Tuesday, March 13, 2007

Toys in the Attic

I had an incredible breakthrough in one of my own biases today, and it made me feel really good about some of the personal work I've been doing this year.

A little background....

I've had an eating disorder for the past ten years or so, and recently reached the decision that I could not live that life anymore. I have been in treatment for about 8 months. Part of that treatment was the determination that I have had a low-level depression for the past few years, through which I have been functional, but not optimal (a dysthymia, if you will). I was advised that an antidepressant could be very helpful to me.

While my logical, medical brain told me that this made sense, my gut put on the brakes. I came to recognize that when I see patients who are taking psych medications/have psychiatric history, I tend to conceptualize them differently in my own mind. At least in the inpatient setting where I spend most of my time lately, it often means that those patients are more difficult to treat. They often have accompanying social issues (I swear I have learned as much social work in my intern year as I have medicine). They may be less likely to take their meds, and keep their follow-up appointments. And now, I was going to be ONE OF THEM.

To clarify, my greatest fear was that, in reviewing my "med list" someone would see that I take an antidepressant medication, and would form the same opinion about ME. That's when my bias stood up and slapped me in the face.

I have tried to keep this in mind as I have carried on through the wards the past few months, and have been able to see things through different eyes to a certain degree. Another facet of this which emerged is that I was often reluctant to talk about psychiatric disorders frankly with patients....as if they didn't know they had it, or something? I think it's mostly because it's not a field that I see frequently/am comfortable treating.

In any case, I am on an outpatient month now, and while in my preceptor's clinic this afternoon, had the opportunity to meet a 70-something lady with bipolar disorder. It wasn't something I could pussyfoot around - the reason she came in to the internal medicine clinic was to talk about her current manic episode. Ok.

The patient was there with her daughter, and both spoke frankly about it as soon as I walked in:

Dr. Raygungirl: "Tell me what brings you in today."

Patient: "Well, I'm having a manic episode. I'm not sleeping, I'm spending more money, and I have 15 projects going on at home right now. And I want to remodel my kitchen." (She meant remodel it herself, not hire someone, FYI.)

And so it went. I found I was incredibly comfortable talking to the patient about her symptoms, explaining why she was experiencing what she was, and even guiding her and her daughter in the best way to navigate the god-awful insurance coverage for mental health. I called it a disease, and the patient stopped, faced me directly, and said, "I never thought of it that way!" So I went on to explain that it was a disease, no different from diabetes or hypertension except that it was happening in her brain. And then she shared with me that forty years ago, after she had her "nervous breakdown," she and her husband moved their family to a different town because they were so embarrassed about her "problem." It felt really good to reassure her, and in doing so, reassure myself. Mental health diseases are diseases, and they can be treated and managed in a similar manner to blood pressure, as long as we are not too hung up on stereotypes or limited experience (me).

I was frank, upfront, and I was helpful. I feel today that I've been more helpful to that one patient than I've been to all the patients I did blood pressure checks and well-woman exams on all month so far. And she, in turn, has helped me. I know that mental health issues are still stigmatized in our culture, but now, I'm not going to be part of the stereotyping and stigmatization. Next time I see a chart with psych meds or diagnoses, I won't jump to my previous conclusions. And maybe, next time someone sees my chart, they'll show me the same respect.

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