like this new doctor. Right. If you if, if you’re having side effects that are unpleasant and there’s a possibility, then it’s worth discussing for sure. I guess like you said, the story isn’t the story isn’t complete yet. We don’t know the ending yet, but it sounds like you at least were able to develop a trust with this person to where you felt comfortable allowing them to make a change to the regimen that the psychiatrist you’ve loved for 20 years made, which that is the that’s the win, because you found somebody that you trusted enough to kind of take the baton from your previous psychiatrist and then carry you on the rest of this journey. So I think that’s the that is the plus.

Gabe: I don’t want anybody to hear that this was easy for me. I want to make sure that that I disclose to the audience that when I found out that my psychiatrist was going to retire, the first thing that I thought is, I’m going to be sick again, that that was actually the first thing that jumped into my mind when she told me in the session, I was like, I’m going to get sick again. You were the one who got me stable and now I’m going to be sick again. This is this is absolutely terrifying. What

Dr. Nicole: Mm-hmm.

Gabe: Do I do? And. And even as I think about it, those feelings are kind of welling up in me a little bit. This idea of going back to who I was before, but I was really lucky. I do have a lot of really good people around me, and they pointed out that my recovery is because of a lot of different pieces, not a single person, and I really took that to heart. She was an important piece of the puzzle, but she was only a single piece. And we were going to replace that piece and find a new piece. And it’s working out. So far, so good, right. You’re just maybe, maybe later on down the road you’ll get a very special episode of Inside Bipolar where it didn’t go so well, but I do think that some of the reason that it’s going well is because I kept an open mind. I

Dr. Nicole: Mm-hmm.

Gabe: Could have freaked out and stood up and said, what are you talking about? How dare you! I had the greatest psychiatrist who ever lived and you dare question her motives? How dare you! I could have even brought in other stuff to it. Like she’s been a psychiatrist longer than you’ve been alive, sir. How could you do that? Right? Like I had all kinds of dirt to throw at this guy. He’s. He’s in his late 20s. He’s stupid. Young, right? I could have said, I know more than you from hosting a podcast. Like, I had all kinds of dirt that I could. I could have brought up Doctor Google, but I didn’t do any of those things. But I’m bringing it out because notice, I thought about him.

Dr. Nicole: Mm-hmm.

Gabe: I thought about doing those things. Those things did pop into my head. I just I didn’t give in to them, and I’m glad I didn’t give in to them because, like you’ve brought up a couple of times, Dr. Nicole, it’s really hard to find a good psychiatrist and you’re going to have to make some accommodations. There’s no perfect psychiatrist. I, my

Dr. Nicole: Yeah.

Gabe: Old psychiatrist, was as close as she could come, but even she yelled at me a couple of times and made me feel bad.

Dr. Nicole: Oh, see, you probably deserved it. I’m not sure what happened,

Gabe: I know I deserved it.

Dr. Nicole: But I bet you deserved it. It you know, I was a young doctor once. No longer do people question. Have I been doing this long enough? So I’ve crossed the bridge. But I was a young doctor once. And the things that you should know is that young doctors still have a crap ton of knowledge behind them. They have trained and trained and trained to be able to get to a place where they can independently take care of the public. I would not question a doctor because of their age, but they do it all the time. When I was a younger doctor, people would often ask me, how old are you? Have you been doing this long enough? Trust me, we are well trained after residency to be able to help you. Also, what I often see is that people come to me and it’s not that they’re 100% great. Their symptoms may be well controlled, but they have side effects. They may be tolerating the medicine well, but their symptoms aren’t under great control. They’re under better control, but not great control. And sometimes your previous psychiatrist has kind of either knowingly or unknowingly allowed you to just continue kind of in this status quo.

Gabe: Dr. Nicole I know we’re running out of time for this episode, but one of the things that we brought up is being terminated from your doctor, Nicole, and you did list some reasons, and those reasons are very extreme. I think that anybody listening can realize that if you threatened waitstaff, if you threatened your doctor, you’re going to not be invited back. And, and even some of the more practical reasons that we gave. You’re off the insurance panel. The your psychiatrist is parsing their patient load because they’re going from full time to part time. Things like that. But I got to tell you, when you get that letter, when you get that letter, it’s a hard letter to get. It’s a it’s a scary letter to get. And I imagine that there’s some people who are listening. They’re like oh. I didn’t realize that a letter like that could come in the mail. Can you just talk about what safeguards are in place in the industry, for lack of a better term, to make it easier on patients? Because I don’t want anybody to hear this and start freaking out that their Dr. Nicole is just going to randomly send them a letter for no reason.

Dr. Nicole: No. And even if you get a letter, standards would dictate that that letter would be very specific about what your termination date is, and it is standard of care on our end to give you enough time to realistically find someone to take over. It is usually within standards of care for us to give you a way to call this number or go to this website to look for a new person, and then we usually will say, you know, we can handle refills in the between time up until this date. So that’s usually the standard when you are terminated.

Gabe: So, Dr. Nicole, if you have to make the change, what are some things that you can do to make the transition smoother?

Dr. Nicole: One of the biggest things you can do is to have a good psychiatric history, good medical history down, like have it written down, keep it in an app on your phone, keep it in a little notepad, keep it somewhere that you can access it. I see people almost daily for a new visit and I’m asking about previous psychiatric history. I’m asking about what medications have you taken, what worked? What didn’t work, what did you tolerate? What did you not tolerate? And people tell me things like, oh, I don’t know, I can’t remember. I think it was an SSRI. I’m not really sure. So then I have to take the time in our very short visit to list off every mental health drug known to man and to hope that you say, oh yeah, yeah, yeah, that one. That sounds familiar. It’s very tough. So to make the most of the time you have with a new person, if you can develop a list with your medication history that can make that session go so much smoother. Another thing you can do is reach out to that new office and find out what’s their process to request records so you can reach out to the new psychiatrist, say, hey, do you have a release of information form I can come by and fill out? I’d like you to get records from my previous psychiatrist before I visit, if you can, and do that as early as possible, because it can take some time for those records to get shared. So make sure you share those records so that the new psychiatrist can flip through the notes from the previous doctor and see, oh, it looks like you tried this, but this happened. Looks like they have you diagnosed with this. Looks like it says this here. Those are two of the most important things you can do when you get ready to transition to a new psychiatrist.

Gabe: The best-case scenario is you walk in with a list of your medications, and you can create that list by taking your pill bottles and writing them down, and then handing that list over to your new Dr. Nicole. If you’re not that organized, I would suggest becoming that organized and actually writing them down because you’re showing that you’re actively participating in the process. But if you can’t get that together, bring the pill bottles in, throw them in the grocery store bag and walk in with them. Because handing your new Dr. Nicole those pill bottles is still preferable to saying, well, I take an orange pill in the morning, and then at night I take a yellow triangle and I think I take half of a white pill, but I’m not sure what it is. Again, you want to be as active as a participant in this process as possible, but if you can’t get it together because of how you’re feeling, because of your symptoms and because of what’s going on in your life. A pro tip is just bring in the bag of pills. Bring in the bag of pills, that’s far better than trying to guess.

Dr. Nicole: Yes. Guessing is never good.

Gabe: We all want to believe that we’re going to keep our Dr. Nicole forever. We really, really do. We want to believe that about our therapists and our support groups and hell, even our friends. But the reality is, is life is long, and there’s all kinds of reasons that you could find yourself in a position to have to suddenly change. We’ve covered some of them here. We’ve covered some of the pitfalls. Hell, we’ve even fallen down a rabbit hole or two, and I, I hope that you’ve got something out of this, and I, I hope the thing that our listeners got out of this is not to be scared that this could happen, but to be aware that it could happen and to know that it’s going to be okay. Dr. Nicole, you have seen lots of patients who are transitioning from other Dr. Nicoles and can you reassure before we get out of here, everybody listening, that if you do find yourself in this position, it’s going to be okay?

Dr. Nicole: It’s absolutely going to be okay. You are going to have a psychiatrist that you can go see. People who are trained just as well as your previous psychiatrist was. They may have a little bit different technique. They may have a little bit different bedside manner. They may just be a little different. And if it doesn’t work out, we’ve talked about how you can go about looking for somebody else who does meet more of your needs. It is going to work out.

Gabe: All right, everybody, we need a great big, huge favor. Please recommend the Inside Bipolar podcast to everyone you know. Share the episodes that you love on social media. Email your friends, mention us to your support groups. The reality is, is that sharing the show is how we’re going to grow, so please don’t keep us a secret. Also, wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free and it’s the best way to ensure that you don’t miss a thing. My name is Gabe Howard and I’m an award-winning public speaker and I could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon, but you can grab a signed copy with free show swag or learn more about me by heading to my website, gabehoward.com. You can also follow me on TikTok or Instagram @askabipolar.

Dr. Nicole: And I’m Dr. Nicole. You can find me on all social media platforms @DrNicolePsych to see all the things I have my hand in at any given moment.

Gabe: And we will see everybody next time on Inside Bipolar.

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