“I will not be adding that to your chart.”
My already racing heart began to sink as the physician’s words ricocheted in my mind. A psychiatrist who was reading a penned letter from my counselor took the diagnosis we had worked months toward, took a personal prejudice and dismissed my borderline personality disorder (BPD) with the drop of a pen. It was deflating to say the least.
After my long-term psychiatrist passed away, I began the tedious task of locating a new professional to take over my medication and care. The search took months and after consuming every review I could find online, I finally set my mind on a well-known local psychiatric nurse practitioner. She had years of experience in the field and peers spoke highly of her, it appeared to be a good fit for my current needs. My diagnosis list is extensive and not always easy to address, so I went in understanding I would need a complex team of professionals at my back. Little did I know in a quick 45-minute appointment I would be dismissed in such a way.
In the weeks leading to my new patient visit, I worked with my licensed counselor to quell some of the mounting anxiety I was feeling about this sudden change. We sat down over various sessions and began to address my fears. I was concerned I would not be heard, a worry many patients face in the mental health community. Even when well-versed and medically sound, stigma can raise its head and leave a patient feeling frustrated with the quality of care they are receiving. It creates a sense of unease in those who are seeking help in, at times, their greatest moments of need.
A paper published in 2017 from the U.S. National Library of Medicine National Institutes of Health on mental illness-related stigma, reports that people who lived with experience of a mental illness commonly report feeling devalued, dismissed and dehumanized by many of the health professionals they come into contact with. Research with healthcare providers is consistent with this idea. It notes patients with certain disorders, such as personality disorders, tend to be particularly rejected by healthcare staff and are seen as less deserving of care.
The report should be seen and heard. My initial consultation was meant to establish care and try to wean down the multiple prescriptions my prior physician had let multiply to an alarming level. I was taking 11 pills a day to maintain a certain level of my own normalcy. The counselor I see weekly was concerned I was overmedicated, and we made the decision, after voicing my reserves about not being heard, to write a letter prior to my appointment to detail my exact list of diagnoses. It was meant to assist the nurse practitioner in taking over my lengthy file and give her an official document to build from. The letter was sent, and I felt a little more at ease.
Finally, the day of my new patient appointment had arrived, and I felt hopeful things would work in my best interest. The nurse practitioner elaborated I would not be seeing the doctor during the initial consult, but that meeting would happen soon. This fact did not alarm me, it seemed like pretty standard procedure. It began with an explanation of my medications and the symptoms I was dealing with as a result. I explained my tendency to paranoia, dissociation and frequent mood swings.
She reviewed my list of prescriptions and agreed that I was in fact overmedicated. Then it came time for the letter my counselor had penned for my benefit. She read it slowly and after she was done, she closed the file and looked over at me with a frown.
“I will not be adding that to your chart. Having a borderline diagnosis will follow you and I will not be adding it.”
I was shocked at her refusal and confused. I’ve lived with this personality disorder for much of my life and asked that it be included for obvious reasons. It details many of my current symptoms and offers an explanation for the ways I tick.
I accepted this as fact, though defeated by it, I could not change her mind. If a medical letter from another professional could not sway her, how could I? The assumption this was the end of the nightmare I was having was farfetched. She addressed my eating disorder and mood swings, stating I was only seeking attention from my parental figures.
“Oh, anorexia is just attention seeking for girls.”
It felt like a punch to my gut as I sat there trying to not squirm in her chair. I had never heard someone with as much experience under their belt refer to my disorders as a mere ploy for attention.
The consult continued and I was informed she would be taking away five prescriptions and instead placing me on three. She explained to do this she wanted to hospitalize me for the withdrawals I would experience so she could “start fresh” with her medical plan. As a full-time employee, student and with the rise in COVID-19 numbers in my state, I declined this action. I was not comfortable taking a bed in a hospital that could be used for someone in distress. She shrugged and said I would be fine then. She told me the names of the medications I would now be on and offered no insight into what they did or why they were being changed. It would not be until I saw my counselor again that I would be told I was placed on a medication reserved for people who have been diagnosed with schizophrenia. A high dose of an antipsychotic that, when spelled out, would not benefit my situation.
The appointment ended and I was left reeling. I had no idea what to feel other than small. I did not feel seen, heard or acknowledged. The following days I would be bedridden with some of the worst withdrawals I have ever experienced. When I reached out to the office for help, I was informed we could discuss it at my next appointment in a month. My decision to avoid the COVID-19 epidemic and the hospital was my choice, one I do not regret. I cannot come to feel guilt over my reserves. So, I dealt with the intense nausea, the trembling, the pounding headache from dehydration and the many other symptoms I had to endure.
On seeing my counselor, the next week, we were able to properly dissect the entire experience and she firmly recommended I locate a new physician immediately. She had safety concerns. She voiced those in a manner that made sense and I was able to come to terms with the fact my voice had been ignored and my health put in danger as a result. My diagnosis was left from my chart, my disorders were called attention-seeking, a new medication was prescribed and not explained, among other issues that arose during the appointment. We made the decision together I would see someone my counselor highly recommended in the same field.
I am reserved about this new doctor, but in the coming days, I must face it. We are writing another letter in hopes this time I will be heard and seen. Red flags in a physician must never be ignored. I was anxious about being seen as a “doctor hopper,” but my medical file cannot be ignored so blatantly. My humanity cannot be discarded because I have borderline personality disorder. I am who I am, diagnoses and all. My needs are complex, and I feel I must write the medical board to discuss this failed appointment at length. I do not wish her to be in hot water, she may be a fine professional, but my experience must be heard.
If you feel the medical professional you are seeking treatment from is not listening or does not have your best interest at heart, you must sever ties responsibly. There comes a time when you are caring for your own mental health that you must lay out the options and weigh them. Seek a second opinion if you must. I encourage you to review your own medical chart and make the hard decisions that will be best for you in the long run. We are all in this together and if your professional cannot see that, it is time to seek someone new. A personality disorder is not a bad thing, you are not less of a person because of it. You are deserving of a high quality of care regardless of your diagnoses. We are people. We are deserving of care.