We all like to think that our psychiatrists are perfect paragons of virtue and that we are their only patients. But, deep down, we all know that isn’t really true. Psychiatrists see multiple patients, have many responsibilities, and are human — just like the rest of us.

Join us as Dr. Nicole, a board certified psychiatrist, shares what behaviors get under her skin. We discuss how doctors don’t know what “the pink triangle pill” is, how they don’t all enjoy hugs, and why screaming at their staff doesn’t improve your care.

Gabe Howard

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
Dr. Nicole Washington

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.

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

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

Gabe Howard: Now, in addition to being Dr. Nicole Washington, you’re also a human. You’re a whole person. Right. And that means you have things that you like and things that you dislike, and that includes things that you like and things that you dislike in your job.

Dr. Nicole Washington: Yes. Like everyone.

Gabe Howard: Tell me the things that annoy you about. And I know, I know we googled annoy and looked for lighter words, but I think annoyance is a word that people can relate to. There’s things that annoy you about your patients, right?

Dr. Nicole Washington: That sounds very harsh, very harsh, the word annoy. But there are definitely things that probably get pretty annoying or that get under my skin.

Gabe Howard: If you don’t want to use annoy, there are many other words that you can use irritate, vex, anger, exasperates irk, gall, pique, put out, displease, antagonize. Any of those better? Could we use any of those words because we don’t want to sound too harsh?

Dr. Nicole Washington: I don’t. I don’t want to sound harsh. I don’t want people listening, thinking, oh, my God, that doctor says that she is annoyed by her patients.

Gabe Howard: Let’s go with rattle your cage.

Dr. Nicole Washington: Oh, my cage does get rattled occasionally. It does. But like you said, I’m human, right? So everything is not always roses and unicorns and rainbows. Like, sometimes I don’t have a good day. Sometimes I didn’t sleep well the night before. Sometimes I’m tired, sometimes I’m frustrated because the system I work in may not always be the best. There are lots of reasons we could be frustrated.

Gabe Howard: I think it’s important to bring this up because so often patients get frustrated. Actually, patients are just straight up like we’re pissed off at our doctor. Like we’re not having this discussion about how to make it sound less, right? Everybody within the sound of our voice knows that we are mad at our doctor. So I appreciate you looking for a softer way of saying this, but we wanted to talk about it because, look, our doctors have a side, too. They’ve got things that frustrate them. They’ve got things that make their day go less than perfect. And I think understanding that will bring us closer to the middle. So, Dr. Nicole, the first question I have, the number one thing. What is the number one thing that gets under your skin when a patient does this in a session?

Dr. Nicole Washington: I don’t, man. Is there a number one?

Gabe Howard: There’s so many.

Dr. Nicole Washington: My gosh.

Gabe Howard: They’re all tied.

Dr. Nicole Washington: There are so many things that can happen because I think people just really misunderstand a lot about how this, how this all works. One thing I will say for me personally that really, really is frustrating for me is when someone refers to their medications by color.

Gabe Howard: You mean like I need more of the pink one?

Dr. Nicole Washington: Yes.

Gabe Howard: I don’t like the blue one.

Dr. Nicole Washington: It may be something like a new patient visit who says, Oh, I took this one thing and it was really terrible and I don’t ever want to take that again. And I say, Great, I don’t want to give it to you. What was that thing? I’ don’t know, it was round

Gabe Howard: See, that’s what I was going to say.

Dr. Nicole Washington: [Laughter]

Gabe Howard: Would it be better if they said it’s the green round one? Is that the problem? We’re only giving the color

Dr. Nicole Washington: No.

Gabe Howard: And not the color and the shape.

Dr. Nicole Washington: No.

Gabe Howard: Listen up, everybody. If you give the color and the shape, Dr. Nicole has memorized hundreds of different. You’re saying that you don’t?

Dr. Nicole Washington: I don’t, I’m not a pharmacist. I do not see these pills. I prescribe them. The pharmacy does their magic. They fill them. They give them to the patient. I may never see what the pill looks like, ever.

Gabe Howard: When I hear that the knee-jerk reaction that I have is, Aha, you don’t know anything about what you’re giving me, you’re just shoving pills down my throat. You don’t even know what they look like. This is proof. This is proof. But then I think about it and I remember like every job I had in sales, I’m just entering SKU numbers into a computer and orders are going out. I’ve never seen these products. I sold server equipment for three years and I have never personally seen 90% of the stuff that I sold. But I knew what it was. I knew how it worked. But listen, the internet solves everything, Dr. Nicole. So can’t you just Google it? I mean, seriously, can’t you just Google it?

Dr. Nicole Washington: I could. There’s a website, Drugstore.com. You go on there. You put in the description of the pill. You can try to figure out what pill it is. But listen, that is time-consuming.

Gabe Howard: Instead of utilizing your high medical knowledge and your experience to get you the right medication so that you can live your best life, your doctor is googling. Yeah, that does sound like a complete waste of time. But you said that you can google it, which means the patient can google it too.

Dr. Nicole Washington: Yeah, that is true.

Gabe Howard: Is that a good solution if you’re like, Look, I don’t want the blue pill anymore and you don’t remember what the blue pill is? Listen, as a patient, I understand I’ve been on so many drugs, I can’t be expected. One, I can’t pronounce the names. I just want to be straight up. The reason that I call them the little blue one is because I can’t pronounce. I don’t even know. Like there’s 15 consonants and then a vowel. I don’t know how to pronounce this stuff. Plus it was four years ago. Plus I was sick,

Dr. Nicole Washington: Yes.

Gabe Howard: But I can, I the patient can Google it and I can look and I can find it and I can take that time. And that way I can sit across from my doctor and say, don’t prescribe me [unintelligible]. That’s

Dr. Nicole Washington: Right?

Gabe Howard: Not a real drug.

Dr. Nicole Washington: Not. Not at all.

Gabe Howard: That’s not? Okay. But I can do that. A patient can do that. Right?

Dr. Nicole Washington: Absolutely. And not knowing your medicine history is very frustrating for me from my end. Not because I’m frustrated with you, because you don’t remember them all, because I get it. They sound alike, they’re long words. Sometimes you don’t know the generic name from the name brand. There’s lots of reasons why a person with bipolar disorder wouldn’t remember every medication they’ve tried. But when you come to me and you tell me things like, I can’t take this or I can’t take that, but then you don’t even know what they were. And I’m starting from zero. I could very likely give you something that you’ve taken before and didn’t like because neither one of us remember the names. Then when something goes wrong, you’ll talk to a random, you know, your spouse, your parent, someone who remembers and they say, Oh, they gave you that again? That’s the one you didn’t do well on last time. And then you’re mad at me because I gave you the thing that you couldn’t tell me the name of.

Gabe Howard: I can see where that would be incredibly frustrating because you’re trying,

Dr. Nicole Washington: I’m trying.

Gabe Howard: Right? You just don’t have the data. I really like to put onus back on the patient because I’m the patient. Right? I’m the person living with bipolar disorder. And any time I can figure out how to advocate for myself, make my life better, and get what I need/want to live my best life, I’m a super fan of this. So I really, really, really, really encourage everybody that’s been on that horrible drug that they don’t want on again, to Google it, to figure it out, to print out some pictures, to go talk to the pharmacist and say, hey, I’m going to start describing some pills. Just do whatever it takes. But not in the 15 minutes that you get with the psychiatrist, because that’s super, super hard. But let’s pretend that that that just didn’t work, right? I told you, I don’t want the blue one. You tried to figure out what the blue one is. You made your best case, you did your thing. But now you’ve prescribed me the same pill that I didn’t want. But it happened like this. You didn’t prescribe me the blue one. The pill that you prescribed was pink because it was the generic version of the blue one. But see, I don’t know if everybody has like a wife or a friend like mine. I get home with the pink one and I’m like, Hey, she didn’t prescribe me the blue one. And my friend looks at the pink one, recognizes the name, and then she immediately says, That’s the one. That’s the one that you don’t want. That’s [unintelligible]. You don’t, you don’t like that one. These are the names that I make up on the spot. Right? And I’m like, Aha, she did it. I told her I didn’t like it. And she, that that’s what I should do, right? I should get angry and resentful and I should just start. I should leave a Yelp review.

Dr. Nicole Washington: You should leave a Yelp review.

Gabe Howard: I told her I didn’t want it. She did it anyway.

Dr. Nicole Washington: Oh, okay.

Gabe Howard: I’m joking. Obviously. What is the best way for me to handle this? So I get home. I realize that that is the pill. I haven’t taken it yet. I just filled it. I got home with it. I realized, Oh, no,

Dr. Nicole Washington: Yeah.

Gabe Howard: Okay, I don’t want to take this drug. What is the professional way for a patient to handle it? Because sometimes we arch our backs and we’re ready to fight because we think you’re going to yell at us, how would you like us? And I know you don’t speak for all doctors, just like I don’t speak for all patients. But what is a good entry point to that conversation?

Dr. Nicole Washington: If there’s a patient portal through the electronic record, if there’s a way that you can leave messages that way, I would go ahead and leave the message and just simply say, hey, when I got home, my wife, my husband, whoever, noticed that this was the same medication that I had the horrible side effects to, and just leave that message and wait for whatever staff monitors those messages to get back with you. Most people will tell you we’ll get back to you within 24 hours. If you haven’t heard from anybody in a day or so, then I would call and I would say, Hey, I left a message. I just want to know what to do. Do I need to come back in for another appointment? Can we do this between visits? I think that’s a very reasonable thing to ask. Now, having said that, if there is someone in your life who has better information than you, you might want to bring them to your first visit. You might want to bring them in. They may be a very valuable source. Or they can give you a list of the things that you didn’t tolerate or the things that you’ve taken. Sometimes the people who are closest to us, who help us with our illness, are the ones who know the most.

Gabe Howard: So Dr. Nicole, in anticipation of this episode, I just texted a bunch of my doctor friends and I was like, Hey, what are some things that annoy you? And one of my doctor friends wrote back, bringing the whole family to your appointment. And I wrote back immediately because I have learned from you. But isn’t it good, isn’t it good to have somebody come in? And this person wrote back, Yes, but pick like one.

Dr. Nicole Washington: One. One, a family representative.

Gabe Howard: And have every member of the family talk to that family representative. Would that be like a?

Dr. Nicole Washington: Yes, absolutely. Because listen, I can’t talk to your auntie who you lived with for six months last year, your wife, who you live with now, your mom, who you grew up with, your adult child who is in medical school. I can’t do all that. Right. One representative, one

Gabe Howard: So one representative.

Dr. Nicole Washington: One.

Gabe Howard: And then in that little text exchange, I will be the first to admit it was at like midnight. So I don’t even know that this person is doing their best doctor hat at midnight on a Friday, no, no less. But this person also wrote back that it’s frustrating when the elected representative does more talking than the patient. And I said, Well, but what if the patient can’t talk? And she gave push back and said, okay, well, that’s different. But it was the competition.

Dr. Nicole Washington: Yeah.

Gabe Howard: It was the she would ask the patient a question, the patient would start to answer and the elected family representative would start answering. Is that frustrating for you?

Dr. Nicole Washington: It gets chaotic quickly. So the patient is still the patient, right? I usually in these situations specifically start my sentences off with a patient’s name and I specifically make eye contact with the patient. So I will look at you and say, Gabe, have you been sleeping? And if they answer for me, I will tell them, Oh, thank you for that. How about I ask him the questions for the rest of this visit? And then if there is a discrepancy or something you want to add, we can do that.

Gabe Howard: I know about to open up a whole can of worms for you, so please don’t throw anything at my head. But that elected official or even really anybody in the family can shoot you an email or leave you a voicemail with information that they think that you need to have. Now, I want to say the same rules should apply, right? Don’t have everybody in the family.

leave any psychiatrist or psychologist or therapist a voicemail, because just the reason for that is not because you don’t want to hear them, it’s because it’s too much information. You become buried under it, right?

Dr. Nicole Washington: I’ve had families or a specific family member send me a letter before or call the office and leave a message or send an email. If there are things that they want me to know and they can’t come to the visit or they don’t want to say in front of the person to upset them. That’s difficult sometimes to manage, right? Because if your loved one tells me, well, I’m sending this about Gabe, but I don’t want you to tell Gabe that I told you, that’s not helpful, because then I’m stuck in this triangle of do I tell Gabe that his mom told me that he hasn’t slept in a week and he’s been up at night screaming? Or do I just ask him and go with what he says as gospel truth and don’t question it? It’s tough. It’s really hard. So I don’t mind the Hey, heads up. This is what’s going on kind of information, but I don’t like when the family member tells me but then don’t tell the patient that I told you this stuff because it just puts me in a really bad situation.

Gabe Howard: First, let’s address the HIPAA of it all, right? Many people believe that they can’t call and leave a voicemail for the doctor because it violates HIPAA. That is not a HIPAA violation.

Dr. Nicole Washington: No. You can tell me whatever you want.

Gabe Howard: Right. Now, you replying back with information, that’s a HIPAA violation.

Dr. Nicole Washington: That would be a violation if I don’t have a release to speak to you. So if you’re not the person that they’ve designated or they don’t have anyone designated for us to speak to about their care, then I can’t say anything back. But you can tell me whatever your heart desires.

Gabe Howard: I think this is another moment for the patient to really understand, right? This is why you want to have your single elected official, the person who you trust most. I believe that you get better care if you sign that release so that the doctor can talk to mom, dad, brother, sister, bestie, spouse, whomever. But that’s one person to manage. If you bring in your whole family and you sign releases for all of them and you have a falling out with any of those people that I mentioned, they still have that release. It becomes a quagmire, right? Having that one person means everybody talks to that one person. That one person filters it out, talks to the doctor. You’re making the best use of your time and you’re protecting your medical records.

Dr. Nicole Washington: Right.

Gabe Howard: I just want to say that because so many people believe, well, it’s a HIPAA violation if mom calls my doctor. Nope, it sure isn’t. It’s a HIPA violation if doctor calls your mom.

Dr. Nicole Washington: Yeah. She can call all day. Lots of offices have their blanket statement. Like I can neither confirm nor deny that we are taking care of that person. Or I can neither confirm nor deny that that person is a patient of our office. If there is a family member listening, I would say, okay, that’s fine. But if this person is being seen there, this is what I’d like Dr. So-and-so to know. Leave the information, but don’t get frustrated when you don’t get a call back. Because if there’s no release, you won’t get a call back.

Gabe Howard: Exactly. And that is for our protection, right? That’s for the person living with bipolar disorders protection. So I love that. But to touch on what you said here, it’s super annoying when somebody says, hey, your patient is doing X, Y and Z, but leave my name out of it. That it’s interesting that you’re like, look, that that is annoying for me. That is frustrating that that drives me up a wall that that just that is irritating. But then you followed it up with because it doesn’t allow you to give the best care for the patient.

Dr. Nicole Washington: Yeah.

Gabe Howard: Really, if the patient knew what was going on, it’d probably aggravate them too.

Dr. Nicole Washington: 90% of the things that I could come up with that aggravate me or annoy me or whatever word you want to use are because ultimately they interfere with what I can do with the patient and for the patient.

Gabe Howard: I immediately wanted to segue to, so what’s the 10% that doesn’t. Right?

Dr. Nicole Washington: For me personally, it’s hugs. I don’t, I’m not a hugger.

Gabe Howard: [Laughter]

Dr. Nicole Washington: I’m not a hugger. I’m not a hugger in my real life or professional life. Another cute little story, when I did home visits and I had a lady and she gave me a very out of the blue hug. I’m usually very good at deflecting hugs. I employ the Oprah method where if someone comes at you to hug you, I grab their hands and kind of yay and just avoid the hug. Like, I’m so good at dodging hugs. And this lady caught me slipping and she caught me off the blue and she hugged me so tight. And the next month, when I went back to go see her, she said to me, I am so sorry. Last month when you were here, I hugged you and I felt every muscle in your body tense up when I hugged you. And I think I made you very uncomfortable. And I’m very sorry. So hugs, hugs are probably like the one thing that I just can’t do. Hugs.

Gabe Howard: I personally, Gabe Howard, use the are you a hugger method? Because listen, I am six foot three, 250 pounds and I have the wingspan of a small car.

Dr. Nicole Washington: Yeah.

Gabe Howard: And when I hug you, you’re getting hugged. I’m a hugger.

Dr. Nicole Washington: I’m not a hugger. And if you think about it in psychiatry, I don’t know if people are aware of this. We have very firm boundaries, right? We have very firm boundaries. Your psychiatrist may likely not answer questions about their personal lives to you. Your therapist may not answer questions about their personal lives to you because there’s boundaries. I know you think on your end, but I’m telling them everything about me. They know everything about me. Why can’t I know if they’re married or if they’re Christian or if they have kids or what political party they belong to?

Gabe Howard: Yeah. Why can’t we?

Dr. Nicole Washington: You don’t need it.

Gabe Howard: But.

Dr. Nicole Washington: You don’t need to know that for me to be able to give you what you need. And in some ways, it can interfere with our relationship, right? That trust can be broken if you all of a sudden know that, Oh, he’s not a Christian. Oh, she’s a Democrat. She’s a Republican. Oh, my gosh, she voted for so-and-so. It can change the way you interact with them. There is no scenario in which the care that I provide to you should be different based on any of those things. Whether you are Christian, atheist, Muslim, whatever religion you practice or not, I should treat you the same whether you’re a Republican or a Democrat, independent, like I should still treat you the same. And those kind of details and those kind of things you know about people definitely can interfere, I think, from the patient and o the doctor on how much they feel like they can trust them if they knew those things about them. And so we’re bound by boundaries and hugs kind of violate my boundaries. Our relationship is professional and sometimes that line gets blurred, I think, by patients because you tell us everything. You tell us stuff that nobody in your life knows. And then all of a sudden you think that we’re friends and we’re not.

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Dr. Nicole Washington: And we’re back with the things that bug your psychiatrist, but they’ll never tell you. I do have a couple of things that we haven’t talked about yet that I think we should talk about. One thing is waiting until the last minute if you need a refill. For whatever reason, let’s say you run out of meds before your next appointment, which really shouldn’t happen, right? Like if we’re on our game and we’re making sure you have enough to hold you, but things happen, life happens. But if you need a refill and you take your last pill on Thursday morning and Thursday afternoon, you call demanding that your refill be sent that day because you don’t have any pills for Friday.

Gabe Howard: I am guilty of this. I want you to know, Dr. Nicole, I have done this. I have made the phone call saying, Hey, I opened my pillbox this morning and I didn’t have any pills. I need you to call this in right now.

Dr. Nicole Washington: Yeah. Yeah. But while you’re making that call and expecting me to do it in the next 5 minutes so you can go pick it up and take it that day, I’m in the middle of seeing people. I’ve got a full schedule. I am trying to give them the attention that I give you when you come in, which is why so many clinics have these policies in place that say, you know, we have 48 hours to get your refill done because practices have tons of patients. And imagine if there are several people messaging and calling with needs of side effects or needing things, needing forms filled out and letters and all this stuff. It’s hard to get to.

Gabe Howard: I will be the first to admit that I am unreasonable when it comes to medication refills. I am that guy. So I just want you to know, Dr. Nicole, it’s fear. There is impatience, but it’s also fear. I am now terrified that all of the things that that medication is preventing, all of the badness that it’s holding back is on its way. It is illuminating for you to say, look, I’m giving attention to the people who are here, just like I give you attention when you are there. Because I know that if I was there for my appointment and you were distracted, you weren’t paying attention, you were trying to refill another patient’s prescription. I’d be upset.

Dr. Nicole Washington: Yes. You are not your psychiatrist’s only patient.

Gabe Howard: Why not? I sometimes feel like I am.

Dr. Nicole Washington: Yes. It would be nice.

Gabe Howard: This is the learning moment for people living with bipolar disorder. Do what you can to manage your own pills, whether it’s you get one of those apps that’ll work. There’s med tracking apps out there. Get the pill minder like I do. So that way when you fill it up, you’re like, Oh, wow. I fill mine every Sunday. And I’m like, Thursday is when I dropped the last pill in. I need to remember to call on Monday and that gives me plenty of time. We do need to remember that we can take some control of this and apparently it will annoy our psychiatrist less. I mean, that’s always nice. That’s because it’s all about you.

Dr. Nicole Washington: [Laughter] That is always nice.

Gabe Howard: It’s all about you, Dr. Nicole.

Dr. Nicole Washington: That is not. [Laughter] Oh, my gosh. It is not all about me, Gabe, but.

Gabe Howard: But listen, here’s the thing that I think many people in my position don’t realize. It is a little bit about you. For as much as people living with bipolar disorder say, I want a partnership with my doctor, we do often not consider it a partnership. When we want something, then it’s all on you, right? It’s on you, it’s on you, it’s on you. Fill my prescription, get me an emergency appointment, change my med, I’m having a side effect. Do, do, do, do. It’s only a partnership sometimes. I was guilty of this. I wanted to be heard. I wanted to form a partnership with my psychiatrist. But whenever my psychiatrist needed an extra day to get something done, that partnership was gone. And I was the customer. I’m the patient. You do it now. What happened to the Kumbayah?

Dr. Nicole Washington: Yes.

Gabe Howard: Where did it go?

Dr. Nicole Washington: Yes.

Gabe Howard: We’re getting along so well.

Dr. Nicole Washington: 100%.

Gabe Howard: So, yeah, you know, I get a lot of angry emails from the patient community, but I sincerely want people to know that I’m trying to give you, like, real options that you can use to better manage your care. I don’t care if Dr. Nicole is irritated or not. I care that it impacts the care that we get.

Dr. Nicole Washington: I mean, I’d love to go through my day and not get irritated. I think these are things that patients should know. Right? Like if you come to me for an appointment and we go through the whole visit and you hit me with what I affectionately call the BTW’s, when you hit me on the way out with, By the way,

Gabe Howard: Oh.

Dr. Nicole Washington: I have this form I need you to fill out. By the way, I need a letter for blankety blank. By the way, I got arrested a week ago and I have to go to court next week. And it’s always like the big stuff, right? The BTW is always a big drop at the end. If you know that there is something that you need like that or you want to tell me, bring it up immediately from the outset. When I say, Hey, how’s it been going? That’s when you tell me, Oh, I got arrested last week and then this thing happened and then blah blah, blah, blah, blah. Because I may be focused on symptoms and I may be focused on medication stuff and I may totally miss sometimes some of those little things that are big things, right? Because I think, oh, maybe there’s nothing going on in that arena. They don’t have any history of this. I’m not worried about that. And then all of a sudden. Don’t bury the lead. Bring it out early. Bring it out early.

Gabe Howard: I would venture to guess that 99% of the people that do the BTW on the way out, it’s because they’re working up the nerve. They’re scared of your reaction. So let me ask you this. If one of your patients walked in with an index card and on it they wrote any of those things, got arrested, need this form filled out, got in a fight with mom, stopped taking my meds three weeks ago. Any of the big high points, they just wrote it on there. They handed it to you and sat down. Would you be cool with that?

Dr. Nicole Washington: I would be so cool with that because I would then know everything they wanted to cover. And I do understand that sometimes it is like, Oh, God, I hate to even have to tell her this. I don’t want to have to ask her to fill out this form. I’m just going to do it on the way out. But then you’re frustrated with me, right? Then you’re annoyed because I can’t get to it right away or because I don’t even understand what it’s for or what it is. And you feel like you get nowhere and then you’re mad because you need this form filled out. Or all of a sudden you tell me you got arrested. And I don’t know what to do with that because I didn’t know about it until the very end and now I have other people. If I extend you, I’m going to be late for somebody else and it just ends up being a whole thing. So if writing it down is easier for you and you bring in a checklist, bring it in.

Gabe Howard: Bring it in and hand it over. I use the top three method. I use this myself. And listen, I’ve been in recovery for well over a decade and I still use this method because there is still a part of Gabe that is fearful of his therapist, his psychiatrist. I just, I. I can’t help it. It.

Dr. Nicole Washington: Right, because it’s that power differential that we talked about. Even if your psychiatrist and therapists are the most wonderful, caring, therapeutic people and you feel like they have helped you and you, man, and you just are so thankful for the care they’ve given you. There’s still this piece of you that sees them as this person who has some kind of power over you.

Gabe Howard: I completely agree with that. So the top three method. I love the top three method and I really do. I, I write it on scratch paper now because I don’t know, I can’t afford index cards. I was trying to make it sound fancy, Dr. Nicole. Write it on an index card in calligraphy and your best penmanship.

Dr. Nicole Washington: You can write it on the back of a receipt from your gas station. You can write it on whatever is, a napkin out the bathroom. I don’t care what

Gabe Howard: Yep.

Dr. Nicole Washington: It is.

Gabe Howard: I write on a lot of fast food napkins. A lot of fast food napkins.

Dr. Nicole Washington: I don’t care.

Gabe Howard: Are getting my top three.

Dr. Nicole Washington: I don’t care.

Gabe Howard: I cannot lie about that, but I think it’s really good. Dr. Nicole, we’ve covered a lot of things that get under your skin, irk you, irritate you, drive you up a wall, annoy, whatever word you want to use. Don’t fall down the semantics rabbit hole. It’s just things about Dr. Nichole’s job that were not as cool as we once thought they were. Have we hit the high bar? I know we can’t get to them all.

Dr. Nicole Washington: Yeah. We can’t get to them all, but we’ve hit a lot of good ones.

Gabe Howard: There is one more that came up in my little survey that I did of all the people that I know and it’s being rude to the staff. I just want to touch on it because I get it. I get it. You’ve got this this pent up fear and worry. You don’t get what you want out of your psychiatrist. Your psychiatrist goes back in and then you’re staring at a receptionist and you just unload. Is that a burden for you?

Dr. Nicole Washington: Yes, it absolutely is a burden. I have to stand up for my staff and I have to talk to the patient about boundaries and how that that’s not how we operate here. Like you can’t yell at people. Don’t yell at me either. I don’t want to be yelled at. Right?

Gabe Howard: Don’t yell at anybody. No yelling.

Dr. Nicole Washington: Anybody listening, if you have a job, do you want anyone for any reason yelling at you at work? I’m going to assume the answer is no. So that same thing applies for the medical staff. They are people and it hurts. I’m a psychiatrist. I am trained. I know what I’m dealing with. But let me tell you something. When patients yell at me and insult me, it is not always easy to then continue to give that person the best of me and 100% non-biased care. So I live in Oklahoma and I don’t know, like maybe I’m racially ambiguous to people who haven’t seen very many people of color. So I’ve been called every racial slur in the book. Everyone you can think of every, for a variety of, I’ve been called a variety of ethnicities. I’ve been called every racial slur in the book over the years. You know, when somebody is manic or psychotic or saying stuff, you know, I’m in a hospital setting, usually I can let those fall off my back, right when it’s someone who’s stable and just angry because they wanted a particular drug that I wouldn’t give them, or they couldn’t understand why I wouldn’t write a letter saying blankety blank or whatever it is that they are angry about. And they hit me with something like that. It’s hard for me too. I’m human. It’s hard for me not to come back. It’s hard for me to not let that interfere, right? Like I have to be so careful and cautious about what I’m doing and checking myself like, okay, but that’s tough. So I think any kind of yelling or being rude to staff or your psychiatrist in general.

Dr. Nicole Washington: And then you joked earlier about the Yelp review, right? Like, oh, I’ll leave, you know, a bad Yelp review. But listen, this is what’s happening to psychiatrists. Sometimes people are angry about somebody not giving them let’s say they want a controlled substance and you don’t feel like genuinely that is something that is in that person’s best interest and you won’t give it to them. And then here we go with these keyboard gangsters, right? Because they’re getting on the Internet and they’re like Dr. Nicole wouldn’t, she would not prescribe the medicine that I needed to get better. She’s a terrible psychiatrist. She’s horrible. And there you go. It lives on the Internet forever. So then some new person’s Googling. I need a psychiatrist. Oh, look at this, Doctor Nicole. She looks nice. And then they read that review and they’re like, oh, I don’t know. Or you get mad at the office staff and you go to my review to my Google and you put her office staff is horrible. They wouldn’t help me. It is very frustrating for psychiatrists to live in this world now where people can go onto the Internet and just put random stuff about you, whether it’s accurate or not. And we can’t respond because of HIPAA. I can’t go back to your review and say that’s not true to defend myself because of HIPAA. And now I’m in this space where it’s very frustrating when people leave these kind of reviews about you. So that is another, we found another. We unearthed another frustration about being a psychiatrist in this era.

Gabe Howard: Dr. Nicole, I appreciate you bringing all of that up. I sincerely, I can imagine how difficult this is to be because you want to defend yourself. You are a person. There’s just a lot going on there. And I know that we could talk about this all day, but I sincerely hope that the listeners get a better understanding of where our medical providers are coming from and the things that they face in their day-to-day life. We’re really good at understanding ourselves, right? We know when we’re not getting what we need and when we have frustrations and those come out in a variety of ways. I think it’s extraordinarily helpful and powerful to understand what challenges and frustrations the other side has, because it allows us to come to the middle. Thank you, everybody, for listening in. Thank you, Dr. Nicole, for being super vulnerable. It’s got to be hard. Is it hard to give people a peek behind the curtain because many psychiatrists just close ranks. They have like the poker face, which I understand, and they never say anything negative about their job, their patients, the industry, anything. They just, they do their job and they get out. When you say, hey, is this frustrating? They consider that a boundary issue and they move right along. So was it difficult for you to share this publicly?

Dr. Nicole Washington: Yeah, it was tough. I mean, I don’t, I don’t want my patients to then hear this and think, oh, my gosh, I annoy Dr. Nicole. I annoy her.

Gabe Howard: That’s not what you’re saying.

Dr. Nicole Washington: That is not what I’m saying at all. I don’t want people to even look at the title of the episode and say Annoy? Doctors are getting annoyed? Like how dare they? We pay them, they are providing a service to me. It is very difficult.

Gabe Howard: So it sounds like you’re saying do not name this episode Dr. Nicole Washington gets annoyed at all of her patients for doing the following things, and they won’t stop doing it. And it drives Dr. Nicole Washington up a wall. Is that, is that a bad title?

Dr. Nicole Washington: That’s a bad title. You should name it Dr. Nicole hates hugs and more

Gabe Howard: Dr. Nicole hates hugs.

Dr. Nicole Washington: And more.

Gabe Howard: You know, I don’t know that that’s keyword loaded, but hey, you never know what happens in post. Thank you, everybody, for listening in. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations” which you can get on Amazon, but you can get a signed copy with free swag just by heading over to my website at gabehoward.com.

Dr. Nicole Washington: And I am Dr. Nicole Washington. And 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 Howard: Dr. Nicole and I are both speakers, and we travel nationally, sometimes together, sometimes separately. But the point is, is that we are willing to leave our house and speak at your next event. You can find out more information on our respective websites. And hey, listen, we need like a favor. The way that this show grows is by word of mouth. Share us on social media. Email people, text people, share the show. It’s how we grow. And wherever you listen to this episode, please subscribe or follow, it’s absolutely free. Because you don’t want to miss a thing. We will see you next Monday on Inside Bipolar.

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