Self-Advocacy at the Doctor's Office
Words by Eunice Brownlee // Image by Sarah Hartley
I find myself constantly longing for the day that the medical community will put as much energy into treating mental illness as they do other illnesses. It seems that when you’re diagnosed with a mental illness, the approach is a one-size-fits-most to developing a care plan.
Depression? Here’s a menu of anti-depressants. Pick one.
Bipolar? Choose from this list of anti-psychotics. Pick one.
Anxiety? Check out these mood stabilizers. Pick one.
The way mental illness presents itself in a patient are just as unique as the patients that live with these illnesses. We need more than 15 minutes with our primary care physician or psychiatrist to determine this. We need more than a prescription pad thrown at us to “try and see if it works.”
It took me a long time to accept that I live with depression. My dad was diagnosed with depression when I was 18 years old and he did not receive that news well. In addition, he chose not to manage it, which only exacerbated his symptoms and he got progressively worse (he was ultimately diagnosed with bipolar disorder).
About three years later, I was visiting my PCP and she point blank asked me if I could be suffering from depression. I recoiled in horror at her question and emphatically told her no, even though I knew I was lying. The last thing I wanted was to be labeled as depressed, because my husband at the time had shamed me so deeply for feeling that I might be.
Every time I went in to see her, whether it was for a routine physical or another ailment, she asked the question. Each time, I affirmed that I was not suffering from depression, while internally, I wished she would just tell me that I was depressed and get it over with. When I moved, I found a new PCP and I was relieved to avoid this confrontation for several years.
In the fall of 2011, I went in for my annual physical and the doctor had me fill out a short questionnaire. It asked things about my level of motivation and my drinking habits and my sleeping habits. All of the questions seemed fairly innocuous until I noticed the title at the top of the sheet: “Mental Health Assessment.” I cringed. This was a passive-aggressive version of the conversation I’d hated for so many years.
I looked down at my scores and added them all up. On a scale of 1-20, I was a 15. I put the sheet face down on the desk and quietly waited for the doctor to come in. When she did, she took a look at my responses and with all the kindness and empathy in the world, she asked, “Were you aware that you are suffering from severe depression?”
I burst into tears and told her how I had known for ten years, but didn’t want to become one of those sad, depressed girls that everyone makes fun of. I wasn’t sure if what followed was empathy or pity, but she simply mentioned that I wasn’t alone and wrote me a prescription for an anti-depressant. I went home and climbed into bed, still fully clothed, and I slept until it was time to pick up my daughter from school.
I filled the prescription and started religiously taking my meds. I even traded pills to my sister-friend who was on the same script when one of us ran out before our insurance company would allow a refill. I was grateful for her, both because she made me feel like I was normal and because we never let each other run out of our medication.
After a period of time, the prescription that I was on stopped working for me. This happens fairly regularly with the medications used to treat mental illness. Either your body adapts to the medication, or changes in your metabolism can cause your body to break it down differently.
I was in a place where I was barely functional each day. Getting my daughter to school was an overwhelming level of effort for me, and I called in sick to work regularly. I went to meet with my doctor to learn about what my options were to adjust my medications.
She offered me a sample of a new medication that was on the market. It was a combination SSRI/SNRI, which would address both my depression and anxiety. She did give me a heads up that it was a new drug, and that it would likely require a pre-authorization from my insurance company.
I took the seven-day sample home, and within just a couple of days, I was feeling immensely better. I brought the prescription to the pharmacy and, as expected, my insurance company required a pre-authorization before they would cover the cost of the medication.
If you’ve never run into the pre-authorization process, it is probably one of the most dangerous levels of power given to insurance industries. It is most commonly applied when a new drug is on the market or if the drug comes with an extraordinarily high price tag (don’t get me started on the prohibitive cost of life-saving medications). Your doctor sends a letter to the insurance company explaining why you need to take a specific medication, as opposed to a similar medication with a smaller price tag. Then the insurance company decides whether or not they want to pay.
In my case, the doctor sent a request to my insurance company, and within a few days, the request was denied and said that they would reconsider only after I had tried and failed on one of two other drugs that had been on the market for some time. I was devastated. Switching meds is never easy, but this felt particularly cruel to be forced from feeling great back into a world of uncertainty.
I selected one of the medications and was given a 30-day script. It took a couple of weeks, but before I hit that month mark, I could already tell that the medication I was taking was not as good as the newer one. I called the doctor’s office on the Friday afternoon before Memorial Day and spoke to a nurse, who agreed to send a new pre-authorization request over to the insurance company.
The following Tuesday (not even one business day had passed), I had a letter in my mailbox from the insurance company again denying my request for coverage, this time asking me to try and fail on one of eight anti-psychotic drugs. Anti-psychotics. For depression. It made zero sense.
I set an appointment with my doctor and asked her what on earth I was supposed to do next. Her answer was not what I expected. “This is how it works; you’ve got to play their game.” Here I was, feeling like crap and my only ally just told me that she wasn’t willing to go to bat for me.
I was still stuck on the fact that the decision made no sense, and she had her prescription pad ready to be complicit with whatever the insurance company dictated. At that moment, I had never felt so helpless with my healthcare in my entire life—not even when I had spent a year trying to avoid having shoulder surgery, only to get new insurance and the new surgeon told me that the course of action I had been on wasn’t covered by my new plan.
My doctor didn’t care about making sure that my mental health was managed. She only cared about following arbitrary rules that were dictated by people who knew nothing about me or my medical history—except for one stupid letter that they clearly hadn’t bothered to even read before rendering a decision.
I fired my doctor that day. I’m an incredibly informed healthcare consumer and that was the last time that I was willing to allow someone to make a medical decision for me without my consent.
About the Author:
Eunice Brownlee has spent her career finding the balance between her left and right brains. She is a passionate writer and writes regularly about mental health, trauma, and abuse. As a survivor of all three, she uses her experience to help others open up and tell their stories. She's also a single mother, striving to raise a daughter who is strong and outspoken. When she’s not doing any of the above, she can be found seeking her next passport stamp and drinking wine.
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