We Need to Talk About the Disconnect Between Psychiatrists and Their Patients

If you are someone who has dealt with the mental health care system, you probably know what I mean when I say there is often a huge disconnect between psychiatrists and their patients. It is absolutely astonishing the number of people I have talked to who can understand this statement without any further explanation. When this conversation comes up, I don’t even have to finish my sentence before the face of the person I am talking to nods and rolls their eyes as to say, “you’re preaching to the choir!”

A typical appointment at the psychiatrist for me starts off where my doctor will make small pleasantries and take my vitals, blood pressure and weight. He then will ask a series of questions probably based on what he recorded the last time I was in. He wants to know how my mood is, what I have been seeing, if the voices have been particularly chatty lately and if I’ve been taking my medication. Depending on my answers, it leads us down another rabbit hole of questions. This goes on for some time. Luckily, he also gets my therapist’s notes since I am treated in the same practice — after all, it is a team effort! I usually get him for the full hour I am scheduled, which is quadruple the amount of time patients typically get with their psychiatrist. He gathers his information.

He knows if I have assigned a gender to any new voices. He knows if I associate an image of a mouth with a specific voice. He knows how many times I’ve cried in the past week. He knows how much I spent on “Star Wars” merchandise yesterday. He knows exactly what I was doing each  night before I fell asleep. This man clinically analyzes and knows the intimate parts of my life more than anyone I have ever known. So, I ask the mental health community, why isn’t my psychiatrist’s treatment plan working for me?

Psychiatrists are trained to diagnose and treat with medication.

Psychiatry is concerned with the medication part of your treatment. If you need additional resources, I’ve found you are typically left on your own with no direction to find and use those resources. Your psychiatrist may only be pushing medication. I think the sequence in which resources are given to a patient matters. Maybe you can’t just start taking medication right off the bat. Maybe you need 10 therapy sessions before you start a new medication. Maybe someone else needs a stronger support system if they are to stay compliant with their medication. A majority of people in recovery with mental illness will tell you there is more to wellness than medication.

Treatment for mental illness is not a one-size-fits-all solution. Every patient needs a specific and individualized approach tailored to them to achieve the best results. Unfortunately, doctors have consistently used a common phrase that creates the illusion specialized treatment is being given. Just because your psychiatrist says, “We need to find the medication(s) that works best for you,” does not mean their approach is individualized. This phrase feels special and unique, but at the end of the day, I’ve found the treatment remains the same for all patients with different problems. As patients, we can begin to feel like lab rats waiting for our next dose of medication to see if life will improve.

In Doc Ayomide’s article, “There’s a Gap Between Doctors and Patients,” he says, “Medical training aims to produce doctors proficient at figuring out what’s wrong with the patient (AKA, making the diagnosis) and fixing or relieving that with the appropriate treatment. But those treatments sometimes get in the way of people’s lives. You know, the medicine being worse than the sickness, that sort of thing.”

Patients may feel like even if symptoms are being treated decently, their quality of life is not improving either because their medication may have side effects that take away from other aspects of their life, creating a lose-lose situation. Or maybe their psychiatrist has not given them direction to those additional resources (talk therapy, group, peer support, etc.) they may need to reach recovery. From the psychiatrist’s point of view, they are helping to manage the illness and its symptoms, but from the patient’s point of view, they may be left with a choice between symptoms that interfere with life, or inadequate treatment where they know they could feel worse, but are not functioning where they would like to be.

My advice for anyone who finds themself in this situation is to communicate their concern with their doctor. Explain to them both parties’ goals are not aligned and it would be beneficial to agree upon one main goal that may need to be adjusted over time. Meet your doctor halfway by understanding symptom treatment is most likely necessary to reach that goal. Meet your patient halfway by realizing making sacrifices to treat symptoms is hard and it takes courage. Just because your patient can get out of bed now doesn’t mean that the weight they gained on their antidepressant is as worth it for them as it is for you. Recognizing there is a life behind the mind that needs treatment is important for doctors to remember when planning treatment for patients.

I got my inspiration for this story from Gabe Howard’s book titled, “Mental Illness is an Asshole.”