Today I saw a rather old Independent article on Twitter. I’m surprised I haven’t come across it before – it’s been out there since 2010 – but now that I’ve seen it, I can’t unsee it. Entitled How not to annoy your doctor, it’s a rather unpleasant little piece detailing groups of patients that GPs find particularly… annoying. Some of these categories are really quite hurtful, especially for people with mental health conditions who are often accused of displaying the kinds of traits this doctor finds irritating such as dependency, manipulation or self-destruction. I will admit that I took this article somewhat personally.
This post is my coping mechanism. You see, doctors may think that dealing with “heartsink” patients is a particular burden for them to bear, but guess what, service users have “heartsink” clinicians that we end up stuck with too. So here are my top five types of psychiatrist guaranteed to annoy a patient.
The File Flicker (now superseded by the Screen Scroller) “Hummty tummty tummm,” murmurs the Consultant File Flicker, deeply immersed in a cream coloured folder. “So your GP says that you are depressed… and he has put you on 75mg of venlafaxine… How are you finding that?” You are surprised to be asked a question, as so far he has not once looked in your direction. You tell him that it’s early days, and he nods, still glued to the paperwork. “So that seems like a reasonable course of action… I’ll see you again in three months.” He stands. You stand. He looks you briefly in the eye as he shakes your hand and the appointment is over. Next time he should probably just spend some quality time with the file as it’s clearly more enthralling.
The Family Guy “It’s understandable that you’re worried about your son leaving for university,” nods Family Guy. “It’s bound to be a source of anxiety. I remember when my daughter went off to Oxford I found it very stressful.” He listens carefully when you tell him that you had a bad episode when you had your second baby. “New babies are really hard work, aren’t they?” he empathises. “No one quite understands how the lack of sleep grinds you down unless they’ve been there.” By the fourth session you feel like you know FG’s whole household, except his wife, who remains strangely absent.
The DSM Delver No one else’s clinical opinion is good enough for The DSM Delver. Maybe she has trust issues. Maybe she believes that she, and she alone, has all the answers. It’s hard to tell. Whatever label you show up with, she will better it. It doesn’t matter how solid the prior consensus is, she will make her mark, delving into the diagnostic manuals for a new interpretation. “Aha!” she thinks. “Maybe she doesn’t have bipolar after all. I can do better than those three previous consultants! Maybe she has major depressive disorder with clinical anxiety. No, no, wait! Maybe she has MDD with borderline personality traits!” Having exhausted the more obvious explanations the DD goes further, coming up with arcane labels the rest of the team has never even heard of. “Adjustment disorder! That’ll get them all thinking!” Sometimes, for extra fun, the DD will keep their epiphany to themselves, burying it in the notes without sharing it with the patient. Because feeling that you’re right and everyone else is wrong is all that really matters.
The Checklist Slave You wait for the duty doctor all afternoon. When she finally arrives she asks you what is wrong and out pour all the details of the current crisis: the thoughts of self harm, the preoccupation with suicide, the inability to sleep. “OK,” she says. “Now I just need to ask you a few questions. Do you currently have any thoughts of harming yourself?” Um, yes. Did you not just say that? “And do you have any thoughts of taking your own life?” Hello? Yes! “And how is your sleep?” You realise that this psychiatrist is using a list, and she’s checking it twice. After a while you begin to doubt that you said anything at all, maybe anything in your life, before the checklist began. You had thought you were in a bad place before you saw the doctor. Now you really have lost the will to live.
The Internet Denier “So you should take your new antipsychotic in the morning.” You are surprised. The consultant has never prescribed this drug before. Neither of you really know what the side effects will be, so in case it turns out to be sedating you had planned on taking it at night. “Yes, pharmacy suggest you should take it in the morning.” Yes, but in the absence of clinical experience, you have been reading around on the internet and everybody says it makes them sleepy. So you want to take it at bedtime. “Well, I’ve written it up for the morning,” persists the ID. Well… look, the only information either of you has on any sedative effect comes from patients. So given that the only information you have suggests it’s sedating, isn’t it better to start off taking it in the evening? “I suppose it doesn’t really matter as long as you take it at the same time every day,” (this seems like a major concession) “but I think it’s best if you take it in the morning.” You take it in the evening.
purplepersuasion 