Inside Bipolar Podcast: Diagnosis Flip-Flop - PsychCentral.com
Bipolar or not bipolar? That is the question. Why do doctors change their minds about a diagnosis, and does altering a diagnosis mean they aren't good at their profession?
Does a change mean you are getting substandard care, and do you ever wonder why your diagnosis isn't consistent from medical professional to medical professional, or even from facility to facility?
Listen in to answer these questions and more.
Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author. He also hosts Healthline Media's Inside Mental Health podcast available on your favorite podcast player.
To learn more about Gabe, please visit his website, gabehoward.com.
Dr. Nicole Washington is a native of Baton Rouge, Louisiana, where she attended Southern University and A&M College. After receiving her BS degree, she moved to Tulsa, Oklahoma to enroll in the Oklahoma State University College of Osteopathic Medicine. She completed a residency in psychiatry at the University of Oklahoma in Tulsa. Since completing her residency training, Washington has spent most of her career caring for and being an advocate for those who are not typically consumers of mental health services, namely underserved communities, those with severe mental health conditions, and high performing professionals. Through her private practice, podcast, speaking, and writing, she seeks to provide education to decrease the stigma associated with psychiatric conditions.
Find out more at DrNicolePsych.com.
Producer's Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You're listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.
Gabe Howard: My name is Gabe Howard and I live with bipolar disorder.
Dr. Nicole Washington: And I'm Dr. Nicole Washington, a board-certified psychiatrist.
Gabe Howard: So the doctor part that can change, right?
Dr. Nicole Washington: Nope. Not going to change.
Gabe Howard: But but but it could, right? You could go to, I don't know, your licensing place and they could say that you're not a doctor anymore. You're like you're a dentist. Now, I guess I would still make you a doctor. You're a therapist. Could it change, like, sincerely?
Dr. Nicole Washington: No. It's not going to change. Not going to change. I could lose my license. I still graduated medical school, still a doctor. It's not going to change.
Gabe Howard: Still a doctor.
Dr. Nicole Washington: Still a doctor.
Gabe Howard: So, but would it upset you like would it upset you if you went someplace and somebody said, hey, I know we told you you were a doctor, but we were wrong. You're not a doctor. You're you're a you're a lawyer.
Dr. Nicole Washington: It, it would confuse me and it would irritate me. Yes, it would.
Gabe Howard: But. But, but why? I mean, we we we looked at everything that you did in college, and we made the determination that you were a doctor. But then we got more information and we decided that you're more of a lawyer.
Dr. Nicole Washington: Oh, Gabe.
Gabe Howard: Right. We got new information and it changed. I know the analogy falls apart and I respect that the analogy falls apart. But can you see how frustrating it would be to be walking around as a doctor and then have somebody say, No, no, no, no, no, no, no, no. We looked at all the data and you're a lawyer or a therapist or a podcaster.
Dr. Nicole Washington: Well, like I said, it'd be confusing. I'd be upset. I would think that person didn't know what they were talking about. I would question their intelligence. I would
Gabe Howard: Look at that.
Dr. Nicole Washington: I would do all those things. I know where you're going because I know what the show is about. So I know where you're going. I know where you're going.
Gabe Howard: That was my mistake. I told you upfront that the show was about changing diagnoses and why this happens and really just doing a deep dove into why can't you? Listen. I'm going to ask it exactly how a patient would ask Doctor Nicole, why can't you get it right on the first try? Why does it have to change at all?
Dr. Nicole Washington: You know, it changes for a variety of reasons. So the first thing I just want to get out in the open is when you see someone for the first time, the diagnosis you make is based on that moment in time and the information you have in that moment. So if I don't have all the information, it may interfere with my ability to make the right diagnosis if you're not able to give me the right information. Because let's face it, sometimes when I see people, it's not when they're at their best. So if you're in the middle of a manic episode, if you are experiencing psychosis and not able to give me an accurate history that's going to interfere with my ability to come up with the accurate diagnosis.
Gabe Howard: See, that all sounds very reasonable. That makes perfect sense to me. But then I wonder, you're aware of this. So why as a psychiatrist would you just assume that you did have all the information and make a diagnosis? Why don't you write inconclusive? Wouldn't it be? I don't want to say smarter, but I don't know, more prudent or easier or nicer or kinder or less jarring to the patient that after the first time, when they say, What's wrong with me, you say, I'm not sure? Inconclusive. Like, would that be better?
Dr. Nicole Washington: I don't know. I mean, you know, the DSM allows for these unspecified diagnoses, right? So someone can come in and I can think, oh, it's a bipolar disorder, like primary bipolar disorder. Is this a substance-induced bipolar presentation? You know, is this schizoaffective disorder? And I just don't have the information to know that right now. I could go with bipolar disorder, unspecified, but it's still going to say bipolar disorder. And that person is still going to be unhappy with me if I change it six months from now to schizoaffective disorder.
Gabe Howard: You understand what I'm saying, though, right? Mental illness is a big, big deal,
Dr. Nicole Washington: Yes.
Gabe Howard: And bipolar disorder is a big, big deal. And I think many of us would prefer no diagnosis over the wrong one.
Dr. Nicole Washington: Yeah.
Gabe Howard: But it seems like there's a reason and I'm not trying to back ya in a corner. But is it a good reason? Like, is this the best practice? If we made you the chief medical psychiatrist of the world.
Dr. Nicole Washington: Oh, the world. Okay.
Gabe Howard: Yeah. Would you change this process or sincerely, we don't see it from the doctors point of view, and most of us don't have access to doctors on podcasts that we can badger in this manner. But I really do think that every single person with bipolar disorder is wishing that they could have this conversation with their doctor and saying, Why did you do this to me? Why did you tell me this just to change it? Why didn't you tell me it could change? Why? Why? Why? Is this the best way?
Dr. Nicole Washington: Well, I think there's a lot of reasons why I think we end up doing this. One, some people really do like to know a definitive diagnosis. People don't want to walk around with this unspecified mood disorder on their chart for a long time. Right? They want, like, what do I have? What does that mean? Unspecified mood disorder is hella vague. Right?
Gabe Howard: Okay. I'm starting to hear it. At first, I was like, Why do you give me a diagnosis just to change it? And you're like, Well, I can give you no diagnosis at all and send you away. So I go to the doctor, I say, Hey, I think something's wrong, I'm scared, there's a problem, etc. I perhaps I was committed inpatient brought there by the police because something happened. And then I have a doctor look at me and say, we don't know. We're just going to watch. Go home. You know, now that I hear it, that sounds worse. Like I'm slowly starting to understand your look, we think it's this. We're going to watch for this. We're going to monitor for this. And then it could shift slightly versus the we have no idea what's wrong with you. Go home and we'll tell you later.
Dr. Nicole Washington: Yeah,
Gabe Howard: That's, that's terrifying.
Dr. Nicole Washington: That is terrifying. And sometimes what we find is, especially in the inpatient setting, if I have someone who's there and they're insured and their insurance company doesn't want to give me extra days because I think they need them. And I have to get on the phone with the insurance company doctor to beg for days just to be able to keep you in the hospital, which happens more than you would think. And they're asking me, well, why don't you know what's going on? Why don't you know the diagnosis? Why don't you? Da da da da da. You know, there are parts of this process where we feel like we need to give you a diagnosis so everyone knows what we're thinking.
Gabe Howard: It seems like there's just this convergence of issues, right? You need to have some sort of diagnosis so you get guardrails for the patient so you know, sort of what you're looking for or in or around. And then you also need a diagnosis for the hospital, other practitioners, other doctors, the insurance companies so they know what they're treating you for. And of course, in the case of the insurance companies, what they're paying you for. Now, I am not a big fan of insurance companies. It's a mess. In the future, we need to do a podcast on how difficult it is to be sick with bipolar disorder and have to fill out insurance forms. Every single one of these insurance forms is made for, I don't know, like MBA, Ph.D. level master's degrees from Harvard to fill out while they're in perfect health. In the meantime, they need to be filled out by people who are sick, like, really?
Dr. Nicole Washington: Listen, this process is maddening.
Gabe Howard: Oh, it's. It's insane. So there's no love lost between me and the insurance companies. I want to say that I've talked extensively with insurance companies about how they need to do better. They are not meeting people where they are
Dr. Nicole Washington: Yeah.
Gabe Howard: But putting that aside, is it fair that the insurance company is asking for a diagnosis there? There is a part of me, the business part of Gabe that's like, well, this person needs to be in the hospital. Why? We don't know. Well, then. Then why are you keeping them? like that? That train of thought does track for me. Are they being reasonable asking for a diagnosis?
Dr. Nicole Washington: Part of me says yes, part of me says no. Right. I think there's still part of me that it is ingrained in me as a trained physician that I need to give people a diagnosis. Right. So I don't know if that may be the system just coming out in me. Right. It's been ingrained in me. You make a diagnosis, you see someone, you diagnose them with something. I do think, however, a lot of times it should just be based on how the person is doing. So I'm really conflicted. Now that you ask me that, I am conflicted on whether we should. There are times I push back and say, I just don't know, so I can't tell you, but this is what they look like. So leave me alone. Like this is all I have to give you. But if I feel very confident that a person has bipolar I disorder, I'm going to put that down.
Gabe Howard: A lot of things about bipolar disorder are traumatizing. They traumatized me and I still sort of wear those scars and I want them so badly to not be traumatizing. Dr. Nicole, I want to go back and say, you know, if the doctor would have done this, I wouldn't have been traumatized or if this wouldn't have happened, I wouldn't have been traumatized. And they could have done this for me. And this would have been better and perhaps. But I really do come to I really land on, you know, it's an illness. I'm sick. I got sick. I went to the doctor. I went to the hospital. You expected to come out of that unscathed, Gabe? Like I literally say this to myself. Listen to what you're saying. You're saying that getting sick, going to the doctor and getting care and being medicated and having a lifelong illness was scary. Yeah. Why are you blaming people for that? It's not the doctor's fault. It's not the hospital's fault. It's not the insurance company's fault. It's that it was scary. Now, within that acceptance, I do believe that there are improvements, but I think that so often people with bipolar disorder are like, well, if they would have only done this, this, this, this, this, I would have been fine. And I count myself as one of those people. If they would have only done this, this, this, this, this, I would have been fine. Yeah. You know, if I wouldn't have had bipolar disorder, I would have been fine. Even if somebody would have done this, this, this, this, this, this, this, I still would have had bipolar disorder. So
Dr. Nicole Washington: But tell me this, when you were in the hospital. Do you feel like you were able to give that doctor the most accurate of history? Right? You're in the fog of depression, your concentration's off, your ability to recall your manic episodes. You know, people tell me all the time, I can remember bits and pieces. I mean, I was kind of like this. Maybe I was this way, I don't know. Trying to get manic criteria from someone when they're not manic and you can't just see it in front of you is so hard because people will tell you, well, I don't know, maybe it lasted a couple of days. I don't know. You know, did you do anything out of character? Well, I mean, no, not that I can think of, you know, and then you talk to a significant other or a relative and they're like, oh, no. For two weeks they were up all night shopping on the Internet and blah, blah, blah, blah, blah, blah, blah. You know, you and your depressive state, were you really able to give that doctor like perfect history? Were you able to rattle off like, oh, and in this episode, it lasted 13 days and I did these things and I had these symptoms? I tell residents and trainees all the time, patients don't read the DSM, they don't know the criteria to rattle them off to you. So you have to figure out how to pull it out of them sometimes. But if you weren't able to give perfect info to your doctor in your depressive state, then it might have made it a little difficult for your doctor to give you an accurate diagnosis.
Gabe Howard: And that's where the onus comes back to us. And I hate it. I hate it when the pendulum swings the other way. I, I really like it when it's the doctor's fault. And if they make all these changes, I'll be better. But the reality is, we have some culpability here, too. Everything that you just said is 100% true. When I went to the hospital, I was in the emergency room and in the emergency room, the doctor diagnosed me with bipolar disorder. I have no memory of this, no memory whatsoever. The person who brought me gave history. The doctor asked me questions. There was just so much history because I had gone so long without getting any sort of treatment or diagnosis. And the doctor said, you have bipolar disorder, sir. I don't know exactly what they said. I'm relying on secondhand information, but I don't remember that. I have no recollection of that. I was apparently in the ER for another 3 hours before I landed in the psychiatric ward and then fell asleep and then woke up. And the last conversation that I remember was 6 hours previous. I remember realizing that I was sick. I remember waking up in the psychiatric hospital. And I say all this because you're right. If I don't even remember a significant life event like being diagnosed with bipolar disorder while in an emergency room right before I was committed to a psychiatric hospital? How can I honestly look at you and say, no, I gave a perfect mental health history to my doctor, leaving nothing out? It is hard to put the microscope on us, though, because, you know, we're sick and we're traumatized and we're scared. Did I mention that we were sick.
Dr. Nicole Washington: Yes. yes, I know.
Gabe Howard: I'd feel much more comfortable if this was your fault.
Dr. Nicole Washington: I know, I know. But in your case, the person who was with you helped you a lot. Right. Because they were able to give you that history. You were not alone. If you were alone in that ER severely depressed and trying to give history, there is no telling what your diagnosis would have ended up being because
Gabe Howard: Exactly.
Dr. Nicole Washington: It was left up to you to give it.
Gabe Howard: Exactly. I was super lucky in how I ended up in the hospital. You know, I talked to providers all the time of like inpatient psychiatric units, the places where if you're pink-slipped, if the police bring you, and so you've done something, right? And that got police involvement. The police decided that you are psychiatrically ill, so much so that you need to be committed to a psychiatric hospital. And then they take you someplace, whether it's a public hospital, a private hospital, they take you someplace where, again, people have no idea who you are. And they say, okay, why is he here? All right. We saw him screaming at the Coke machine. He thought it was a red dragon. Well, and then what? Then he cried and said he was going to hurt himself. People were scared. Clearly, this man needs help. Okay. Do you have any other information on him? Yeah, we've got his wallet. His name is Gabe. Okay. And then they talk to me and I'm like, you know, I hate myself. I hate everything. And, like, all right, you know, he's got some psychosis here. He clearly sees a red dragon. He's super depressed. He's clearly suicidal. He talked about maybe some previous suicide attempts. You know what? We've got enough psychosis, depression, brought in by the police. That's it. That's all the information that you have. Dr. Nicole, your knee-jerk reaction is that I have?
Dr. Nicole Washington: So my, my first thought would be, wow, what is the differential? Because honestly, in that scenario you described, I don't have enough information to really say for sure one thing or another. So a differential in medicine is our fancy way of saying we're not 100% sure, but this is the list of things that we think it could be. And you really want your doctor to think in terms of differentials, right? Like you want somebody to hear what you say and you want them to in their mind think, okay, this could be this, this or this and this is and that workup should then reflect what we think is on that differential. So this case, the differential would be major depressive disorder with psychotic features, right? Somebody who's depressed severely and now they're having psychotic symptoms because of their depression. Two, schizoaffective disorder. Right. It could be someone who has schizoaffective disorder, depressed type, and they're here, they're mostly psychotic and then they have some depression on top of that, or I would think substance-induced, because really I kind of keep that on the differential regardless of what's going on, especially my first time seeing somebody, we kind of think, okay, this could be substance-induced and then we go from there with our workup. But what your diagnosis would be on paper? Unspecified psychosis, unspecified
Gabe Howard: Right. So?
Dr. Nicole Washington: Depressive disorder. That's what would be on your paperwork. Unspecified.
Gabe Howard: And I noticed that you didn't say bipolar disorder, like
Dr. Nicole Washington: I didn't.
Gabe Howard: Bipolar disorder didn't come up. And the reason that bipolar didn't come up is because nothing that, I'm going to be a doctor. I'm going to pretend I'm a doctor. I'm so excited. It's because there is no mania. Right? You saw no mania. I reported no mania. So why would bipolar disorder be on your radar?
Dr. Nicole Washington: I mean, I think it should always be on the radar, but it's further down the list, right? Like it may be on the differential of a list of six, but it's not going to be in that top three, probably because that's not what we're seeing at the moment. But that's where the history comes in. That's where we try to talk to a loved one, somebody who knows you better than we do. That's where we dig through records to see if we've seen you before. Do we have a history with you? What do we know about you? That's where those things come in.
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Dr. Nicole Washington: And we're back with changes in your diagnosis.
Gabe Howard: So sticking just to what we just talked about, there's no loved ones around. The police brought me. Everybody is done with me, right? This happens. Not everybody is fortunate enough to have a family. Not everybody is fortunate enough to have friends. And many of us who were fortunate enough to have those, depending on how our illness progressed, we may have driven them all off. These are the realities of our illness. So you're now talking to us and things are not going well. So now it's the next morning you come and you talk to me. And like you said, bipolar disorder is on the radar. Right? You're a good doctor, Dr. Nicole. And you say, have you ever had mania? Now I'm going to respond with what's that? And you're going to give me a million examples of mania, you know, godlike, where you think you're invincible, you know, super happy, aggressively excited, staying up for days at a time and thinking that you can accomplish anything. And listen, this is Gabe Howard speaking. I'm going to look you right in the eyes and tell you no. I don't recognize any of those things as being problematic. You want me to tell you that I've been manic? No, no. I was happy for like a week back in February. But why are you trying to make that an illness?
Gabe Howard: I'm not lying to your face on purpose because I don't see it as mania. I just see it as part of my personality. So now it's off your radar as well. You've decided you've got all this information once again. You're a great doctor. You tested me for substance abuse. I did not have drugs in my system. We'll just, you know, we'll keep it nice and tight on mental health and mental illness. I still do not have this bipolar diagnosis. Right. You've talked to me. You've seen me. I'm in the hospital. You've got me stable. You're going with major depressive disorder, and psychosis. Right. And I leave and I'm like, hey, everybody, I'm depressed and I'm psychotic. That's what I'm going to say. Right? And then I'm going to start getting people around me. They're like, Hey, Gabe went to the hospital. Like, maybe he's finally getting help. We've watched this for a while. Now and remember this all doesn't happen on the same day. Dr. Nicole is not following Gabe around. So now here we are four months later, right? I'm starting to get better. I'm starting to respond to the medicine. I'm doing what I need to do. This is a best-case scenario.
Dr. Nicole Washington: Yes.
Gabe Howard: Woohoo. So now it's four months later, and I bring in my mom, right? My mom's come back around. My dad's still pissed off, right? But, but my mom, you know, my moms, they love us so much. My mom agrees to come in with me. And I want to point out for many, many people, let's be honest, in the bipolar community, many of us are not willing to bring our moms in. I'm telling you, we should probably rethink this. But for this scenario, we bring our moms and we bring our mom in and you say, all right, you know, tell me about your son. And my mom just started well, he just he thought he was going to be president. He stayed up for a week at a time. And it's mania right now. You've got it. So you're a good doctor, Doctor Nicole. And again, I figured this out. I didn't go to medical school. I barely graduated high school. I just hosted podcasts for a living. I've now figured out that it's bipolar. So you, of course, introduced the idea that maybe the diagnosis is wrong and that it is bipolar disorder.
Dr. Nicole Washington: Yeah. Yeah. And then I might get cussed out.
Gabe Howard: Yeah. Yeah. And then everybody. My son is not bipolar. I'm not bipolar. Well, that's stupid. Yeah, well, why didn't you know? I'm not coming to this hospital ever again. Like, the the righteousness that comes from us is it spews out. And I hate saying it that way. You know why I hate saying it that way? I don't hate saying it that way because it's untrue. Because I can hear every single person with bipolar disorder saying, wow, he's just another person lecturing us.
Dr. Nicole Washington: Yeah.
Gabe Howard: I swear I'm not. I'm not lecturing you. I'm actually putting the power back in your hands. I'm letting you know that look, you were afraid. You were scared. It's horrible news. Your doctor is going to forgive you, but you've got to own this. I got to own this. I got to own the moment. I cussed out my doctors. I can't wait for them to forgive me. I have to make amends. I feel that this is empowering. I am not lecturing people with bipolar disorder. I am encouraging you to think about the entire situation and make different choices.
Dr. Nicole Washington: So
Gabe Howard: Please don't send me hate mail.
Dr. Nicole Washington: Please don't send Gabe hate mail.
Gabe Howard: It makes me sad.
Dr. Nicole Washington: I know it's hard, right? I can absolutely empathize with thinking you have this one thing and then being told you have something that in the eyes of the world is much worse. Right. I think anyone would rather say, oh yeah, I have depression. Then they would rather say, oh, I've got bipolar disorder. Like there's a whole negative connotation that comes with saying, I have bipolar disorder or I'm bipolar, right? Like just that statement in and of itself just evokes different reactions from people than when you tell them, I'm depressed or I have depression. So I could absolutely understand that. And like you said, I mean, one of the, one of the problems for a lot of people who have experienced significant mania is they may not think it's necessarily the worst thing in the world. Right. They felt good. They had lots of energy. They were getting stuff done. Now, was it productive stuff? Who knows? Sometimes yes. Sometimes no. Do they forget that they went into debt because they bought $1,000 worth of nail polish? Yes, they may forget that part, but they felt good. And so I think it's hard to think that, you know, you're telling me I have something that I feel like is a positive and you're telling me it's a problem. But where I see people get the most upset is not so much. If I am seeing the same person for four months and I come back and I say, you know, with this information, this sounds like bipolar disorder. This is what bipolar disorder is.
Dr. Nicole Washington: I don't see people getting as upset in that scenario. Where I see them upset is now you're in the hospital the second time and you come back and you're manic this time and you're diagnosed officially with bipolar disorder. And so now, okay, first they told me I had depression and now they told me I had bipolar disorder. Maybe it's the same doctor. Maybe it's a different doctor. Then you come back to the hospital, you know, two months down the road and we get more history and we say, Ooh. Remember when we said we thought this was bipolar I disorder with some psychosis? Well, now we think maybe you have schizoaffective disorder. So then people are like, y'all don't know what you're talking about. Like, nobody knows what they're talking about. And y'all a guinea pig-ing me and you don't even know what you treating me for. And y'all are just giving me medicine. And that's where I see people getting the most upset when over time, it changes from doctor to doctor to facility to facility. And so then I see them and I say, Well, tell me what all you've been diagnosed with. And they're like major depressive disorder, bipolar disorder, schizophrenia, schizoaffective disorder. They could have been diagnosed for all those things, depending on what information was in front of the person who diagnosed them, what access to other records they have. They could, that could very well be true. And that is maddening for somebody.
Gabe Howard: Before I say anything else, I want to ask you as a doctor, can you understand why that's maddening?
Dr. Nicole Washington: Yes.
Gabe Howard: And why that's frustrating?
Dr. Nicole Washington: Absolutely.
Gabe Howard: Why that's anger inducing?
Dr. Nicole Washington: Absolutely.
Gabe Howard: Like you're, you're on our side. You understand why we're pissed off?
Dr. Nicole Washington: Yes.
Gabe Howard: Good. Good. Because I want to get that out there. So often patients feel like the doctors don't care. And I do realize that's unfair, because doctors do care. Doctors just don't always have the time or the ability to let us know that, or we're not in the position to hear it. There's a lot of opportunity for misunderstanding in that room.
Dr. Nicole Washington: Absolutely.
Gabe Howard: Now, Dr. Nicole, one thing that I want to touch on real quick is that new information part, right? Oftentimes the new diagnosis comes up because people aren't doing well. I think that sometimes we forget that people who are stable doing well, they don't just get a new diagnosis. Right. It's it's it's not like everything was going great in your life. And then your doctor said, oh, by the way, you have X instead of Y, you usually get the new diagnosis when things are they're shitty anyway, right?
Dr. Nicole Washington: [Laughter]
Gabe Howard: You're mad that you got a new diagnosis, but you didn't like the old one.
Dr. Nicole Washington: Yes.
Gabe Howard: Things weren't going well before. Things already sucked. I recognize that this now makes it suck a little bit more, but
Dr. Nicole Washington: Yeah.
Gabe Howard: I think sometimes we need to remember that as well because we always seem to tell the story of everything was fine and then my doctor gave me a new diagnosis.
Dr. Nicole Washington: Yes.
Gabe Howard: No, that's not what happened. Everything was garbage.
Dr. Nicole Washington: I was minding my own business. And then they brought me to the hospital.
Gabe Howard: You had a severe and persistent mental illness. You had a mental health problem. You were not doing well. Yes, the name changed. And that is frustrating. But this is part of the journey. And listen, here's the part that I want to touch on. New information is good because like I said, things weren't going well before. And now you've got a new data point. You've got a new diagnosis, which means new things to try.
Dr. Nicole Washington: Right.
Gabe Howard: Now, once again, Dr. Nicole, this this provides opportunity, because once that diagnosis changes, you have access to, well, essentially more attempts, more tries, more more things that you can do to help us get well. So it's a good thing.
Dr. Nicole Washington: Absolutely. And we can stop things that may be making you worse. Right. So if you were diagnosed with depression and you've been on antidepressants and you say, well, I feel okay for a little bit, and then I feel down again and then I'm all over the place. Or I felt really irritable or I'm not sure I'm not sleeping. Well, you know, we may figure out that, oh, the antidepressant may be making you worse. So what it can do that change in diagnosis is it can allow us to maybe take away some things that aren't helpful and add in some things that are. But I think one of the big things that we need to think through in this scenario, too, for someone out there listening who has had their diagnosis change a lot, I will ask you this. Under what setting has it changed? Is it changing because you're in and out of the hospital because you're not established between hospital visits, not going to visits, because really a lot of this process is relationship-driven. The only way that I can truly say I have a good feel for what's going on with you a lot of times is if I see you on a regular basis in the office when you're stable, like, I need to see you a lot when you're doing well. It's a really, really firm up and I think a conversation about a diagnosis changed is better received in those scenarios in the outpatient setting where you're more stable than in the hospital. And so I would ask anyone who's frustrated about their diagnosis constantly changing. One, are you having lots of hospitalizations? Because that's really where we see that happen a ton. And if you are, then I will ask you to ask yourself, why am I following up in-between visits to the hospital to make sure that we're trying to avoid that? Am I seeing someone regularly in an office? But if your treatment mainly consists of when you're in the hospital, then it's going to be very difficult for you to get a firm diagnosis.
Gabe Howard: I want to tell everybody that it's a good thing when your diagnosis changes and hear me out. It means that the doctor is not so rigid, not so egotistical, not so. I mean, just. Just fill in any word that you want. It means the doctor has gotten new information and has changed course, and that is in your best interest. So often we don't think that it is. But listen, for as often as we call doctors evil, egotistical, they just think they're better than me. They're sitting on their sheepskin, they think because they went to medical school, they know it all for as often as we say that. And then we get an example of where a doctor is like, look, I've been given new information and I am changing my mind. I am saying that I was wrong before and I am hopefully right now they're really evaluating everything as it comes in. And then we hit them with the other thing. Oh, they don't know. They're flip-floppers. You really have to ask yourself, are you just insulting doctors for the sake of insulting doctors? I understand it. I do. But is it helping you? Again, if you've got a doctor that gets new information that's willing to change course, that is in your best interest, and that's the doctor that you want to work with. I guarantee it.
Gabe Howard: I know that when we're really, really sick, it is difficult to evaluate things. But. But sincerely, ask yourself this are you just angry at the situation and you're blaming your doctor? Because I hear a lot in the in the bipolar community about my doctor is so egotistical. She thinks she knows everything. He thinks he's always right. He won't listen to me. And then when a doctor does change the diagnosis, I hear they don't know what they're doing. She's a flip-flopper. He's constantly changing his mind. And those two things are mutually exclusive, right? If the doctor gets new information and is willing to change up what's going on to get you better care, that is an example of where things are going. Right. And we as patients need to understand that that's an example of where things are going right!
Dr. Nicole Washington: I completely agree with that, Gabe.
Gabe Howard: Thank you, everybody, for listening. My name is Gabe Howard and I am the author of "Mental Illness Is an Asshole and Other Observations," which is available on Amazon. Or you can get a signed copy with free swag by heading over to my website gabehoward.com.
Dr. Nicole Washington: And my name is Dr. Nicole Washington, and you can find me on all social media platforms @DrNicolePsych to see all the things I have my hand in at any given moment.
Gabe Howard: And Dr. Nicole and I both travel nationally. We could be at your next event. You can find out more information on our respective websites. Wherever you download this episode, please follow or subscribe. It is absolutely free and do us a favor. Tell your friends about this podcast. Sharing the show is how we grow. We will see everybody next time on Inside Bipolar.
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