Recently in Doctors/Insurance Category

One of the most hurtful comments made to me during the worst of my depression was this: "You must not want to get better."

I'm having a hard time forgiving the person who said that, even as I know she didn't intend to be spiteful or mean. She's just plain ignorant regarding mental health issues.

Comments like that are why I'm so passionate about educating folks on mental illness and eliminating the isolating stigma of our condition. Because it's hard enough fighting all the negative intrusive thoughts within our head. We don't need additional insults and negative opinions--confirmation of our weakness--from folks who have never wanted to die and consider all suicidal thoughts self-absorbed and pathetic.

But boy do we hear a lot of them, even from the persons who are supposed to be on our side: our doctors and psychotherapists.

Richard Friedman, M.D. penned a compelling, salient piece for the New York Times a few weeks ago (thanks to my editor Holly for forwarding it to me, since I don't read anymore) on why so many doctors and psychotherapists blame their patients if they don't get better. It beats blaming themselves!

Friedman writes:

Doctors and psychotherapists generally don't like it when their patients don't get better. But the fact is that lots of patients elude our clinical skill and therapeutic cleverness. That's often when the trouble starts. 

I met one such patient not long ago, a man in his early 30s, who had suffered from depression since his teenage years. In six years of psychotherapy, he had been given nearly every antidepressant under the sun, but his mood hadn't budged.

Weeping in my office one day, he explained that he was depressed because he was a failure and a whiner. "Even my therapist agreed with me," he said. "She said that maybe I don't want to get better."

You can't see me, but I'm nodding right now, as I read that. Because I've been there, done that, bought the t-shirt, and shrank it in the wash. I can honestly say that my current doctor, number seven, is the only psychiatrist who didn't look at me with some speck of skepticism in her eye, as if I might be playing sick to prove that she should have never graduated from med school when she doesn't know a thing about the brain, or how she and the entire field of psychiatry is a sham--a well-contrived conspiracy to get the people's money, or that I just was on a mission to make her miserable. Because ... I have nothing else to do?

One therapist told me that he knew people who wanted to get well, and he knew people who wanted to stay sick. It's no wonder, then, that he couldn't understand why I lost control of myself during a panic attack, why I couldn't access that "happy place" in my brain, to stop me from shaking, losing my grip of the steering wheel, and ultimately finding myself with a flat tire up on the curb of main road in Annapolis. In retrospect I know exactly why that happened: I wanted to stay sick!

One of the many reasons I very much respect my doctor, Milena Hruby Smith, is that she is extremely modest and humble. And while some patients are reassured by a doctor who delivers his assessment in an unequivocal, confident style that says "there is no other way," I am refreshed by a psychiatrist is absolutely honest with me and says, "I can't say for sure, but I THINK that this is what might be going on. Let's at least give this treatment a try."

Now mind you, I've had the magician before, who swore with a few medication adjustments he could practically cure me from my bipolar disorder. When I asked him how he could be so certain that I was bipolar, and why he insisted on treating me with atypical antipsychotics even though I had difficulty tolerating them in my past, he became quite snippy with me and said, much like Sr. Carol in the third grade with her ruler, "Ms. Borchard. You ARE bipolar. End of story."

The other week when I went to Dr. Smith after a turbulent month, she told me about the growing amount of research suggesting that antidepressants aren't helpful for persons with bipolar disorder who are bothered by depression more than mania (which is just about everyone with bipolar disorder.

"Huh?" I asked. "I don't understand. So then why have you been treating me with antidepressants?"

She smiled (and believe it or not THAT reassures me much more than any fake sermon about how a doctor is going to cure me) and explained her reasoning: given the older research suggesting that antidepressants are helpful, and the clinical experience of herself and those who trained her that antidepressants seem to be helpful in some patients, it is still very reasonable to use them, especially for someone like myself whose manias have been much less dangerous than the depressions. In other words, for a person with an illness like mine, the risks of worsening the illness by use of antidepressants are outweighed by the risks of not treating depression aggressively. Furthermore, Dr. Smith suspects that physicians may eventually have more specific classifications of the bipolar spectrum that will allow for more targeted treatments.

There was an interesting editorial in the New York Times last month (click here) about what to do when doctors err. All the malpractice suits has driven up insurance. Says the article:

The willingness of doctors at several major medical centers to apologize to patients for harmful errors is a promising step toward improving the quality of a medical system that kills tens of thousands of patients a year inadvertently.

For years, experts have lamented that medical malpractice litigation is an inefficient way to deter lethal or damaging medical errors. Most victims of malpractice never sue, and there is some evidence that many patients who do sue were not harmed by a physician's error but instead suffered an adverse medical outcome that could not have been prevented. The details of what went wrong are often kept secret as part of a settlement agreement.

What is needed, many specialists agree, is a system that quickly brings an error to light so that further errors can be headed off and that compensates victims promptly and fairly. Many doctors, unfortunately, have been afraid that admitting and describing their errors would only invite a costly lawsuit.

Now, as described by Kevin Sack in The Times, a handful of prominent academic medical centers have adopted a new policy of promptly disclosing errors, offering earnest apologies and providing fair compensation. It appears to satisfy many patients, reduce legal costs and the litigation burden and, in some instances, helps reduce malpractice premiums.

For the rest of the article, click here.

To read more Beyond Blue, go to www.beliefnet.com/beyondblue, and to get to Group Beyond Blue, a support group at Beliefnet Community, click here.

Thanks to readers Sandy Slaga and Larry Parker for bringing this AP story, "Study: Treating Depression Is Good for Business" to my attention.

Here's the gist:

Investing in depressed employees -- quickly getting them treatment and even offering telephone psychotherapy -- can cut absenteeism while improving workers' health, a study suggests.

Many employers view mental health coverage as a financial black hole, but the study shows that spending money on depression is a smart business move, said researcher Dr. Philip Wang. Wang works for the National Institute of Mental Health, which funded the study.

Employees who got the aggressive intervention worked on average about two weeks more during the yearlong study than those who got the usual care -- advice to see their doctor or seek a mental health specialist.

Also, more workers in the intervention group were still employed by year's end -- 93 percent vs. 88 percent -- savings that helped employers avoid hiring and training costs, the researchers said.

Dr. Ken Duckworth was interviewed for the article because, as medical director for NAMI (National Alliance for the Mentally Ill), he is heading NAMI's campaign to support a bill before Congress that would require employers to offer mental health insurance coverage that is equal to that provided for physical illnesses.

To read the entire article, click here.

It’s not everyday that you show up to a nice swim club in Belmont, Massachusetts as someone’s guest and get to talk shock therapy with Kitty Dukakis’s doctor.

My guardian angel Ann introduced me to this wonderful man as "the Therese who had the breakdown I was telling you about."

"Nice to meet you!" I said, wearing a bathing suit that was two shades of blue. Get it? Beyond Blue?

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If a person weren’t mentally ill before dealing with health insurance companies about her mental health benefits, she surely would be after a phone call or two. Marbles start rolling out of the noggin a second after the back-stabbing representative...

Producer Michael Moore could have used my conversation this afternoon with a CareFirst representative for his documentary "Sicko": Me: "I just want to know why I received an explanation of benefits 18 months ago that said the patient responsibility was...

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