The Doctor is...In

I have to apologize for this?

I have a patient who’s relatively new. I’ve seen her maybe three times, including today. She’s about in her mid-20s. And she has bipolar disorder. The real thing, not the mind-numbing overdiagnosed kind. It sounds like she’s persistently manic.

She is of course on the wrong medication — they all are — and she’s unstable. One sign of her mania is increased libido and sexual indiscretion. Sometimes, she’ll sleep with a few men per week. She’s adequately attractive, but men respond to availability more than they respond to fine points like whether or not the woman is particularly good-looking. But she’s close enough, and not well-controlled or well-contained, so she has no problem finding hook-ups.

This, of course, leads to at least minor versions of sexually transmitted diseases, so she has genital complaints.

The first time I saw her, I began treatment with the mood stabilizer I like best: very reliable, usually not much in the way of side effects, and dirt cheap. But between the medication I used, and her mania, and her non-psychiatric problems, and medications, she complained of excess perspiration, and couldn’t continue. Then, she missed an appointment or two, finally came back, and I started my next favorite mood stabilizer. (When things work well, all you need is one medication, and it’s a mood stabilizer. Although about 30 years ago, I wound up having to use three mood stabilizers at the same time to get the bipolar ups and downs to go away. And there was a very patient and attentive husband who helped stabilize things. It’s always good when I have someone like that who will call me, so we can adjust or pivot as necessary.)

The current woman is persistently manic, taking a mix of medications, and marijuana, and “microdosed” mushrooms, and over the counter “probiotics” recommended by her non-medical mother, and antibiotics.

We talked a little bit about sex today, and she confirmed what I suspected: her libido is higher when she’s manic, and she doesn’t rely on condoms. Hence, some of the STDs.

So we increased the dose of the current mood stabilizer, stopped the probiotics, will gradually reduce one of the other unnecessary medications, and she’s going away for a week with her latest boy. She reassured me she’s not a prostitute, and he’s not using her for sex, as if she would know. Her friends tell her that if she wants to be taken care of by a billionaire — not that he is — she should give them whatever they want. There’s very little control going on here. And she’s unreliable. Although reliable enough that I can do this with her in the outpatient setting. It’s not like in the old days for me, when I did hospital work, and I could monitor and make changes whenever and as often as I wanted to. But hospitals are one of the crimes that are part of the American medical industry, so part of my job is to keep people out of the hospital.

I was thinking about her after she left my house today (I see patients in my house), and how she’d be away for a week, then get a blood test a week from today, and I’d see her at the end of next week, and I didn’t want to wait that long for follow-up. I was thinking about calling her back this evening, to ask her to check in with me by phone at the end of this week, when she called me. She wanted to talk about her stomach pain and genital symptoms, which are not of central interest right now, and I was glad to hear from her, so I could ask her to call me at the end of this week. But I did ask her about her other symptoms, because she wanted to talk about them, and I asked if she’d discussed any of this with her gynecologist, and when. Yes, two weeks ago, and she was hustled in and out so fast that nothing was meaningfully addressed, and certainly not resolved.

She said something about how that’s how medicine is these days, I said I was more than well aware, and I apologized to her for the two-bit treatment she (and all the rest of us) get from doctors these days. I’ve watched it go from bad to worse for almost 50 years.

I’ve experienced it myself. I have problems I’d love to get treated, but the doctors are so bad that I have no reason to expect any help. When things have gotten bad enough, as they did twice this year, and I do make an appointment, I don’t wind up with help. So I mostly just give up.

I have said this very many times: 1) we spend far more on the American medical industry than real countries spend on actual health care, 2) our results are worse than almost all developed countries, 3) the commonest cause of personal bankruptcy currently is, and always has been in this country, an inability to pay medical bills, and 4) whatever access we could theoretically provide to the medical industry we don’t provide to everyone. The American medical industry is not “health care.” It commonly has little or nothing to do with anyone’s health. Its purpose is to move money from wherever it is to providers, other vendors (drug companies, hospitals, etc), and insurance companies.

Well, at least my apology to my patient for the quick and pointless hustle she got from her gynecologist was sincere. And if she’ll let me stabilize her, I can get her down to the one mood stabilizer she should need, and improve her life. I’ll have to treat her until I’m gone, but I’ll be very happy when I have to give her late or weekend appointments, because she has a job. In the meantime, I’m treating a couple, and the wife is in training to be a psychiatrist. If I think she’s good, which I’m working on effecting, I can eventually turn my practice over to her.

If there’s any larger scale good news, I have befriended two people running for federal office. One is running for Senate, and the other for House. I have told both of them that if they win, which I have very firm confidence they will, I will take myself to DC and talk to as large a gathering of electeds as they can put together, and explain to them what they have no way of knowing about the dysfunction that is the American medical industry (no one could understand it if they weren’t in it), and how to fix it.