Why don't GPs want to get involved or take responsibility?

[poss]

Hi guys,

I'm feeling really frustrated at the moment.

I have BPD and usually I automatically put on a brave face when talking to GPs about how I'm feeling. I see my psychiatrist every few months but have to see a GP every 4 weeks for my prescriptions. I see different ones. Usually they ask how things are going on the meds and usually I say I'm fine or that things are okay or improving as I feel like I don't want to waste their time or that they won't believe me or take me seriously if I tell them how I really feel.

Last time I went I felt really bad and had just had a borderline episode where I was out of control again, self-harming etc. I felt desperate and the next day I saw the GP. When she asked how I was, for the first time I was actually honest and said that things were not ok. She asked a few questions about how often the episodes happen etc. but then just handed me the prescription and that was that. I was nearly crying (which is very unusual for me in front of people) trying to talk about it. I felt so let down. I said, so what should I do then? Contact my psychiatrist and she just said yes do that. But I had to drag that out of her. Why bother to ask if you really don't want to know the answer? They just want you to shut up and go away.

When I left I went to the toilets and cried my eyes out before leaving the surgery. I felt SO bad for taking the risk to be honest and ending up feeling so much worse for it. I hate this disorder and my constant feeling of not being taken seriously. Nobody seems to understand what I mean when I say I'm desperate. No one gets it. They just think it will pass like every other time. But it's terrifying for me and I don't have any guarantees that it will pass.

Sorry for the rant, just really fed up and frustrated

Poss

 

[Andy]

Re: Why do GPs never want to get involved or take responsibility?

I'm sorry you are feeling dismissed by your GP. I and I'm sure a lot of other people, feel the same way.
It's not just because you have BPD (although that makes it extra difficult). I think a lot (not all) of GP's would prefer to leave psych stuff up to the usual specialists. Just as a psychiatrist wouldn't do medical stuff like prescribe anti-biotics even though he could. I know my old MD who I saw before I was able to get a psychiatrist hated dealing with my meds because it wasn't her specialty. I mean basic psych meds but not having to mix and match and all that. I have seen other MD's that do not know me and all they see is my thick psych file and I am treated like something on the bottom of their shoe because they assume (don't actually look) that it's all psych stuff when it's just blood work. It is really hard when your going in there for help and feel like your leaving with more problems because of the way you have been treated. I know it's easier said than done, and I still will get that one doctor that really bothers me more than the rest but you just have to think of them as being ignorant. They aren't ignorant to the conditions but they are ignorant in how they treat people with psychological problems and again not all of them, I'm speaking of those ignorant ones alone. Maybe your GP was just treating you, knowing that you do have a psychiatrist and can discuss all that with him/her. Also, GP's don't really have all that much time to get into conversations of that matter. With that said I know that doesn't help when your trying to get some help at the time.

Seeing your psychiatrist every few months isn't that great. Are you able to or interested in doing some therapy or groups? That would definitely help if you had an episode, to have some one you can speak to that is there to actually listen and that has the time set aside to do so.

No need to apologize for the "rant" I completely understand your frustration. In fact I'm sure I did my own rant about something similar to this somewhere on this forum.

 

[charlene]

Re: Why do GPs never want to get involved or take responsibility?

Hi guys,

I'm feeling really frustrated at the moment. I have BPD and usually I automatically put on a brave face when talking to GPs about how I'm feeling. I see my psychiatrist every few months but have to see a GP every 4 weeks for my prescriptions. I see different ones. Usually they ask how things are going on the meds and usually I say I'm fine or that things are okay or improving as I feel like I don't want to waste their time or that they won't believe me or take me seriously if I tell them how I really feel. Last time I went I felt really bad and had just had a borderline episode where I was out of control again, self-harming etc. I felt desperate and the next day I saw the GP. When she asked how I was, for the first time I was actually honest and said that things were not ok. She asked a few questions about how often the episodes happen etc. but then just handed me the prescription and that was that. I was nearly crying (which is very unusual for me infront of people) trying to talk about it. I felt so let down. I said, so what should I do then? Contact my psychiatrist and she just said yes do that. But I had to drag that out of her. Why bother to ask if you really don't want to know the answer? They just want you to shut up and go away. When I left I went to the toilets and cried my eyes out before leaving the surgery. I felt SO bad for taking the risk to be honest and ending up feeling so much worse for it. I hate this disorder and my constant feeling of not being taken seriously. Nobody seems to understand what I mean when I say I'm desperate. No one gets it. They just think it will pass like every other time. But it's terrifying for me and I don't have any guarantees that it will pass.

Sorry for the rant, just really fed up and frustrated

Poss

Granted I am a newbie here, (no intro yet) I will say I have had similar experiences with my GP. For 30 years, I am not kidding, he would treat me for depression with drugs such as Elavil, Prozac, Wellbutrin, Effexor, all of which did nothing for depression and in fact made it worse. It has only been recently, in the course of trying to discover the basis for my palpitations and low pulse rate, that he hit upon the idea of sending me to psychiatrist to explore the idea of being bipolar. I am now a diagnosed BPD2 on Seroquel. I know well that feeling of being dismissed by your GP. If you present a brave face, there is no problem in their eyes. If you are upset, it is still not their problem and only reluctantly will they deal with it, or, if they think you are not faking it, send you off to a psychiatrist who may see you, in say, 6 weeks time, when you really need to see someone right now. Or the great alternative of going to your local emergency department and waiting several hours to even see the psych triage nurse.

 

[David Baxter PhD]

Re: Why do GPs never want to get involved or take responsibility?

The reality is that most GPs are enormously overworked. They have about 10 minutes per patient on average and then they have to move on to the 30 other patients already in the waiting room. If they know you are already working with a specialist, where the assumption is that the specialist already knows your history and has the treatment history to work from, they are not going to want to interfere.

Additionally:

I see my psychiatrist every few months but have to see a GP every 4 weeks for my prescriptions. I see different ones.

Why is that you see different GPs? This may be part of the problem. If you do not see the same GP each time, there is no opportunity for them to build up a working relationship with you - or even a medical file really. That increases the likelihood that you are just one more patient presenting in ER or in a clinic.

 

[poss]

Re: Why do GPs never want to get involved or take responsibility?

Thank you STP and Charlene for your replies. It's interesting to hear about your experiences and good to know that someone knows where I am coming from, although I am sorry that you have gone through this type of thing too. It's exasperating. I do understand that GPs don't have time to go into long conversations as they aren't therapists, but at my last visit I would have expected the GP to either contact the community mental health trust and maybe ask for an appointment with my psychiatrist or suggest to me that I should call them. I think that's the least she could have said. As it was, I had to ask her what I should do. That's what annoys me the most, not so much that she didn't have the time for it, but more that she wasn't prepared to even try and offer a solution or direct me somewhere else. It's as if she wanted to pretend she hadn't heard anything I said and I would be willing to bet that she wouldn't have mentioned much on my file because that would mean taking responsibility or having to refer me to the right person. It infuriates me.

David, thanks for your reply. The reason that I see different GPs is that at this particular surgery you are not assigned to one GP but can see whichever one you want but it's not always possible to get an appointment with who you want. This particular time I didn't even have an appointment, I was just popping in to pick up my prescription (the psychiatrist sends a fax to my GP when my meds are changed and I just pick up the new prescription) but for some reason the fax said that I had to make an appointment. So they asked me to see the duty doctor there and then. I didn't know her and I wasn't expecting to have an appointment. But since I really felt bad at the time (usually I have had time to compose myself before appointments and put on my brave face) I decided to be honest about how I felt. I really wished I hadn't bothered in the end as it made me feel so much worse. It's just a shame that the different services in the UK can't just work together properly. So many times I have had to chase things up between my GP and psychiatrist with one claiming the other one should be doing something different than they are doing. It drives me crazy. And to add to that, I have had 3 different psychiatrists in the last 3 years so not much continuity there either. I can really understand why people that can afford it go private. Sorry, I'm ranting again...

Poss

 

[Crazy Cat]

Re: Why do GPs never want to get involved or take responsibility?

The reality is that most GPs are enormously overworked. They have about 10 minutes per patient on average and then they have to move on to the 30 other patients already in the waiting room.

My problem with this is that the doctors themselves do the overbooking to rake in the dough. My vet told me that some vets & family GP's, as well as other doctors, will schedule as many patients they can get in a day, even if it means spending 2 minutes with them. My doctor charges me $90 for writing my scrips. Nothing more. He doesn't even check my heart or BP or anything else. And yes, he's a GP. (note...my vet schedules 15-20 minutes apart but spends much more time than that with his patients, if needed)

My previous GP refused to give me my Ritalin script because he said if I went out and killed someone, he'd be responsible. I sat in his office and cried & begged since I was at the end of my rope. He totally refused. But I ask now, what would have happened if I killed MYSELF because he failed to help me? I'm sure he wouldn't feel responsible in the least.

I don't have a psychiatrist right now because I can't afford it (no insurance), but I had a psychiatrist's report that confirmed my ADD diagnosis. He still wouldn't help me.

After that I went to a new doctor who refused to give me my normal dose of Zoloft. I was taking 250 mgs. a day and he would only write it for 200mgs a day. His reasoning was that 200mg is the highest recommended by the drug company. However, I explained to him that I would go into withdrawals and that I'd been taking the 250, prescribed by a psychiatrist, for a couple of years.

I just don't understand why its any skin off their nose to write a script for exactly what a person has been taking all along! I even brought in my prescription bottles to prove what I was taking.

In all honesty, I don't think its because these doctors care about their patients, but they're so afraid of liability and I think they build their egos by having their patients plead for what they need. (Ok, I'm borderline and think the worst of everyone), but I've seen alot of doctors in my life.....if I've seen 25, I'd say one or two actually cared.

Believe it or not, my mother's doctor told her that she better not die because his kid needed a college education!!! I guess she got the last word though.....she died a few months later. Nice guy, huh?

Adriane

 

[David Baxter PhD]

Re: Why do GPs never want to get involved or take responsibility?

Up here, there are caps on physicians' billings. Here the problem is not enough GPs to meet the demand, not "moneygbrubbing".

 

[Meg]

Re: Why do GPs never want to get involved or take responsibility?

I am sorry you had such a disappointing experience, Poss.

In my experience my GP just sometimes doesn't know what to say... I feel quite sorry for her because I can see her mind desperately trying to think of something helpful!! I think she's used up her entire repertoire of suggestions. Now the things she says make me feel a bit better at the time because I have a little internal giggle at the bizarre things she comes out with. I know that she remembers me and that she really cares, but she leaves all the psych meds and counselling up to others. She found me a good psychiatrist and a good psychologist and she does her best.

I agree that most GPs are incredibly stressed - the waiting room is perpetually crowded, the phones ring constantly, and people who need long appointments only book in for short ones. I suspect 3/4 of their mind is on the person in front of them, and 1/4 is thinking about the fact that they're running an hour behind time and haven't had time for lunch even though it's 4pm. I know that it would be nice if they were 100% focused on us and had always had pearls of wisdom to share. I wish the GP you had seen had thought of something more empathic to say, you certainly needed and deserved a shoulder to lean on when you were so distressed, but remember that they are human. When we're stressed we find it hard not to focus on our discomfort too.

 

[Jackie]

Re: Why do GPs never want to get involved or take responsibility?

Hi Poss,

The same thing happens here in the UK. Surgeries sometimes have 10 GP's in them and you end up seeing a different one each time, its so frustrating having to go over things again and again, and feeling they don't care. At my surgery I am assigned a GP but he's very often busy or not there so you have who you are given. It doesn't help with continuity of treatment. Gone are the days of the family GP who had time and knew you well.

 

[Jesse910]

Re: Why do GPs never want to get involved or take responsibility?

I concur with all that has been previously said. The situation is prevalent here in the U.S. as well. I have learned that education is the key. The more I know about my illness, the more I can clearly communicate to my doctor about what's going on and what I expect from them. Asking the right questions is crucial. And, before I select a doctor, I find out as much as I can about them because I'm looking for a certain temperment. I want a doctor who treats their patients well and takes the extra few minutes to listen when necessary. Obviously, this isn't always possible. There have been times when I have taken insensitive doctor to task. At times, even therapists can be insensitive. During those times, they have displayed a level of humanness that may or may not make for a next visit. The bottom line is, this is your life and your health. You must take responsibility for same. You have the right to be treated in a manner befitting of you as a person. Don't settle for less. What has helped me over the long haul was cultivating a support team who is willing to help me figure out the hard stuff when I need time explore my options. If you're lucky and have such people within your life, go to them in good and bad times so that they don't feel used or burned out. They can be wonderful life lines.

 

[wheelchairdemon]

Poss, I'm new here, but in this case, the doctor is wrong. Their job is to listen and to act responsibly about the information you convey to them. It is well documented that there is not a one-pill solution for BPD - it might help, but couselling and a supportive environment (and a trust relationship with the doctor) is vital to healing as well.

If the response was to pass you more pills, it was probably because she didn't know what to do exactly, or it had something to do with the 15 minute, 1 issue per appointment, 1 appointment per month,

What might help is try asking at the end of the appointment, if you can go back sooner than the usual 4 weeks so, by using a combination of medication and talk therapy, you can progress better between appointments. By framing it that way, you are showing you are wanting to take responsibility and you are putting them in a position of medically having to follow through on treating you. Sometimes the doctors are so busy, or they don't know what to do (and BPD is tricky) so they rely too much on pharmaceuticals.

Good luck, have heart, and realize that you are not the problem.