Stopping or changing Psychiatrist

[NurseMinxy]

Hi everyone,

I started seeing a Psychiatrist about 15+ years ago after a Bipolar diagnosis - I feel this was a misdiagnosis and would now be considered PMDD as my symptoms match PMDD much better than Bipolar, which was not in the DSM all those years ago.

I'm a registered nurse and my psychiatrist of 10 years, regularly threatens that I need to stay stable or I'll have to deal with AHPRA - the regulatory body for health professionals - I'm just a little tired of these threats and would really like to stop seeing him, but I'm worried that he will report me if I don't go. He assumes that anything new I do is a manic episode, eg cleaning my partners house, or planning to buy a car, or go on a holiday.

I'm unmedicated and have been since 2014, and feel I'm more stable off than I was on - my friends all agree. I've had no manic/hypomanic/depressive episodes since I left an abusive relationship 15 years ago.
Now that my partner and I are planning to have a baby, he wants to see me every month, 'because it's stressful' and 'I'm more susceptible to postpartum depression and psychosis'. I'm just seeing that it's a lot more money in his bank account.

So I need some help in stopping seeing him, without him thinking that I'm unstable in anyway and reporting me.
I'm more than happy to see a psychologist if I feel I'm struggling.

Please offer some suggestions...

[Croix]

Dear NurseMinxy~

You sound as if you have had a tough time and a psychiatrist that may be very unhelpful. To be threatened with AHPRA as a means of encouraging your stability seems to me to be a counter-productive and dubious practice.

I've had to tell my GP that a particular psychologist was worse than useless, and another simply ineffective. I did have the advantage that the referring doctor had known me well for many years. There were no repercussions.

I would think if I was in your position I'd talk with my doctor first and get his/her view, and if that is favorable then you might ask for a second psychiatric opinion, something that is entirely acceptable, particularly if you feel there has been the possibility of a misdiagnosis between very different conditions that may sometimes exhibit similar symptoms and that your current psychiatrist is giving you no benefit. I do wonder what treatment your psychiatrist has been administering all these years.

You might like to prepare to face the threat - which may never happen, but the process might give you more confidence.

First, find out exactly the criteria AHPRA uses, then see what you can offer as evidence you are stable and do not meet their criteria for withdrawing a practice license

The best evidence may be partly medical, and partly from the rest of your life. Employment records may point to stability, as can those around you.

Being medication free for so long is also a plus as is having no manic/hypomanic/depressive episodes for 15 years.

What happens then might depend on the findings of the second psychiatrist, and the knowledge your doctor has of you. It may be prudent to have some medical supervision whilst pregnant, this does not mean it has to be that particular psych.

It is not a situation I've ever faced and I'd like to know if you think the above is on the right track and you, looking at things dispassionately, feel you have good evidence of prolonged reasonable stability.

Croix

[romantic_thi3f]

Hi NurseMinxy,

Thank you for your post and your question - I'm so glad that you're advocating for yourself and your mental health here.

It is a big red flag to me that your psychiatrist would want to contact AHPRA; his role is to be your psychiatrist and he's bound by the limits of confidentiality. Regardless of your behaviour, or even if you were to make really harmful decisions in your workplace - it still doesn't give him the authority to do so.

With seeing another psychiatrist, this is completely up to you. You may find that you just want to stop seeing him now, or you may find that it's better to connect with someone you trust first (i.e. a new psychologist or psychiatrist) and then stop seeing him.

Either way, your confidentiality is bound by law, although personally I imagine he'd feel less compelled to report if he knew that you were seeing a professional of some sort.

I hope this helps- I'm sorry that you found someone who doubts your integrity and threatens your confidentiality and I wish you the best in finding someone who is a better fit, and also who you feel comfortable seeing regularly.

rt

[Aunt Jobiska]

Hi!

Firstly, be wary of people telling you he shouldn't be mentioning AHPRA - fitness to practice is very important for people with bipolar. Maintaining stability is key to the life you want.

However, It sounds like you don't like his approach and disagree with the diagnosis - I'd get outta there and find a new psychiatrist pronto. I can understand that a diagnosis of bipolar one (more of a fitness to practice issue) doesn't usually mesh well with pmdd, so it sounds like you and he have a different perception of your experience? Usually bipolar diagnoses revolves around people's perceptions of mania, which is tricky. I'd tell my new psychiatrist I'm unsure about the diagnosis, and am wondering if pmdd is a better fit. But seriously, I wouldn't tolerate someone who I didn't get on with. I know finding a new psych can be a nightmare, but I'd do it instantly. From someone with a fantastic psych who I know has my back as far as AHPRA is concerned, we have heaps of conversations about fitness to practice, but never have I felt threatened - my psych is supporting me to stay well. But then I have a rock hard BP1 diagnosis. Id also see a psychologist pronto and establish a relationship with them, use the MHCP, so that if you end up dropping this psychiatrist before you've established a new one, you can point to the relationship with the psychologist as something you're doing to ensure stability.

Fitness to practice matters, but if you basically don't like the guy, find someone else! I have never felt threatened over fitness to practice and I have a severe illness. It sounds like he's wary of your compliance and doesn't trust your self monitoring skills... Doesn't sound the kind of relationship I would want.

[Aunt Jobiska]

Romantic, you don't understand the mandatory reporting requirements that treating practitioners have to AHPRA concerning their patients who are also their health professionals, and you have given false information. They absolutely do have mandatory reporting requirements. The threshold is higher, but it certainly exists, and psychiatrist who did not report a patient who was a health professional whose mental illness was placing the public at substantial risk of harm (don't quote me but I think that's the threshold) would be liable for penalties themselves. AHPRA is very relevant to healthcare practitioners with mental illnesses.

[geoff]

Hi in all fairness for your treating GP, they may refer their patient to someone who is associated with the same practice they are actually in for protocol reasons, but this psych may not be suitable for you, so you can't expect them to automatically be your saviour, this happened to me when a psychologist in the same clinic was suggested I visit, but his attitude that no one should take any medication or any reason, certainly was against what I believed, so I only had a couple of visits and then didn't see him again.

If you can try and get a list from your GP because who they believe is the person to visit, may not be the person suitable for your needs.

We all have different personalities and requirements so we can heal ourselves.

Best wishes.

Geoff.