Bipolar blogger Natasha Tracy offers exclusive insight into the world of bipolar disorder.See all posts »
Family Doctors Cannot Be Expected to Treat Bipolar Disorder
I have many bugaboos about the psychiatric system in North America, but one of them is that family doctors (primary care physicians) try to treat bipolar disorder and other mental illnesses.
In my mind, a family doctor often can’t even diagnose a serious mental illness properly, let alone treat it. And yet they do. Over and over. I see it all the time—typically in those for whom treatment has been ineffective.
Why Family Doctors Try to Diagnose and Treat Bipolar Disorder
There are many reasons for this and many of these reasons are not the doctor’s fault.
Family doctors are usually doing the best they can for their patients, but they face an uphill battle. For example, even if a primary care physician recognizes the need for a referral to a psychiatrist, but that can be hard to do in many parts of the U.S. It can be difficult to find a psychiatrist who is accepting new patients or the payment type offered by the patient. And so the family doctor is stuck trying to find a place to refer the patient. (Although I would argue that if they truly can’t find a place they’re just not trying hard enough.)
Secondly, seeing a psychiatrist can take a very long time—often months—and people with a serious mental illness like bipolar disorder often cannot wait that long to be treated. Even if a person isn’t so manic or depressed that they need hospitalization, months is far too long to go without some treatment being started.
Why Family Doctors Can’t Be Expected to Diagnose Bipolar Disorder
But the thing is, bipolar disorder is really tricky to diagnose, particularly bipolar type II. This is because the symptoms of hypomania can be hard to ferret out. Patients typically don’t see hypomania as symptoms of anything—because it feels good—and so they don’t offer up the information. Additionally, sometimes people may be best served by bipolar treatment but only exhibit soft signs of bipolar disorder, something the average physician is likely to know nothing about.
So the patient gets misdiagnosed with depression and then treatment with antidepressants. This, of course, can cause mania, hypomania or rapid cycling. It can also make the illness harder to treat overall. So a family doctor’s mistake in this instance actually makes the patient worse and not better, even with the best of intentions.
Why Family Doctors Can’t Be Expected to Treat Bipolar Disorder
Bipolar disorder is also very hard to treat.
While selecting an initial medication to treat bipolar disorder may be fairly simple (although one might argue even that is not true) it is the case that most people with bipolar disorder are on multiple medications. In fact, according to a survey done by Global Medical Education, more than half of all people with bipolar disorder are on three or more medications and 13.5 percent are on five or more. And these are often specialized medications used in specialized ways (off label) that a primary care physician just won’t know anything about.
Patients Need to See Psychiatrists
Treat the Whole Patient: Bring in the Psychiatrist by Dr. Marnin E. Fischbach talks more about this issue and points to possible solutions. Namely, bringing psychiatric and general medicine practitioners together so that patients can receive care for their brain the same way, and with the same ease, as they do for the rest of their body.
Certainly, I would never argue against this, but the fact of the matter is we are simply not there yet.
We are currently in a place where there is a (ridiculous) brick wall between general medicine and psychiatry. So we, as patients, must navigate this system as best we can and the best thing we can do is advocate for ourselves.
If you receive a diagnosis of depression but treatment isn’t working after 12 weeks, get a referral to a psychiatrist. If you have any serious mental illness, get a referral to a psychiatrist. Demand these referrals. Don’t let the doctor’s own ego stand in the way of getting the best care, because you deserve to see someone who seeing patients like you every day.
That’s the best chance you have of getting better and that’s what everyone—family doctors and psychiatrists—want.