Inside Bipolar Podcast: Unpacking the Psych Appointment: Questions, Expectations, and Outcomes

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: Hey everyone. Thanks for being here. My name is Gabe Howard and I live with bipolar disorder.

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

Gabe: One of my favorite movies is Uncle Buck. And there’s this. There’s this really iconic scene in Uncle Buck. It’s a, it’s an 80s movie. It’s a John Hughes movie. I’m the right age. But there’s this really iconic scene where a young Macaulay Culkin like, like before Home Alone asks Uncle Buck all these questions, just one question after another, the stereotypical child asking the adult questions. And of course, the reason that it’s funny is because Uncle Buck answers all of them. Instead of dismissing the kid, he takes the questions really seriously. And he, you know, so it’s it’s question, answer question answer question answer question answer. And it’s played for comedy and it’s hilarious. But this is how I feel whenever I go see my Dr. Nicole, like I’m just trying to live my day, but I’ve got the equivalent of a cute little Macaulay Culkin pre- Home Alone asking me all these random questions. They’re just so random. What’s up with these intake questions? What’s the point of all of this?

Dr. Nicole: Well, first of all, I’ve never seen Uncle Buck, so I’m gonna watch it. But you are not the only one who is so bothered by these questions. I just can’t even tell you the number of times that patients have just in a very exasperated way, said to me, like, why are you asking me all these questions? That’s all you do is ask me questions. And to that I say, what am I supposed to do? I am the psychiatrist. You’re psych, what are they supposed to do? If you walked in and they pulled out a stethoscope and started looking at your ears and checking your heart, then you’d say, well, this person’s weird. I came here for them to manage my mental health and they’re doing a physical exam. What do you expect us to do?

Gabe: I mean, I get it intellectually. I know that you have to ask me questions in order to get this information. It’s just that the questions don’t sound serious enough. Bipolar disorder is serious. This is a serious illness. And your questions are how do you feel? How are your relationships right now? I, it just it just sounds like the minutia that you just asked while you’re at work or walking down the street or in an elevator or standing in line. I feel fine and my relationships suck and it’s none of your business. I, I, I guess from my perspective, sincerely, we don’t see the connections between these questions actually leading to a medical diagnosis because the questions just sounds so, well, frankly, basic.

Dr. Nicole: You got to make your mind up, Gabe. Now you want us to be real people. You want us to be real people. You want us to seem personable and to seem like we care. And so if we ask a very simple pleasantry question, how are you doing? How’s it going? What’s been going on in the past month? Now you don’t like that, but if you walked in the room and the first question out of my mouth was, have you been taking your meds? Have you missed any suicidal thoughts? How’s your mood? Well, then you’d be ticked off because you’d say, well, she doesn’t even care about me. She’s just over here asking me her checklist questions to get me out the door. You need to make your mind up, Gabe. What? What do you want from me?

Gabe: Oh, I want you to know everything perfectly without, like, any intervention from me. I sincerely, you know what I want, and I think this is what all psychiatric patients want. We want it to be more like physical health, where we really don’t have to talk to you at all. We pee in a cup, or you take a blood test, or put us through a brain scan machine. We really just want to remove this conversation from it. And we just want you to be all knowing and tell us what to do.

Dr. Nicole: Mm-hmm

Gabe: And I do think that that is part of the patient experience that is frustrating for us.

Dr. Nicole: Mm-hmm.

Gabe: Now you’re right, you’re handcuffed. But I think that patients we kind of hurt ourselves by not taking these questions seriously.

Dr. Nicole: And you just said, I’m fine. My relationship sucks and it’s none of your business, but it is very much my business. So maybe that’s the disconnect. You don’t see how those things are important to me. And

Gabe: Exactly. Exactly.

Dr. Nicole: Why do I care how your relationships are?

Gabe: We have no idea how these questions go together.

Dr. Nicole: No you don’t. You just think I’m being nosy. Let me tell y’all, personally, I don’t like to get in other people’s business on a personal level. But when you come and sit in front of me in the office, yeah, I’m all up in your business because I need to know how things are going. How are things at home, how are you getting along with your significant other? How are you getting along with the kids? That is very important. If you are telling me, well, we’re not getting along. We’re arguing a lot. I’m snapping. That might lead me to think, oh. I wonder if there’s something going on with Gabe’s mood control that I should be asking about. You know, if you say we’re not getting along because I’m not sleeping and she’s mad that I’m up all night. Oh, really? Tell me a little bit more about that. I need to know what is disrupting your life beyond the basics of. Are you taking your medicine? Are you thinking about killing yourself? Yes. Those things are very important. I’m going to ask you every visit. So also, you can stop getting mad at your psychiatrist for asking you about suicidal thoughts at every visit, because it’s their job and they’re going to ask you every freaking time. So just stop getting upset about it.

Dr. Nicole: They’re not going to stop. And patients get really mad about it. I mean, I have I have had over the years of my career, I’ve had a couple folks who walk in, and the first thing they say to me is, I’m sleeping fine. I have not had any thoughts of killing myself. I have not had thoughts of hurting anybody else. I have not heard any voices. Now, can we get to everything else because they hate me asking those questions so much that they just want to get them out the way. So just know there are certain things I’m going to ask you every time and that’s fine. I need to know; I need to know how your bipolar disorder is affecting your entire life. I want to make sure that you have a level of stability socially, interpersonally, at work, not just the basics of am I suicidal? Am I super depressed? Can I get out of bed and put one foot in front of the other one? Those things are important, but as you get more stable, I’m much more focused on the other stuff because I want to. I want to help you achieve a level of stability that you just had not experienced.

Gabe: I think more often than not, patients try to figure out why their doctor is asking the question rather than just answering the question. I

Dr. Nicole: Mm-hmm.

Gabe: Know that I am guilty of this, so let’s go back with that. You’re asking me if I am suicidal? See, here’s the truth, here’s the reality you have to ask. You need to ask, and you need to be direct. And you need to show that you are unflinching and do a check in and ask me about if I am having suicidal thoughts and you want a yes/no

Dr. Nicole: Yeah.

Gabe: Answer, is that correct?

Dr. Nicole: Yeah. I don’t want you to beat around the bush. I don’t want to beat around the bush. I don’t

Gabe: Right.

Dr. Nicole: Want to say. Well, have you had any thoughts of hurting yourself? Well, that could be a wide range of things. You could have self-harm thoughts. You could have thoughts of harming yourself without necessarily having suicidal thoughts. I need to be direct. I need to

Gabe: Yes.

Dr. Nicole: Know for sure. You know what I don’t want?

Gabe: uh-oh.

Dr. Nicole: You know what I don’t want? I don’t want a well, not really, because that is so frustrating. Like

Gabe: [Laughter]

Dr. Nicole: I don’t want to I mean and people will say, well, and they pause and they go, no. And I’m like, what was that? What? What was that?

Gabe: Yeah. You’re, you’re inviting a follow up question there, right?

Dr. Nicole: You are.

Gabe: And probably in a good way. Right. Like that’s hard. Like you can’t tell, but I just Man, some sometimes I think being a doctor might, might be hard. I don’t know, I don’t know.

Dr. Nicole: So not really. It’s not an answer. Not really. It’s not an answer. You can’t not really. You’re not, you know. No, I mean, I wouldn’t say not really, or. I don’t think so. No, those things will not fly. And I will dig deeper and further.

Gabe: And I can hear in your voice how serious of a question this is for you. And of course,

Dr. Nicole: Mm-hmm.

Gabe: Suicide is very serious. 15% death rate in bipolar disorder. Obviously, no doctor of any specialty wants to have any wants to have their patient die, right? We’re being direct. So

Dr. Nicole: Absolutely.

Gabe: So getting that out of the way off the table and deciding where to focus your attention right out of the gate. Super smart doctoring. Like I can tell you went to medical school for this.

Dr. Nicole: [Laughter] Super smart doctoring.

Gabe: Yeah, but I want to flip it a little bit because here’s what the patient hears. Why? Why are you asking? What do you see? What are you thinking? Remember that episode that we did where you said the number one thing you hate about being a psychiatrist is when people find out you’re a psychiatrist, they’re like, oh, you can read my mind,

Dr. Nicole: Yes.

Gabe: You’re reading my mind. You’re using your magical skills and your psychology and you’re predicting the future, which of course is complete bullshit. But people believe it. And of course, this is reaffirmed in pop culture, where psychiatrists and psychologists are always, you know, solving crimes and behavioral experts. Or are profilers for the FBI using pop psychology to determine that the narcissist probably killed his wife and buried her in the basement, because you have to have a degree to know that the abusive husband did it right. I just and on and on and on and on and on and on and on. So let’s go back to that thing. Right. Let’s go

Dr. Nicole: Okay.

Gabe: Back to that room. We’re sitting there. You ask if us you ask us if we’re suicidal. And I’m telling you, the vast majority of patients think, why what’d you see? What’d you notice? Because we’re afraid of suicide as well. So it’s triggering. To boil it all the way down. We don’t want to think about suicide because we’re terrified of it. And like you said, you’ve got to be direct. You recognize that most people aren’t direct about suicide. And when people

Dr. Nicole: I know.

Gabe: Have been direct about suicide with us, it’s probably been in a crisis mode.

Dr. Nicole: Yes.

Gabe: That’s what it takes us back to for the vast majority of a of us. I believe that’s why we hate that. I can’t speak for everybody, but

Dr. Nicole: Mm-hmm.

Gabe: I believe that’s why you get so much pushback on what should be a yes or no question.

Dr. Nicole: It should be. Now it gets tricky because there are people who live with bipolar disorder who have chronic suicidal thoughts. You know, I’m having a bad moment and their brain takes them to I should just kill myself. Like their brain takes them there. You know, you something bad happens, something big happens. And that is where their brain takes them. And that may happen for them. Ongoing. So much so they don’t even think twice about it because it happens so often. So then I have this person who’s having these suicidal thoughts, but then they don’t tell me because they’re like I mean, it was no big deal. So they just don’t tell me. And they assume that if they tell me, I’m going to throw them in a hospital. And so they then they don’t want to tell me.

Gabe: Ding ding ding ding ding ding ding ding ding. That’s the other thing. That question is one of the first questions that doctors ask too, and police officers ask and

Dr. Nicole: Yes. Yeah.

Gabe: Authority asked to determine if they are going to commit you.

Dr. Nicole: But if we know each other well, and I know that you have those thoughts on an ongoing, regular basis, then I’m not as moved by them. So when you tell me, yeah, I’m still having those thoughts and I might say, oh yeah, you’ve told me before, when you get very stressed, you usually have those thoughts. And then I ask you questions like, well, how long do they hang around? Do you go on to develop a plan? Do you go on to think you might actually carry it out? How, you know, how do you cope with those thoughts? What kind of things do you do to shift those, shift your thoughts away from suicide? If I know that this is a chronic thing for you and it happens a lot and it’s no different than it has been for the last two years, and that’s not the problem. But when you don’t tell me for years and then all of a sudden maybe you’re having a little bit worse day and you’re like, yeah, I had a suicidal thought yesterday, of course I’m gonna get worked up about it because I don’t know, you’ve been having them for two years, every day, and you just didn’t tell me until now. So it’s important for you to share, because I need to know that this is part of your baseline. This is part of your makeup. I need to know that.

Gabe: Sitting here recording with you in a safe place. You’re not my doctor. It’s so understandable. And I hope that the listeners are like this. This, this really does make sense. They see the challenges because they’re in their homes with their headphones on or in their cars driving, and they feel safe and they’re listening to it and they’re thinking, okay, this makes sense. I mean, obviously, how can we have an illness with a 15% death rate and not talk about death? That that would be wholly irresponsible. And then trying to figure out where that is, how can we correct it? How can we create a protective factor? All of this is gelling perfectly on an intellectual level. But

Dr. Nicole: Mm-hmm.

Gabe: I think if you talk to anyone managing bipolar disorder, even well into recovery with long term stability, there’s lots of things that make sense intellectually. As I’ve shared before, I know damn well that when I was on the bar singing, the reason the band stopped and the lights came up was to throw my ass out. Intellectually, I know that. But in my heart of hearts, I’m sorry I was a rock star for an evening. I just that’s how I remember it, and that’s how I feel about it. So my feelings and my intellect are at odds. And that’s part of therapy. And it’s one of the things that we, we talk about. So I, I don’t want to, you know, beat a dead horse for lack of a better phrasing, but every single time you bring it up, we get scared we’re going to die. We get scared we’re going to have a crisis. We get scared. We’re going to be committed. We get scared that if we don’t answer correctly the first time, you’re going to overreact. And we’ve already established that whenever there’s a disagreement on commitment between a patient and a doctor, the patient loses. And on and on and on. I, I don’t know what the answer is for the Dr. Nicole’s of the world to make the Gabe’s of the world more comfortable with this medically necessary question, but I think that’s why you’re getting the pushback. If all I can do is explain why patients are so uncomfortable with it, that’s I hope no doctors are listening. But if they were, that’s

Dr. Nicole: Yeah.

Gabe: What I would tell them.

Dr. Nicole: You want them to know why? And we get that. I mean, I 100% get the concern, but it just doesn’t stop the fact that I’m going to do it. I mean, I I’m going to.

Gabe: You have to do it. It doesn’t stop the fact that you have to do it.

Dr. Nicole: Yeah. No, I absolutely have to. It

Gabe: Yeah, yeah. Yeah.

Dr. Nicole: Is. It is a part of the process. If you had had breast cancer, you’d be nervous every year you went for a mammogram, but you still that person still is going to ask you about previous cancer histories. Have you had a mammogram before? Have you had a biopsy. Have you had an ultrasound they’re going to bring back? And all those memories of, oh, everything I went through and you’re going to be scared, but you, you got to go in for it. And they got to do what they got to do. Same thing.

Gabe: I love it. Dr. Nicole when you point out that living with bipolar disorder isn’t so different from living with any other chronic illness,

Dr. Nicole: Yes.

Gabe: Being sick is triggering. It’s traumatizing. And

Dr. Nicole: Yeah.

Gabe: I, I know this is sort of a cop out, but for everybody living with bipolar disorder, who, who is triggered, bothered, traumatized, annoyed by this question from their doctor. Nicole. Well, what I would say to you is you got to go to therapy. You got to bring it up in a support group. You’ve got to find a way to get right about it. Because I can absolutely, unequivocally tell you, if your Dr. Nicole is not addressing suicide with you, they’re dropping a very dangerous ball. And you might want to consider getting a new doctor. Nicole. Dr. Nicole I, I suicide is always the big one, and I’m

Dr. Nicole: Mm-hmm.

Gabe: Not surprised that we talked about it first, but I want to go back to the how do you feel? I just it listen,

Dr. Nicole: Yeah.

Gabe: I have watched so many pop culture representations of therapy, psychiatry. You know, we got Dr. Frasier Crane you know, a famous psychiatrist. We’ve got every single person who lays on the couch and, you know, and it’s. How do you feel? How are you feeling? I would say that the how do you feel? How are you feeling? Is second only to tell me about your mother as far as stereotypical questions that psychiatrists ask. And I think it’s sort of become this running gag where people just roll their eyes, they’re like, well, of course you ask that. It’s a joke. It’s a setup. Do you think I know that that question is important, but can you see where patients are just like, oh yeah, I’m visiting a psychiatrist. And she asked me how I feel. Can you see it? Can you see it from our perspective just

Dr. Nicole: No,

Gabe: A little bit?

Dr. Nicole: No, I think you’re just out here trying to make fun of psychiatrists, and I don’t like it, but I know I don’t see it, I don’t

Gabe: It can be two things. It can.

Dr. Nicole: It could be two things. No, no, I get how that would be that it’s very cliche to ask, you know, how do you feel or how do you feel about that? Anytime I catch myself asking a person, well, how do you feel about that? I do a little, a little cringey thing on the inside because I think, oh God, I hate that I said that out loud. So I get it, I get it, I get it. But we do have to ask how you how you feel? How have you been feeling? How’s the past month been? How’s the past three months been? How’s life been treating you? Like you have to have some basic question. So we’re always going to ask you an open-ended question.

Gabe: I agree that how are you feeling is in fact an open-ended question, but I think society has sort of made it not an open-ended question, because there’s only a few acceptable answers to that. How are you feeling? Fine. How are you feeling good. How are you feeling? Well, I just I notice like all of those things are within the realm. On the positive side of the spectrum, we have been conditioned as a society to only answer in the affirmative to that question. Because listen, I just I want to be fair. I want to tell all my bipolar peeps, if you go to a job interview and they ask how you’re doing, how are you feeling, what’s been going on? And you say, I got to tell you, I think demons are under my bed. Sometimes I scream for no reason. I haven’t slept in three days, so I’d say I’m doing really, really shitty now. How much does this job pay and what are the hours? You’re not getting that job, right? You should answer fine. But yet the rules are exactly different if Dr. Nicole answers. And I do think for the average patient, we don’t realize the rules have changed. This isn’t the superficial question that you get at the grocery store. This isn’t the superficial question you get from your coworkers when you come in on Monday and they ask how the weekend is. This is real.

Dr. Nicole: Mm-hmm.

Gabe: When your Dr. Nicole is asking, how are you feeling? How have you been doing things like this? This is the time that, well, frankly, steer into those bipolar urges to overshare. This is our moment. This is what we’ve been training for. TMI is not a thing with your Dr. Nicole. Dump it all out. It sounds funny, but

Dr. Nicole: Dump it all out?

Gabe: I’m being serious because like you’ve said, Dr. Nicole,

Dr. Nicole: Yeah.

Gabe: You find these moments that we don’t even hear.

Dr. Nicole: And we’ve already talked a lot about how the system is just very broken, and you get a very short amount of time with your psychiatrist. So you get there and they ask you how you’ve been and you say, oh, I’m fine. And you just answer very affirmatively that everything is fine. Then they’re just going to assume you’re fine, maybe because the time is short and maybe they aren’t asking the right questions to dig and hit on a problem area for you. So then you are continued on the same meds for months on end because you come in and say, oh, I’m fine when you’re actually not fine. So your quality of life is suffering because you gave a very superficial answer. You can tell the random person at work you’re fine and that’s okay.

Gabe: In fact, I encourage you to do that.

Dr. Nicole: Yes, okay. Gabe encourages you to tell the random person at work, yes, I’m fine. But

Gabe: [Laughter]

Dr. Nicole: When you get to your psychiatrist, we absolutely want you to tell us if you’re not fine and in what areas you’re not fine.

Gabe: There’s another angle to this. How do you feel question that I think gets a lot of people with bipolar disorder in trouble. We’ve already talked about, you know, they don’t understand why the psychiatrist is asking so maybe they think it’s a stupid question we’ve already talked about, you know, our fake it till you make it. Don’t overshare. Set up good appropriate boundaries kicks in so we don’t share the information. But there’s a third very huge problem with that question we tend to answer in the moment. So for example, if we have been flirting with suicide for the last three months, if we have been depressed, unable to get out of bed for the last month, if six weeks ago we spent a week awake with just the biggest manic episode that just the world has ever seen, see that that that’s all in the past. That’s over. See, for the last week, we’ve actually been doing really well. In fact, for many of us, we have rituals surrounding our Dr. Nicole visits. Maybe we meet somebody for lunch, we take a half day off work to make the appointment work. Right? We have someplace to go. If we’re unemployed, we now have a reason to get dressed. So there’s an excitement, right? And often these things elevate mood. So when you say, how are you doing? And we’re say, we’re fine. The third biggest problem with that question is we’re not lying. We are in fact, fine. In fact, we’re stupid excited, right? We’re just we’re just we’re as happy as can be. And we just left out three months’ worth of bipolar symptoms that are both dangerous and are no doubt going to return in a couple of days. After the excitement of seeing our Dr. Nicole wears off. So we’ve got to talk about strategies for that, because you’re not asking how we’re doing today. You’re asking how we’re feeling since you’ve seen us last.

Dr. Nicole: Exactly, exactly. And this does happen a lot. And I will tell you, it is usually a man and their wife that show up. That is usually when I get the real deal. Like I love it when my male patients wife show up, they give me all the tea, all of it. They can tell me like Mm-hmm two weeks ago. This happened three weeks ago, this happened. And he is sitting there looking at me like a deer in the headlights. He’s like, oh yeah, oh, oh yeah. And she’s like, remember that time? Remember at the restaurant? Remember at the kids’ school, remember? I mean, she can like bam, bam bam because it’s a superpower that we have. We can remember everything about you. So I love it when I get feedback from other people. So I would say one of the strategies that I usually ask people to utilize is before your visit, if you’re coming in alone, if you live with somebody, just ask them, hey over the past month, how do you think my mood has been? How do you think I’ve been? And that’s when I get the well, my wife said or my husband said or my mom said, you know, she notices that I still have several nights a week where I don’t sleep much and she can hear me, you know, piddling around, cleaning.

Dr. Nicole: And yeah, I guess I do that. I guess a few nights a week I’m still having this. So sometimes those are the things that people just do, and they don’t even they don’t even pay attention to it. So it’s somebody who’s close to them that says, oh no, I still notice this and this and this. And really that person just doesn’t say anything either, because what is the value in them pointing out every time? Oh, you didn’t sleep last night. I mean, that is just going to incite, you know, World War Three in your home. And so they’ve learned to just not speak on every little thing. But I think it is valuable to ask before your visit, hey, I’m going to go see doctor so-and-so. How do you think I’ve been doing the past month? Have you noticed anything? That’s a great way.

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Gabe: And we’re back discussing those annoying questions that your Dr. Nicole is probably asking you.

Dr. Nicole: I also love a good mood tracking journal, like I just love.

Gabe: I’m glad we got to the journal.

Dr. Nicole: I love a good mood chart.

Gabe: Oh, I love, love, I love journals, I love journals.

Dr. Nicole: I just love a good mood chart. Like back in the day because I’m. I’m older. I’m not. I’m not as old as Gabe, but I’m older,

Gabe: [Laughter] Telling you my age was the worst thing I ever did.

Dr. Nicole: And. And I love a good mood chart. So back in the day, we would print actual mood charts out and hand them to patients and say, track your moods over the next month. Well, now there’s fancy apps that do that and you can track your mood. But tracking your mood however you choose can be so valuable. Because you know what I know?

Gabe: What do you know, Dr. Nicole?

Dr. Nicole: You don’t remember how you were the past month. You don’t remember. You do not remember. You remember the past few days. You do not remember the whole past month or three months. But if you’ve been tracking, you can say, oh yeah, I noticed, like I had a week two months ago where my mood was low and I didn’t go out and I didn’t. I called into work. And like, you can track those things and be able to go back and look at them in time and notice patterns. For my ladies out there listening, you can tell me if your symptoms are worse around your menstrual cycle and if that’s affecting you at all. But those are the kind of things you see as you track and as you can look at it over time and see patterns. That’s also a good way for you to keep up with how you’ve been doing. And that’s especially valuable if you don’t have a person who lives with you who can say, well, yeah, I noticed this, or I noticed that so either tracking it yourself or getting input from someone who lives with you those are very valuable things that you can do and then bring to your visit with me.

Gabe: When I got introduced to mood journals, they were just like, look, we’re not asking you to write your feelings. We’re not asking you to do anything. Just go get one of those desk calendars. This is before apps. I

Dr. Nicole: Mm-hmm.

Gabe: Know, I know, but go get one of those desk calendars. Sit it on your kitchen table. Write every day before you go to bed. Write one, two, or three. Right? One is a great day. Two is a mundane day. Three is a shitty day. There you go. That’s it. That’s all you got. That’s all we want you to track. Like, that was step one. So then when I would go in, it’s like, how have you been? You add up all the ones, you add up all the twos, you add up all the threes and you’re like, you know what for? For the vast majority of the days I wasn’t doing really well. But then you’ll notice the last week were all ones when you’re like, you know, this last week has been great. This this last week has been fantastic. Oh

Dr. Nicole: Mm-hmm.

Gabe: My God. But you’re right. I gave myself all threes every other day. But this last seven are shitty. And then you can expand that out. Write what time you went to bed. Write what time you got up. Rate your sleep on the same 1 to 3 scale. That, for me, was the most empowering moment when I would walk in with those results. I am telling you what I’ve done over the last six, 12, 18 weeks. This is all me. I also felt like I was doing something. Like, Gabe did this. I’m not relying on my wife. I’m not relying on my mom. I’m not relying on my bipolar buddy. Gabe is taking the reins. That felt really, really good to me. The last thing that I would recommend. The last thing that I write down before I go see my Dr. Nicole are my top three, the top three things that I’m worried about and talking to people, looking at my mood journal, over the last three months, not just the last week, I determined the top three things that I want to resolve, and I start asking the questions on that basis. So when you ask me how I feel, I feel like I want to resolve the fact that I can’t sleep. Or whatever the issue is.

Dr. Nicole: I love a list. I love when a patient comes in with their own list. I love when they come in and they say, oh, there were these things that I wanted to make sure we talked about because, you know what happens? You get in front of the doctor. I start asking you about random life things. Sometimes we talk about your family and work and all these things, and then you get home and your significant other says, oh, did you ask her about your sleep? And you’re like, oh, I forgot. And then you’re not going to see me again for a month or two months or three months. And so having a list is very, very it’s helpful. It’s helpful because it keeps us on task, it keeps us on track, and it makes sure that we actually address the things that are bothering you.

Gabe: What are some other intake questions that that you think that your patients are getting annoyed by with our this isn’t what your Dr. Nicole is asking. This is what the Dr. Nicole is noticing. This is her own personal experience. What question are patients giving you push back on?

Dr. Nicole: I think people just don’t like what feels like a firing army of questions. You know, you think about especially in the inpatient setting in the hospital. Here you are. You’re admitted. You have talked to 50 million people. You don’t remember which person is feels, what role. You don’t know if you told this person something or the other person, and frankly, you’re annoyed at the fact that you’re answering the exact same questions repeatedly. So that that, I will say, is one thing. When you’re in the hospital and you find yourself in that setting, take a breath. There is a reason that you get asked the same questions over and over again and people will say, well, I already asked that. Is it not in the system? Like, why are you asking me the exact same questions? And the reason is it may not be in the system the way that you think it’s in the system. It may also be that we get different answers. I can’t tell you how many times the nursing questions don’t pull up something, because at that point you just didn’t remember to tell them that. But by the time you get to me, after you’ve seen the intake counselor and the nurse and the unit therapist, and you’ve seen all these people, then all of a sudden you’re like, oh, oh, well, yeah, I did have my appendix out.

Dr. Nicole: I did have that surgery. I forgot to tell them about that. So we learn things along the way because you’re not always necessarily in the best place to give us that. So I think a lot of people just get frustrated at the amount of questions. But again, I’m a psychiatrist, y’all. That’s all I have. That’s all I have are questions. I’m not drawing blood and telling you, oh yeah, this test says you have bipolar disorder. I have words, I have questions, and I know they feel intrusive, but these are the things that we have to figure out. We’re going to ask you about your medical history. And this frustrates people and I, I don’t always understand why, aside from the fact that I think they are like, oh my God, it’s one more question. Here she goes again. But I do think that sometimes the patient feels like it’s an unnecessary question. So they feel like, well, why is my psychiatrist asking me if I about surgeries? Like, why does she care if I had my wisdom teeth out or if I have my appendix? Or like, why does she care? She’s supposed to be worried about my mental health, not my physical health. Why does she care? You know what medications I take for things other than mental health reasons? Why? Why does she need to know all these things? I need to know because I need to know about interactions between medicines I could prescribe and medicine that maybe your primary care or another medical specialist is prescribing.

Dr. Nicole: I need to know that if you’ve had multiple surgeries, that might be valuable for me to know, it tells me some things about you and your history. If you’ve had a gastric bypass surgery, that might be valuable for me to know in how you might respond to certain formulations of medication. There are all kinds of things I need to know. I need to know if you have thyroid disorder, I need to know because if you have hypothyroidism and you’re coming to me complaining about being tired and gaining weight and blaming your meds, I may say, well, but let’s just make sure your thyroid is in check before we jump to blaming the medication or your mental health, or let’s see what that looks like. Those questions I know are very frustrating, but medically I. I am still a doctor. Y’all. Still a doctor, still a doctor, still a medical doctor. It is. It is well within psychiatry for me to ask you these questions. So stop getting mad when I ask you about your medical history.

Gabe: So first, I just think that we could hard stop and we probably should hard stop on the idea that going to the hospital and getting treatment for bipolar disorder sucks. I don’t think it’s supposed to be a good time. So I just think maybe there needs to be some level setting in in the in the bipolar community that this process blows. Right? Like I think we should own that. This sucks. This isn’t our best day. This is not something that we want to do. It’s not entertainment. It’s not a sporting event. It’s not a concert. It’s not a movie. It’s not dinner with friends. It’s a sucky thing that we have to do to be well, so that we can get to all of those things that we want to do. So the fact that you’re annoyed is, yeah, I think you should be. I think it is annoying. The next thing I think about is I think there’s a basic misunderstanding of what is actually happening. You know, when you said different, you know, nurses and doctors and intake people, they’re all asking you the same questions over and over again. And in in our minds, it’s you all are disorganized and you’ve done something wrong, right? The

Dr. Nicole: Mm-hmm.

Gabe: Fact that you’re asking us the same question is proof of your disorganization. That is not an unreasonable thing to consider. Could be happening. But that’s not what’s happening. And I think it’s important that we understand that. One of the reasons that that that different people ask you essentially the same questions is to gauge your answer over time, because they don’t know if you’re experiencing psychosis, they don’t know if you’re experiencing severe depression, they don’t know if you’re being manipulative intentionally or unintentionally. It’s sort of an interrogation technique. And I really wish that I had a better way to phrase it, but it’s just where different people ask you the same question to see if your story changes. Because if your story changes, and again, through no fault of your own, I know that when I went to the hospital and I was ultimately committed, I thought demons were chasing me. I was very suicidal. And I started to notice this repetition of the questions. And I remember saying to somebody, well, they asked me the same question twice, and my friend said, they asked you the same question multiple times, and you almost never gave the same answer. It was all over the place.

Dr. Nicole: And time is limited. So imagine we’re not going to ask you questions that aren’t important and that don’t hold value. So when we ask you about the medical things and the history and it may sound like it’s not relevant, but we really don’t have time to ask you things that are irrelevant. I’m not asking you about your kindergarten teacher and who your favorite teacher was in elementary school. I’m not asking you those things because those things are irrelevant. I am asking you the things that are important and you may not understand the importance, but they’re still important. You know, I will ask you about your family history when I first see you. I’m going to ask you about where you were raised and were you raised by both your parents or what your upbringing was like. I’m going to ask you those questions not because I’m nosy and I just want to know things about you I don’t need to know. As a psychiatrist, those things are valuable to me. You go to a surgeon, the surgeon’s not going to ask you. Oh, were you raised by both your parents? Were you? Because they don’t care. They don’t need to know that to be able to give you the care that you need. But I need to know those things. I need to have a basic understanding of who you have been from inception. Like who, who were, who have you been from day one? So I may ask you about what you were like as a kid.

Dr. Nicole: Developmental milestones, anything like that. Or did you have any struggles? I’m going to ask you all kinds of things that feel intrusive. I’m going to ask you about marriages and how many times you’ve been married. And, you know, if they ended in divorce, I might even ask you, like, oh, tell me a little bit about what happened. I will tell you, there are several people that I have picked up on their bipolar disorder, or at least tipped off to the strong possibility that that maybe they had bipolar disorder. Because they tell me, well, yeah, I’ve been married seven times, like I’ve met this guy. And then we got married impulsively, and then we were divorced like three months later and oh yeah, my other marriage, I had moved here and then we, we got divorced, you know? So I learned a lot about people based on those kinds of things. So those things are important. And then the very last thing that that I will say is, is a source of tension between me and patients on a regular basis. I am going to ask you about your previous psychiatric history. I am fully aware that if you have been diagnosed with bipolar disorder for any length of time, you’ve probably taken a million medications. You probably took a buttload of antidepressants before somebody figured out you had bipolar disorder. You took mood stabilizers you’ve taken. But listen, I need you to tell me. I need you to go back through your mental Rolodex. I need you to go to your pharmacy app.

Dr. Nicole: If you use any of the big pharmacies I need you to go back through. I need you to figure out what it is that you’ve taken before. I need to know that I. It is very valuable, but it is something that really ticks you all off. I mean, people just get so upset with me when I ask them. Well, tell me what you’ve taken before. Everything. Like I need to know what you’ve taken. I need to know what caused you really bad side effects. I need to know what worked. But then you stopped it, and then you went to the hospital, and they put you on something like, I need to know those things. And the reason I need to know is because what stops me from giving you something that you’ve already taken and had a bad reaction to. If you don’t know what it is, and I give it to you, and then you figure out that’s what I took last time, and then you’re mad because you were given the thing that you didn’t want to take, but you didn’t remember the name of it. And so I just would say, you know, that medication piece, as frustrating as it can be for us to ask you that it is so, so valuable and can maybe stop us from repeating mistakes of the past and, and it just gives us a leg up as far as, as far as development of a new treatment plan. And as frustrating as it is for you to have to try to go back and remember what you took five years ago, it is really helpful.

Gabe: I always like to point out that we have listeners all over the world, and whenever we talk about things like this, sometimes I get emails from other countries that are just like, why is this not a problem? Your universal medical records follow you. It’s law. Right? Why would you? Your doctor obviously has that. They just log into the medical system where everything is. Yeah that’d be nice. They also don’t understand this concept of preexisting condition because it’s not a preexisting condition. It’s your medical history. But we are largely listened to by people who live in the United States. And we don’t have things like this. It’s super, super nice, right? If you are of the age or, or have the life where you’ve had the same health insurance your entire time. If you’ve been with the same network the entire time, then those medical records could follow you around. But if you’re somebody like me who is job hopped a lot, who is insured by his parents, who is self-employed, who bought insurance on his own, who had multiple jobs with multiple different people, or if you’re somebody who’s lived in multiple states, for example,

Dr. Nicole: Mm-hmm.

Gabe: You are going to have to gather this information on your own.

Dr. Nicole: Mm-hmm.

Gabe: And I want you to know, Dr. Nicole, they’re not actually frustrated at you. They’re just frustrated. You have just you have just cost somebody a day when you ask for this information, nobody just listen to you explain why you needed that information and thought that there was anything wrong with what you asked. And in fact, they believe that everyone else should do that. That’s how good of an idea it is. They just don’t want to do it. Because that’s a lot of pharmacies. That’s a lot of doctor’s offices.

Dr. Nicole: Mm-hmm.

Gabe: That’s a that’s a lot of research to do, especially if you’re older, you know, almost 50 years old. I was diagnosed 25 years ago.

Dr. Nicole: Yeah.

Gabe: You want me to go through 25 years’ worth of doctors, jobs, pharmacies, health insurance? Oh my God, this is going to take forever. So the reason that I’m pointing this out is because if you are a young person, start writing now, like, oh my God, just write everything down. Just, just find an app, find a notepad, find something. Just

Dr. Nicole: Yeah.

Gabe: Keep track of this in the moment. So at some point in 15 years from now, when you do have that side effect, or you do have that symptom, or you do have that reaction with the new medication that you’re put on to treat something that you don’t have yet. And

Dr. Nicole: Yeah.

Gabe: Somebody says, well, have you ever had X? You’re not like, I don’t know. Start now, start now.

Dr. Nicole: And if you’re young, absolutely keep track of dosages like, oh, I took up to this amount and then this happened. Because I there’s a, there’s a different there’s a different reaction on my end to if you tell me, oh, I took this thing up to, you know, the starting dose and I had a really bad side effect. That’s a whole different concept than you telling me. Oh, I took the starting dose for, like, a week, and it didn’t work. And so I just stopped it like that. That’s not a that’s not a real trial of that drug. And we might want to try it again in the future. So all of that information is valuable. And if you’re young, just start now. Build that list so that you have it for every treatment provider you see from here on out.

Gabe: Dr. Nicole, I’m glad that you brought that up, but I do want to remind all the people with bipolar disorder listening, we can’t get mad at the outcome if we don’t participate in the process. We’re constantly saying that we want our Dr. Nicoles to partner with us and work with us so that we have a good outcome. Well, that means that we want them to do more work on our behalf because we see it as relevant. But then when they want us to do more work on our own behalf, because let’s face it, it’s our own behalf. We’re like, I don’t know, why don’t you have that? That’s not fair. And I get it. How frustrating this is and how expensive it is and how time consuming it is, and how rushed we feel and how scared we feel and how we don’t feel like anybody’s looking out for us. And unfortunately, this is how the system was designed. It’s not going to get better any time soon. I know all of these questions can be annoying, but I do think that we as people managing bipolar disorder would do better to just understand that this is the system. It’s just the system griping about it, complaining about it, demonizing Dr. Nicoles, etc. it’s not going to fix it. We just need to understand that it’s a frustrating process. But if we get through the process, tolerate the annoying questions, have a little information on how it works. I think we’ll get where we want to get, which is stability with bipolar disorder, which is recovery with bipolar disorder. We’ll get to the promised land. So yes, the questions are annoying. Dr. Nicole I’m not going to back off that, but I hope that we have given the listeners a lot of understanding on how to make them less annoying and why. Even though they’re annoying, they’re absolutely necessary.

Dr. Nicole: Well, I have to tell you, as annoying as it is to you, please know. Please know that I do not enjoy having to ask you the exact same questions repeatedly, every day, day in, day out. But it’s what we have to do. And I think if you know the reasoning why, it’ll just help the process go a little bit better.

Gabe: To all of our listeners, thank you so much for tuning in. We have a couple of favors to ask you wherever you downloaded this episode. Please follow or subscribe to the show so that you don’t miss anything. It is absolutely free. Another favor that we need share the show. You know those Reddit threads and those social media threads and those support groups and all those other people with bipolar that, you know, tell them about the show, because sharing the show with the people you know is how we’re going to grow. My name is Gabe Howard, and I’m an award-winning public speaker. In fact, I could be available for your next event. And hey, if you want me to, I can ask Dr. Nicole to come with me. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon. However, if you go to my website, you can get a signed copy and I’ll even throw in some swag. That website is gabehoward.com.

Dr. Nicole: And I’m Dr. Nicole Washington. You can find me on all social media platforms @DrNicolePsych or at my website, DrNicolePsych.com.

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

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