Inside Bipolar Podcast: Second Opinion for Bipolar Disorder Diagnosis

Meet Your Inside Bipolar Podcast Hosts

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

He is also the host of Healthline Media’s Inside Mental Health podcast available on your favorite podcast player. To learn more about Gabe, or book him for your next event, please visit his website, gabehoward.com.

Dr. Nicole Washington is a native of Baton Rouge, Louisiana, where she attended Southern University and A&M College. After receiving her BS degree, she moved to Tulsa, Oklahoma to enroll in the Oklahoma State University College of Osteopathic Medicine. She completed a residency in psychiatry at the University of Oklahoma in Tulsa. Since completing her residency training, Washington has spent most of her career caring for and being an advocate for those who are not typically consumers of mental health services, namely underserved communities, those with severe mental health conditions, and high performing professionals. Through her private practice, podcast, speaking, and writing, she seeks to provide education to decrease the stigma associated with psychiatric conditions.

Find out more at DrNicolePsych.com.

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: Welcome, everyone. My name is Gabe Howard and I live with bipolar disorder.

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

Gabe: Dr. Nicole, I ask a lot of people about our podcast. Did you listen? Do you like it? Was it helpful? And people give me all kinds of opinions on it. In fact, arguably they give me a second opinion on it because I already have an opinion. You have an opinion. And we’re like, we’re like the core group,

Dr. Nicole: Right.

Gabe: Right? What Healthline media thinks is opinion number one and what the audience thinks is opinion number two. Now, I’m going someplace with this. Obviously, what I want to do is only talk to the people who love us. I want to find all of our superfans, all of the people who tell us that we changed their lives. They gave us that bit of information that they needed to move forward. And I only want to focus on them for the second opinion. I think this is a genius move when seeking a second opinion on something as trivial as a podcast is only listening to the people who agree with you. Is is that the best idea?

Dr. Nicole: Well, obviously not, because how are we going to get better?

Gabe: Oh.

Dr. Nicole: How do we know if we’re doing something wrong? How do we know?

Gabe: You pulled out an obviously not

Dr. Nicole: Obviously not. Yes, obviously.

Gabe: I. I say this because obviously, the goal for a podcast or a bipolar disorder diagnosis or treatment is both to get better, right? It’s to learn things and hear things that may make you uncomfortable and that you don’t want to know, but it gives you the opportunity to fix it. And I really feel that this is analogous of why people seek treatment for bipolar disorder. They’re going to their Dr. Nicole to fix it. The first thing I want to say is just like in podcast world, I think it’s a great thing to seek a second opinion. But just like in podcasting world, if you don’t seek that second opinion correctly, then you’re not going to get the information that you need. Dr. Nicole do you feel the same way? Obviously that is my opinion as a patient. What do you think is a doctor?

Dr. Nicole: Absolutely. And you may get the opinion you want, but it absolutely may not be the opinion that you need. And that’s where I think we need to look at the reason for the second opinion. But I love second opinions. Like I’m never telling someone you shouldn’t get a second opinion.

Gabe: I want to stay with that for just a second, because I talked to a lot of people with bipolar disorder who are reporting that their doctors become angry and annoyed and challenging and defensive when they say that they want a second opinion. And I want to be clear, I don’t think those people are lying there. They may be wrong. They may be misinterpreting the signals. But there is this belief that when they seek a second opinion, they don’t get as good of care from their primary doctor or that their doctor becomes angry. Can you address that? What does the medical profession really teach and feel about second opinions in general? I know you’re a fan of them, but what’s the industry opinion?

Dr. Nicole: I am a big fan and I. I don’t know that we get a lot of training about how to handle it. When a patient says, I want a second opinion. I think there are some specialties where second opinions happen a whole lot more often. In surgeries, elective surgeries, you know, orthopedic surgery like those areas are areas where you see a lot of second opinions, rightfully so. One person says we should just we should just replace that knee. And you think, oh, but surely there are other options that we can do. Maybe that first doctor didn’t tell you any of those options. You go see somebody else and they say, Well, we could, but we also can do A, B and C beforehand to see if that helps, blah, blah, blah, blah, blah. So second opinions in those worlds are a little bit more common. We don’t see them as often in psychiatry, but I do see them a lot for bipolar disorder diagnoses and schizophrenia diagnoses. So those are the two areas where I think I see them the most. I’m fine with them, like I’ve said before, but I can’t tell you that there are not doctors whose ego might be hurt a little bit that you are questioning, you know, their diagnosis.

Dr. Nicole: I think it’s human to feel a little slighted if you’re an expert in something. And let’s face it, your doctors are experts in mental health. So for you to come and say, well, I’m not 100% sure if you’re right because I was reading on the Internet, I think I think that just tips some people over the edge. So I can’t tell you that your doctor may not get upset or angry or any of those things. But I, I question maybe how the information was relayed to the doctor. So how did you say I want the second opinion? I do think if you say, well, I’ve been doing some reading and I noticed that some of these things are symptoms of mania and I’ve never had those things. Can you help me understand why you gave me the bipolar diagnosis? Can you can you talk me through my symptoms and why you think that they are a good fit for that diagnosis? I think you’ll get a better response.

Gabe: And as you know, we did a episode of this very show on horrible things Dr. Nicole has heard from patients. And it’s weird to say, Hey, the way that you handle that appointment is going to determine whether or not you get push back on that second opinion. But I do want to say that one, it doesn’t matter if you get pushback on that second opinion, you have a right to that second opinion. Now you may have to pay for it. Your insurance may not cover it. And we there is a reality that your initial provider may drop you. And that’s that’s not cool. I want to say to all the providers listening, please don’t drop people who are getting second opinions. There are other reasons to drop

Dr. Nicole: [Laughter]

Gabe: People that people will support you on. Don’t let your ego get in the way.

It’s always sticky to bring up power dynamics between patients and doctors. So I don’t want to fall down a rabbit hole. I just want to say that if you’re the patient and you have become annoyed at your doctor because you don’t think they’re supportive of that second opinion, consider two things. What was your behavior and were they as annoyed as you think they were?

Dr. Nicole: Mhm.

Gabe: Because I also talked to a lot of patients and like, well, my doctor is upset with me and I’m like, okay, why is your doctor upset? Well, they told me that I needed to eat better. And when I came back, I didn’t eat better and I actually gained a pound. I’m like, okay, so what did they say? Well, they said I needed to eat better and that I’ve gained a pound. Okay, that’s not upset. That’s that’s fact. You have absorbed that. I’m not saying that happens 100% of the time. I’m just saying that it’s worth considering.

Gabe: I want to say unequivocally and please sincerely hear me, doctors disagreeing is not proof that your doctor is an idiot. A second opinion coming out differently is not proof of fraud. It is not proof that anything went wrong. It is simply proof that two separate people looked at the same data and came to different conclusions. But now I want to touch on that for a moment. The nature of bipolar disorder is there’s no definitive test. All the Dr. Nicoles of the world can’t, like draw your blood, read the chart and say, Well, yes, Gabe, of course you have bipolar disorder. See these markers right here? Meaning that all the Dr. Nicoles of the world are deciding whether or not you have bipolar disorder based on the data you give them. And this is why this is very, very important. If you tell the first Dr. Nicole. Well, yes, I’ve experienced such grand heights. I think I’m a God. I think I’m amazing. And Dr. Nicole says, well, that that really sounds like mania. And you’re like, No, no, no. I don’t think that’s mania. Nothing bad has ever happened and Dr. Nicole says, Well, remember that time that you lost your job? Or remember that your wife left you and you really described this euphoric feeling while that was going on.

Gabe: And you think, well, but I still don’t know that that’s mania. So you go get your second opinion. All right. So far so good. So you go over to the next doctor and you’re like, Hey, look. Yeah, I felt a little bit, you know, high. I felt pretty good. I had a lot of confidence. Notice you removed all references of feeling like, God, I’d like to point that out. Right. And that doctor is like, Well, maybe it’s hypomania. And then you’re like, Well, has anything bad happened? And you’re like, No, I can’t think of anything bad that’s happened. Okay, so now, now we’ve got hypomania, but it hasn’t really affected you that much. So we don’t need to be as aggressive with the treatment because it’s hypomania versus mania and you’ve been able to largely control it on your own. So therefore, our aggressive treatment is going to be different. And now all of a sudden you’re like, Aha, See. That other doctor wanted to fill me with pills, just wanted big pharma all up in my business. And this other doctor gives me exactly what I need because they saw it differently. Completely different set of facts and circumstances. But in your mind, you gave them the same information. As you can see by those two stories, you did not.

Dr. Nicole: And I guess it’s important to point out that’s not always intentional on the part of the patient. Sometimes that can happen in the questioning. So a great example would be if this person is telling me all about their mania or hypomania or whatever these symptoms are, and then I say, well, how long does that last? And they tell me, Oh, a couple days. That’s not going to meet criteria for mania or hypomania if I don’t ever ask the question. But what’s the longest it’s lasted? But because people who have mania, hypomania aren’t always the best reporters of how long their symptoms last because they’re manic or hypomanic at the time. And then when they come out of it, they don’t always remember. So they may tell me, oh, just just 2 or 3 days. It’s just 2 or 3 days. So it’s never lasted longer than 48 hours. And then I may get well one time it did last up to a week and blah, blah, blah, blah, blah. So I think the way we question can also pull out certain things and we’re going to be a little different in the way that we question. So I tend to question things a little step further because I’m trying to I’m trying to find a criteria. I’m trying to see if it’s there. So that can also add to, you know, the discrepancy, the way we ask the questions and then the way you answer the question.

Gabe: I want to talk about what you just said right there. You said you’re looking for criteria. So for some people that’s going to hit as she is an excellent doctor who’s looking for the symptoms. To other people, it’s you find what you’re looking for. If all you have is a hammer, everything looks like a nail. So that one statement can can make two people think either you’re a great doctor

Dr. Nicole: Mhm.

Gabe: Or you’re a terrible doctor because it’s lacking context and you know what you meant.

Dr. Nicole: Yes.

Gabe: I only want to point that out because I think it’s an excellent real world example of how look, no matter how ridiculous you what you want is, you can probably get a doctor to quote unquote, fall for it. Again, because we don’t have that definitive blood test. And once you get to that third opinion, fourth opinion, you start reading online, you get on Reddit threads, we start learning what to say. We start learning what the doctors are looking for. We start running interference on the questions to make sure we get that diagnosis that we want. And I want to be clear. I’m not saying this as in we’re all manipulative liars and horrible. No, no, no, no. Unintentional bias is still bias. Accidentally leading your doctor is still leading your doctor. And I believe a lot of us do this accidentally because we believe that we’re helping. We believe that that little bit of knowledge allows us to get ahead of the doctor’s questions and just be more efficient when in actuality it doesn’t. So whenever you’re seeking a second opinion, I just want to be as clear as I could be. Don’t try to figure out what the doctor wants to know. Just answer them super, super, super honestly.

Dr. Nicole: And just to add to that, I think it’s important for people to know how our brains work. So when I see somebody for the first time, I have screening questions for just about every common disorder there is. And so I’m always looking for criteria for everything. When I do an initial evaluation with someone, I’m screening for a major depressive episode. I’m screening for mania or hypomania, I’m screening for psychosis, I’m screening for generalized anxiety. I may ask questions to screen for social phobia or obsessive compulsive disorder or post traumatic stress disorder. I’m doing all of that in the first visit, so I am looking for criteria because I’m trying to figure out what’s going on, but I’m looking for criteria for everything, not just the bipolar disorder.

Gabe: And Dr. Nicole. That is an excellent example of how research is supposed to work. You’re just researching and looking. You’re not researching does this person have bipolar disorder and then looking to find things that support that while ignoring things that don’t. And I only bring this up because I hear this phrase a lot. Well, I did my own research, and that’s how I know my doctor is wrong and I always fire back immediately. Did you look on both sides? And they say, What do you mean? And I said, Well, are you trying to support that you don’t have bipolar disorder? And they’re like, Yes. I was like, okay. So you probably look for a lot of information to support that you do not have a bipolar diagnosis. Like, yes, absolutely. YouTube videos, Reddit read all kinds of stuff on on and I use real websites. Gabe I hear that one a lot. I was on I was on Healthline.com, I was on WebMD, I was on Psych Central. So, so, you know, I did my research and I’m like, excellent. How much time did you spend on proving that you did have it? Well, none.

Gabe: Well, what do you mean? You looked up all the information to support that you do have it, right? No, I didn’t look on that side at all. That’s not research anymore. That is answer shopping. And answer shopping is very, very, very different from research. And again, I only bring this up not to shame anybody who does this because I understand. I as someone who lives with bipolar disorder, I super understand answer shopping and finding the answers that I want. They’re comforting. Comforting lies are so, so much better than uncomfortable truths. They really, really are. But I want to remind our audience, getting this wrong hurts you. Getting this wrong doesn’t hurt Dr. Nicole. She’s going home. It doesn’t hurt your practitioner. It doesn’t hurt the medical community. It doesn’t hurt big pharma. It doesn’t hurt big psychology. It doesn’t hurt anybody but us. And that’s why it’s super important to get this right, because the consequences of wrong only impact, well, you.

Dr. Nicole: And I completely understand why you want me to be wrong. Getting a bipolar diagnosis can be extremely scary. The medications that we use to treat bipolar disorder are not sexy drugs. The side effect profiles are frightening. I get that too. So I know why a person doesn’t want the diagnosis. I completely understand. I would just like for you to tell me that you’re questioning me. I would like for you to say I’m just not sure. This seems like a really big deal. I’m just not sure that I have bipolar disorder, because what I typically recommend in that instance, I say, okay, we don’t have to do meds today because nine times out of ten, if somebody comes to see me in the office, they’re not in a crisis necessarily. And they’ve been dealing with these symptoms for months or years. So waiting another two weeks is not a deal breaker. So I usually will say, go do your research, Go, go do research. I want you to go to reputable sites. I tell them you can go to threads on social media platforms.

Dr. Nicole: You can join Facebook groups. That’s totally fine. But realize there’s going to be a mixed a mixed bag in that group. You’re going to have people who say, yes, I have bipolar disorder, I manage it. I’m so glad I got my diagnosis. So now I know what’s wrong with me and I can treat it. And then there are those people that say, you know, these doctors don’t know what they’re talking about. They misdiagnosed me. And then I found somebody finally who recognized that I don’t have bipolar disorder. I have something else. That’s that one person’s experience. Is it possible that I’m wrong? Is it possible that another doctor you see could be wrong? Absolutely. It’s possible. We’re not with you 24/7. We are not there to see the patterns, to see what’s going on with you. Your loved ones are. So I also recommend that you have them read the same things, have them read the threads and kind of see what they think. But I also recommend that you go to reputable sites, reputable sites, CDC, National Institutes of Mental Health, go to a site like a Healthline Media, Psych Central. Those articles, they’re reviewed by physicians in the field, people who are experts in the field. Go read those things, but don’t just read them yourself. If you have a spouse, have them read them too. If your parents have them, read them, whoever it is that you’re closest to, have them look and say, Hey, what do you think about this? This is a great time to bring in your support system and do some reality testing because you just may be wrong.

Dr. Nicole: Wrong as two left shoes and not know it because in those moments you’re not a great person to remember what’s going on because of the fact that you’re in those moments. So I usually do recommend Go read about it. Go go back. We’ll regroup in two weeks, and then we’ll have another conversation and we’ll see where we stand. A lot of times that takes care of it. They don’t necessarily feel like they need to go second opinion. Sometimes they come back with information that makes me change my mind. Maybe they come back and say, Well, I read that somebody said that these episodes are happening the week before their period and they finally got diagnosed with PMDD, Premenstrual Dysphoric Disorder. And I say, Oh, I didn’t ask you about these episodes in relation to your cycles. Are they only during that period? And they say, Yeah, I think so. Maybe I was wrong. So maybe you can go back and do some research and come back to me and tell me, No, I really think it might be this instead and we can have a conversation about it.

Gabe: I also want to ask you a question, Dr. Nicole. You said that you like it when you have a relationship with your patients, when the patients talk to you and they say, Hey, I read this online or I saw this or somebody said this in a support group and I want to address it with you. Many patients believe that that doctors don’t like that. They call it Dr. Google. They call it oh, you did your own research. And there’s a lot of mocking in your industry. But you brought it up. I didn’t even pull it out of you. You literally offered it up. Do you like it when people bring you articles that they printed out and saying, Hey, is this me?

Dr. Nicole: I. I like it in the sense that it opens up conversation. I like that they feel comfortable enough to say to me, Hey, I read this thing. What do you think about this? If you send me 50 pages of reading, I’m probably not going to have time to read it. Trust me, I have had people send me hundreds of pages that they have printed out for me to read about their diagnosis. And is there a part of me that gets a bit of a chuckle about it as if the person thinks I didn’t go to medical school and residency and study this topic thoroughly. Sometimes people send me things and say, Well, I didn’t know if you knew this or you’ve seen this, but here you go. And it’s like basic, basic psychiatry 101 stuff. So I chuckle. But I can’t tell you that some doctors don’t feel offended because they think, Why? Why would you give me that? I’ve gone through all this training and you don’t trust that I know the basics?

Dr. Nicole: You don’t take pictures of engines to your mechanic and say, well, I was reading online that this is blah blah, blah, blah, blah. You just take your car and you say, fix it. I’m not saying just give us carte blanche and just say, okay, fix me, prescribe whatever you want, because that’s also very dangerous. But let’s figure out how to how to get that going. So I like good research. If their research isn’t good, I tell them, okay, I don’t like this site because. I don’t like this because. This is why I don’t like this. These are the ones that I typically recommend you look at. Look at those. Tell me what you think. Let’s let’s have a both sides conversation. I will play devil’s advocate. I will say why I think these things are wrong or not appropriate for that person or why I didn’t say that for them. Like, I don’t mind giving them the specifics of why I said what I said and why I gave them the diagnosis. I don’t mind that at all. It takes a little more time. We’ve already talked about how sometimes time is limited when you’re trying to have these appointments, so you may have to schedule a second appointment to come back and have this conversation just to be able to make sure it has happened to your satisfaction for you to understand.

Dr. Nicole: I don’t mind it because I personally don’t ever close, close the door to the fact that I could be wrong. I mean, I could have been wrong. So tell me tell me why. I might learn something new about you that I didn’t know before. The TikTok video sparked it off. It might have been a question I didn’t ask. It might have been something you forgot to tell me because you didn’t see the importance of it at the time when we did the evaluation, any of those things could be true, I don’t mind. But I do know that there are some doctors who die a little bit on the inside when somebody says, Hey, I saw this on TikTok. When when the word TikTok comes up, they kind of lose it.

Gabe: There is a difference between dying a little bit on the inside and absolutely rejecting the conversation.

Dr. Nicole: Yes, but I can’t tell you that there aren’t some who don’t reject the conversation. Like, I just can’t tell you that there aren’t doctors out there who say, well, fine, if you don’t think that I know what I’m talking about, go see somebody else. I cannot tell you that those people don’t exist because I know they exist. I don’t think they’re the majority, but I do think they exist.

Gabe: We talk a lot on this show about finding a good fit. So obviously, if you have a doctor that just shuts down conversation that you feel are important, that’s not a good fit. Now, I know that’s easier said than done depending on where you live, your socioeconomic status, whether you have insurance or you’re self-pay. Etc. So I don’t want to just say, Oh, well, find a new doctor and pretend that it’s super easy. If it is super easy, you have no excuse. Find a new doctor. One who is a better fit. If it’s harder, talk to the people in the clinic. Talk to your insurance company. Talk to your payer source and try to find that better fit. It can be a challenge, but I do believe that it pays big, big dividends. Because if something is important to you and it’s not important to your doctor, then you’ve got a little bit of a power struggle there. You’ve got issues there. And again, I it this is where it’s always a little hard for me, Dr. Nicole, because in your world, a second opinion is met with another medical professional. But in our world, a second opinion is talk to a peer got on a support group, read on Reddit, looked on TikTok, read on reputable sites and of course read on non-reputable sites. And we believe that that is a

Dr. Nicole: Right.

Gabe: Second opinion. And I don’t think I’m going to be able to convince the whole world that that’s not a second opinion. That’s just the difference between how patients think and how medical doctors think.

Dr. Nicole: And I don’t know that I considered a second opinion talking to your peer support person, going to Reddit threads, I don’t know that I ever consider that to be a second opinion, but I could see how somebody on the other side might consider that to be a second opinion. So maybe our second opinion. There’s a continuum of what that looks like. So we start with our peer people. We start with our loved ones, Go to your loved ones and say, Hey, this doctor says I have bipolar disorder. What do you think? And that person might say, Well, I’ve always thought that, so that might help out a little bit. It may look like doing the research a little bit deeper. But it also may look like you finally saying me and this person are not seeing eye to eye. I need to see a different doctor. And if you don’t have the ability because as Gabe said, it’s not easy. If that’s true for you, that’s more of a reason for you to work on your communication skills with your doctor, because seeing somebody different may not be an option for you. You may have to figure out how to make this relationship work and it might cause you to do some reflection on what can I do to approach this differently, to be heard and to to have a conversation with this person.

Sponsor Break

Dr. Nicole: And we’re back discussing how to approach a second opinion when you’ve been diagnosed with bipolar disorder. If you can see somebody different, that brings up a whole new set of stuff, right? So you’re going to go to this new person. Do you make sure they have records beforehand? Do you not want them to see records beforehand? It can go either way. Sometimes I have people come to see me and they make sure that I have records from the person who they disagree with before I see them so that I can look at those things, interview the patient, see what I think. Some people say, I don’t want you to have the bias of that person’s note. I want you to just see me and let’s talk. You’re going to get different results either way, but you have to decide, you know, where you land on this. And if you go see somebody for a second opinion and they say, I can’t really make an opinion until I can see those records, maybe they do the interview first and then get the records later.

Dr. Nicole: That has been my typical approach. If someone does not want me to have records beforehand and they don’t trust that I won’t look at them if I have them, then I will say, okay, you know, let’s do the interview, then have the records sent, and then let me see what that person said, because I need to make sure that we’re comparing apples to apples. I need to make sure I have all the information in front of me that they have in front of them. And honestly, it’s a little unfair to me to expect me to make a second opinion about somebody else’s diagnosis if I don’t have their thoughts, their records, to be able to see why, because they may have put something in their records that makes me go, Oh, no brainer. Absolutely bipolar disorder. Or I may look at those records and say, Um, maybe they did misunderstand you a little bit. Maybe I can tell that from what’s in there. But you just have to be open when you if you see another person, you just have to be open to that person’s way and not be upset if they want to see records from the first opinion.

Gabe: One of the things that I tried to do in preparation for this show is figure out how often a bipolar diagnosis was overturned. And I know that’s not the right language, but.

Dr. Nicole: I envision me in court with a gavel in my office and a gavel. And if I think it’s not bipolar disorder, I bang it on the desk and I say overturned. That’s what I’m envisioning right now.

Gabe: Yeah. So I know that I used the wrong word, but remember, not a doctor, but there is no data on

Dr. Nicole: No,

Gabe: This. I couldn’t

Dr. Nicole: No.

Gabe: Find data on the number of people who were diagnosed with bipolar disorder, then got the second opinion. And then and look, that’s that’s unfortunately that’s that’s the end of that statement. It was very, very difficult

Dr. Nicole: Yeah.

Gabe: To find data on that because it just doesn’t seem to be tracked. So this is not this is only Dr. Nicole’s experience

Dr. Nicole: Right.

Gabe: That I’m about to ask. And I just want to make sure that we’re very clear on that. But Dr. Nicole, in your career giving second opinions, do you find yourself again, overturning, put on put on the black robe? You got the gavel. Do you find yourself finding again? I apparently have legal-ese on the brain. Do you find in favor of the patient or the doctor more often than not? What is what have you found? Again, this is only Dr. Nicole’s experience.

Dr. Nicole: I’d probably say most of the time it ends up being that I agree with the doctor most of the time, but there’s a considerable amount of time that I do agree with the patient, and this is the thing we’ve talked about this early on. Back in the day when we first when we first started out, we’ve talked about how diagnoses change. So your record is going to be peppered with a variety of diagnoses. In one person’s record who has bipolar I disorder, for example. They may have schizophrenia diagnosis, they may have schizoaffective disorder in there. They will have bipolar. They may have major depressive disorder like it may all be in there. So it’s a little bit difficult to tease out when I do end up siding with the patient. I guess it usually is a situation where the person says, I was diagnosed with bipolar disorder a long time ago and you know, I don’t agree with that diagnosis. I just want to see somebody to try to figure out what’s wrong with me. And usually when I do agree with that person, it’s a situation where maybe they were an adolescent when they were diagnosed. And usually when I go back and do a lot of history, there was a lot of chaos and trauma in their environment. So they were having mood swings, they were angry, so they were teenagers anyway. And then you put them in this chaotic environment where there was violence and all this trauma, and they were angry and they were swinging left and right with their moods. So in that case, I do see a lot of times as we can kind of look further into the future of how have you been as an adult now that your life is more stable? What does that look like? Those are overturned. Um, overturned. Now you got me using the word overturned.

Gabe: [Laughter] I love that we’re on the same page with this new language.

Dr. Nicole: Now you have me saying overturned, but that might be a time when I tell them I don’t think that that was a right or a proper diagnosis. Maybe the person was using substances heavily at the time. Maybe, you know, in their younger days they were using psychoactive drugs, cocaine, crack, amphetamines. They were using things like that. And now they’re not. And they say, well, I haven’t had, you know, one of those episodes since I stopped using cocaine. Well, that’s a no-brainer, too. So we can start thinking through what that means. Did the person who saw you back then even know that you were using drugs? Maybe not. Maybe that’s why they gave you the bipolar disorder diagnosis. You know, we don’t know. So those are some of the the times when I am more likely to overturn overturn. Again, I cannot get over that word.

Gabe: There it is again.

Dr. Nicole: There it is again.

Gabe: I have created a thing.

Dr. Nicole: You have. But those are the most common times that I would change a diagnosis. Trauma during the time the diagnosis was given, lots of chaos in the environment or substance use. Those are usually the top two things that would make me side with the patient, I guess, and change their diagnosis officially on my end.

Gabe: There’s just a lot of research and data that we don’t have. I just want to find like, you know, a range, you know, how often does this happen? How often is bipolar disorder misdiagnosed? And everybody’s like, I don’t know. And I’m not trying to blame anybody. I’m just I’m just pointing out that there’s just a lot of information that we don’t have that would be nice if we could keep. I also want to point out that there is a fair amount of data on second opinions in general. Forget about bipolar disorder for a moment. Forget about mental health. There’s there’s some data on certain illnesses that that are tracked and not to fall down that rabbit hole. But Yale Medicine actually has a lot of information about when you should seek a second opinion If you want to read the whole thing, just Google second opinion, Yale Medicine. But this is the paragraph that caught my eye. Patients should seek another opinion if they feel uncomfortable with their initial team. If they have a rare cancer, for example, that another doctor may have more expertise with, or if they are confused about their diagnosis or treatment options.

Gabe: I really like this for a few reasons. One, if a patient is confused about their diagnosis or treatment options, they should seek a second opinion. I do agree with that. You should tell your provider that you are confused about your diagnosis and your treatment options and see if you can work with them. And obviously, if that doesn’t work out, that’s where a second opinion or a change would absolutely help you with. They use rare cancer. If you have a rare cancer, for example, that another doctor may have expertise with. We’ve been assuming that everybody’s talking to psychiatrists throughout this episode, but there are some people who are diagnosed with bipolar disorder from a general practitioner or maybe even a therapist or a psychologist. Maybe, maybe they haven’t even actually been diagnosed. It’s an offhand comment. You might have bipolar or we’ve suspected bipolar. In that case, going to a psychiatrist is literally the example of seeing that doctor with more expertise. And then I think that if you’re uncomfortable with your treatment team, your doctor, that’s a really good reason to move to to move on, get a second opinion or to try to make that comfort. Because, again, this is this is not diagnosed with a blood test. If you are not comfortable reporting symptoms to your doctor, if you find yourself hiding information, lie by omission or lying to your doctor or avoiding treatment or giving your doctor misinformation because you’re afraid of consequence, then that’s not a good fit. And it’s definitely a reason to move on. So Yale provided some information. I do think that it applies, but I do want to say, Dr. Nicole, it was interesting to me that when I tried to research, getting a second opinion for psychiatric issues, there was just a whole bunch of information about why you shouldn’t do it. Whereas if I put in getting a second opinion for cancer, there was a whole bunch of reasons about

Dr. Nicole: Mhm.

Gabe: Why I should.

Dr. Nicole: It’s not a very common practice in psychiatry, honestly. And I’m glad you brought up the primary care thing. I do think that’s a valid point that we did not talk about earlier. Primary care doctors are fantastic, but I do believe that with the way our health care system is and as busy as primary care doctors are, the second opinion is important because they are so limited on time, they may not have the ability to be able to ask you all the questions they need to ask you to solidify that diagnosis. But I do think the second opinion, if you don’t agree with it, if they start treating you and you feel like this is not right, the second opinion is is appropriate. And then you you mentioned us sticking together. You know, we’ve all got each other’s backs. I definitely could see how it feels that way. You will never hear me say something bad about another psychiatrist because I don’t think it’s professional for me to go around bashing people because there are times that we all do things that are off label or we have our reasons for why we did it.

Dr. Nicole: And that isn’t always translated to the patient or why we’re doing something different than what most people would do. There could be a very valid reason. We have all done things. I know I for sure have patients who I’ve been seeing for a while and they’re on some pretty unique medication regimens that if somebody just looked at their medication list and looked at the person, they would say, Oh my gosh, Dr. Washington is horrible. She’s got you on this weird medication regimen. This is not typical. That’s okay because I’m treating that patient and that particular person needed something that wasn’t typical. So I did we did that because that’s what they needed at the time. So it’s not so much that we just stick together and we’re always we’re in this secret fraternity where we will never, ever say anything bad. I just don’t think it’s professional for me to do so when I don’t know what that person was thinking.

Gabe: I want to say, Dr. Nicole, usually when I’m seeking a second opinion or additional information, it’s because I’m upset. I’m upset with the other practitioner. Right. I want you to say that they’re bad because I think they’re bad. I want you to match my energy with them. And that’s not your job, right? Your job is to treat me. Your job is to give me care. You’re not. Your job is not to support me in my upset or annoyance or anger or whatever feeling I have toward the other person. And in fact, I like that you don’t, because it doesn’t serve me, even if I have every right to be angry, annoyed, bothered, upset by that other practitioner. That doesn’t move me forward in life. It keeps me grounded in that situation. I’m doing the right thing by seeking that second opinion. I’m doing that right thing by meeting with you. And if you just pull me right back into the place that I left, then why did I leave? I, I like that you addressed that. It can seem that way. But I do want to put out there for patients that doctors not matching your energies and doctors not carrying your water is actually a very good thing. And that is that is excellent proof that you are moving forward and leaving that that annoyance, anger upset in the past. And isn’t that what we all want to do? That said that said, Dr. Nicole, you all have like a club though, right? I mean, you all go and play tennis, ride horses. I just don’t burst my bubble too much.

Dr. Nicole: We do. Yeah.

Gabe: I know you’re all hanging out, drinking, drinking champagne somewhere.

Dr. Nicole: We. Yeah. There are whole conferences on how we can disrupt the lives of our patients systematically. No. No.

Gabe: I know you’re kidding, Dr. Nicole, and and everybody else. She’s kidding. I sincerely promise. Really. The bottom line is that seeking a second opinion is healthy as long as you do it with some boundaries and some guardrails. If you are answer shopping, you are not seeking a second opinion. You will always be able to find somebody who agrees with you. Listen, there are whole communities out there on the Internet that say that the Earth is flat, that prominent politicians have been replaced with robots and and they are robust and they are huge. The flat earther movement has made its way into the pop culture zeitgeist. It is so common. The Earth is not flat. Believe me when I tell you you will be able to convince a doctor of what you believe and the the detriment is to you. And make sure when you’re seeking a second opinion that they have all the information that you give them the information the exact same way that you did to the first practitioner, make sure that you carry on that information.

Gabe: You don’t leave anything out. Even the things that are embarrassing, even the things that you are ashamed of, even the things that you don’t want to talk about. That data is really super important when you’re getting that second opinion and you’re going through all of the questions, make sure you don’t water them down. Oftentimes, the first opinion came in the moment in the crisis and that doctor saw it live. Whereas the second opinion, you are giving that information to the doctor, it I understand. No, no, no. It wasn’t that bad. I wasn’t yelling at everybody. Whereas the doctor saw you, the first doctor saw you yelling at everybody. Make sure you get that out correctly. Don’t be afraid to bring in a support system, a family member or a friend or maybe someone who is there. This is all very valuable for you because ultimately you want the correct diagnosis, not the comfortable one.

Dr. Nicole: You sure do. And if multiple people, two doctors, three doctors are telling you they think you have bipolar disorder, I would recommend you sit with that a little bit and and see is there any validity to this? Why are you fighting this? Because ultimately, if you keep fighting this, you can find somebody to say, oh, yeah, I think you just have major depressive disorder. But if they treat you like you only have depression and you do indeed have bipolar disorder, that is going to be bad juju for you eventually because they’re not treating you appropriately and your symptoms are not going to be controlled. And sometimes those treatments can make your symptoms worse as the doctor, given the other opinion, every time we see somebody, we should be doing our own diagnosis. I am I am going to say I am blessed with the spirit of discernment. That’s the how I describe it. But really I side eye everybody. Like that’s the reality of it. I side eye every everybody in most situations. So I don’t trust even my colleagues with their diagnoses. If they say, Oh, this person has bipolar disorder, I’m asking all the questions. Still. I’m not just taking their word for it. I’m asking, okay, so tell me why they think you have this. What’s your manic episode like? I’m asking all these questions. I don’t care what Doctor so-and-so said because my license is on the line and I choose to decrease my use of my malpractice insurance as much as I can. So I do not want to give you a diagnosis that’s inaccurate and there be bad outcomes. I don’t want to do that. It doesn’t serve me well if I just blindly take other people’s recommendations and I don’t I don’t trust people like that because I am discerning.

Gabe: All right. Dr. Nicole, I think we covered the topic as thoroughly as we can. Of course. Thank you so much for hanging out with me and a big thank you to our listeners as well. 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 is on Amazon because everything is on Amazon. However, you can grab a signed copy with free show swag or learn more about me by heading over to my website, gabehoward.com.

Dr. Nicole: And I’m Dr. Nicole Washington. You can find me on all social media platforms @DrNicolePsych to see all the things I tend to get into at any given moment.

Gabe: Wherever you downloaded this episode, please follow or subscribe because you don’t want to miss a thing and it is absolutely free. And hey, can you do us a favor? Recommend the show, share it in a support group, share it in an online forum, share it on social media. Hell, send somebody an email or a text because sharing this show is how we’re going to grow. We will see everybody next time on Inside Bipolar.5

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