Daily Archives: October 15, 2012

When the Doctor is Away

Many people I know who experience symptoms of mental illness have partnered up with a therapist, psychiatrist, prescribing nurse, or general doctor to aid in their care. These kinds of relationships may take a lot of time and effort to grow, and from my own experience I can say that things like trust and understanding don’t come immediately, they generally take some time to form.

That said, it can be a harrowing experience when you have built this kind of relationship and lose access to it when your professional partner in care is sick, experiencing an emergency, or taking time off.

I know I’ve talked a little bit about this before, but my recent circumstances (basically experiencing intense symptoms and being unable to work while my psychiatrist is out of town) have been something of a reminder that it is never a bad time to create a plan in case of future emergency -and know what you need to do in case that emergency occurs when your professional support person is not available.

Now that the weather in Seattle has finally started to turn and it is obvious that fall is upon us, I thought this might be a good time to bring this up again as well. Winter can be a particularly difficult time for people who experience depression or mood swings, particularly in the Pacific Northwest.

So, here are some suggestions that could help you avoid unnecessary risk and potentially make a difficult situation much easier.

1. Talk to your professional support people about what to do in the event of an emergency in their absence. Your therapist or doctor may have special instructions on who to contact if you are having an emergency and they are gone, so speaking with them before and emergency occurs is a great way to start setting up an emergency plan for yourself. At the same time, you may want to request that your support person give you notice if they will be going out of town so you can be well prepared in the event of an emergency.

2. Consider the needs you might have in an episodic emergency and discuss with your doctor if having an emergency medication (such as an antipsychotic you can take as needed) is a possibility in your situation. If an emergency medication is not a possibility, at the very least I would suggest making sure you have enough refills to last the duration of your doctor’s absence.

3. As discussed in In Case of Emergency, I would highly suggest taking the time to create a card or sheet of paper you can carry in your wallet/purse with the following information on it:

  • Your primary care doctor’s name and contact information
  • Your therapist’s name and contact information
  • Any diagnoses you may have
  • Your current medications and dosage information
  • Your medication allergies, if any
  • Any previous hospitalizations
  • And if I am in a situation where I might be given a new medication to try, I like to include previous medications I’ve taken, dosages, and what effects they had (namely the reason I am no longer taking them).

This information can be extremely helpful to have in an emergency when the professionals attempting to help are unfamiliar with your particular situation. It might even be wise to add notes on things like, “do not give antidepressants” in the medication allergies section if you have a history of switching to mania when given an antidepressant. Just last week I had to wrestle with my general physician because the seemingly obvious thing to do (in his opinion) was to give me an antidepressant for my current situation of depression. My psychiatrist absolutely knows better, but my physician isn’t familiar with my history -which is why it is important to be able to relay this information to someone new.

4. Create a plan with someone close to you that defines exactly what an emergency situation is, and when emergency procedures need to take place (such as the emergency room or potential psychiatric hospitalization). It might be helpful to consider the following questions to help define what an emergency looks like to you:

  • Are you someone who is more likely to seek emergency care because of a depressive episode, a manic episode, or a mixed episode?
  • Have you sought emergency treatment before? What symptoms made it an emergency? (Ex., suicidality, homicidality, psychosis, self harm, etc.)
  • Have you experienced a range of severity levels in these emergency symptoms?

For example, I have a 0-3 rating scale for suicidality. If it is at 0, it is not occurring. At level 1, new suicidal thoughts begin occurring in a fleeting way. At level 2, I begin flirting with the suicidal thoughts, and that is where suicidal ideation begins (imaging different acts of suicide). Level 3 denotes a place where I feel convinced suicide is the correct course of action.

So even though “suicidality” might be my emergency symptom, I often feel stages one or two without feeling concerned enough for hospitalization. If I reach a stage 3, I have a contract with myself and my doctors to seek hospitalization immediately.

For issues of psychosis I generally consider severity and length of psychotic period. If you are someone who typically has long psychotic episodes, I would suggest considering any psychotic symptom a cause for emergency.

The idea here is to consider what is the worst you can foresee, based on what you have experienced. I would take those symptoms and make a checklist, and perhaps fill out that checklist twice a day, once your mood begins going into a more intense area.

Talk with someone about what you would consider an emergency, and share the scores you get from the emergency checklist with that person. This way, if you reach a point where you can no longer discern what is an emergency and what isn’t, your friend/family member can make that judgement call for you. And the checklist is a great tool if you do go to the emergency room, they can look and see exactly what the emergency is about.

5. Maybe you don’t have access to a friend or relative that you feel comfortable sharing this kind of information with, and that is ok. I would still recommend coming to conclusions about what you would consider an emergency, and if you ever find yourself at a loss for someone to talk to, contact the Crisis Line. 

I am pretty sure the number varies from region to region, but I am under the impression that most states have one, so it may be worth your while to google it and jot the number down on a card in your wallet/purse. The people on the other end of the line are used to receiving calls from people who are in crisis, so in lieu of a physical person who is present and able to help give direction in an emergency, I would highly suggest this route. These folks are level-headed, and if they are under the impression that your or someone else is in danger (which really trumps whatever your definition of emergency is in the case of most medical professionals), they will suggest going to the emergency room.

Ok, so those are a few ideas on how to handle emergencies in the absence of our professional support team, and I would suggest taking a look at In Case of Emergency as well where I talk a bit about mapping out emergency rooms and hospitals in your area to be prepared in the event of a psychiatric emergency.

For all of this, and for all emergencies, it is much more helpful to begin working on a plan of action when feeling fairly stable, as opposed to waiting for an emergency to happen first. By having a plan worked out, knowing that your psychiatrist or therapist or whomever is out of the office will be a lot less stressful, and less risky in the event an episode does occur.