When I think of people, I often think of a puzzle, with many pieces encompassing diverse shapes and sizes, which ultimately come together and create complexity and beauty. Each puzzle piece is unique, just as much as each person is. So why is it that the systems in place treat people like they should all fit in a Jell-O mold, which may hold contents of a different color, but must still stay within the confines of that mold? The answer is simple and complex: power, control, and the almighty dollar are the foundation of the Jell-O mold.
Those that hold power in this world often use it to get what they want and to control the people around them. Our education system is a great example of keeping children oppressed by providing a subpar education and placing them in classrooms with high student to teacher ratios. Often, it isn’t until a child attends a university that they receive a quality education, but that comes at a price that many simply cannot afford. Some children are fortunate enough to attend a school in an affluent neighborhood or get a private education, but those children often already hold privilege, because their parents are wealthy.
Our education system is only one example because the list goes on and on if you take the time to look around and think critically about what’s happening around the world, and especially in the United States. The barriers put in place are extensive and often impermeable for those that hold marginalized identities. Even for people that hold privilege, as I do because I am white, the threat of being shoved back into that Jell-O mold is very real.
The health care system in the United States is wrought with barriers to quality healthcare, no matter how much a provider wants to offer equitable care to their patients. The requirement of putting patients into a mold that “works” well for everyone begins in medical school. Physicians are taught a specific way to provide care, which isn’t necessarily negative.
For instance, when we go in for an appendectomy we certainly hope that our surgeon has been trained properly and that they will remove our appendix and not our kidney. However, when providers care for a patient that doesn’t fit into the typical mold, what happens then? From personal experience, I can tell you that some physicians do everything they can to put you back into that rigid mold because that is where they feel comfortable
I work with an entire team of providers, ranging from mental health to neurology, to primary care, to immunology, because I have multiple chronic medical conditions that require follow-up, tweaking of medications and treatment plans, and communication between my various providers. I have a unique relationship with each of them, that has been developed over time and works well for both of us. That doesn’t mean that there aren’t frustrating times, which is natural for any relationship. For the most part, my physicians provide me with the level of care that I want and need, and we discuss what that looks like collaboratively.
I acknowledge that my care is complex and often skirts along the edges of what my providers existing knowledge base is. This can make my physicians uncomfortable even when they work in collaboration with other physicians. When this happens, most of my providers can refer me to a specialist within their specialty. That has not been the case within one specialty, psychiatry.
A prior psychiatrist I was treated by works in private practice and had been an asset to me over the past year and a half. He listened to me when I had concerns and we worked collaboratively to create treatment plans and trial medications. Because I take so many medications to manage my severe migraines and postural orthostatic tachycardia syndrome (POTS), my psychiatric care is more complex and difficult to manage. Most recently my psychiatrist acknowledged that we were reaching the edge of his comfort zone and asked me to reach out to another psychiatrist to for further consult and get another perspective.
This led to multiple email exchanges where he laid out a plan moving forward that included aligning my care more so with his other patients, creating reoccurring appointments at regular intervals, regardless of what level of care I needed, and proposing that if there are not a lot of medication changes, that we could work on other areas, such as the way I think, feel, and communicate about illness. He also suggested that this may improve my relationships with my other providers; the ones that I identified no communication issues with, but clearly, he felt otherwise.
Ultimately, the conversations went downhill fast, partially because he did not follow the boundaries that he personally set, and he felt an urgency in determining a treatment plan because he was leaving for vacation the next day. During the e-mail exchange, he decided to communicate his desire for me to begin the process of looking for a new psychiatrist through an email message, rather than in person, as I believe I deserved. This felt dehumanizing and like I wasn’t worthy of the courtesy of telling me in person.
Furthermore, the suggestion of working to improve communication with my providers created a lot of second-guessing, causing doubt about the effectiveness of my communication with my physicians.The e-mail exchange ended with him stating that my neurologist was confident in moving forward with a treatment plan that he wasn’t and that I should go forward with it.
Even though I trust my neurologist completely, it didn’t feel good to me that I was doing something that my trusted psychiatrist felt was not in my best interest. When I get that knot in my stomach, it’s an indicator to me that further action must be taken on my part. In this case, I messaged my neurologist and asked if I could take one of the medications in the morning and the other at night, skipping the night dose of the first medication so they would not interact. He concurred and said that it felt like a solid starting point. I was so relieved and quite annoyed.
Why did it take the patient, the one without the medical degree to propose a solution that might work for both physicians, to get the level of care I deserved? What if this happened to a different patient, one without as much medical knowledge, or one that spoke a language other than English as their primary language? Would they have received the proper care needed in this instance? Certainly, the answer would be a resounding no.
I had the opportunity to speak with my prior psychiatrist at my last appointment before transferring care to another provider. I knew it was going to be awkward going in because he knew I was quite unhappy with his behavior and professionalism, yet I was determined to make this a learning experience rather than a complaint session. I owed it to all his other patients and to every other person that doesn’t fit in the proverbial Jell-O mold. I was able to calmly and professionally tell him how his behavior affected my ability to care for myself, and further unpack the Jell-O mold.
What I appreciate most about my previous psychiatrist is that he was receptive to the feedback, thanked me for offering it, and told me that he was grateful that our professional relationship was parting as it was. I know that just because my care was out of his comfort zone does not mean that he is a poor psychiatrist; he just wasn’t the right one for me. Even though change is difficult, and I honestly hate it, when that door closed a new one opened; in the end, although stressful, the change has been positive.