Exactly how terrible is this thing I did? (Aka "why my pdoc called my boss")

So there's lots and lots of context (isn't there always?)... but the short version is that I'm awkwardly between mental health providers because I just moved from one city to another, and I'm not really established with my new t/pdoc yet (he's an all-in-one; I've only seen him three times over six weeks b/c he's been away at conferences and stuff) so my former therapist and psychiatrist were still providing some support until I got on my feet.

So anyway. I had an appointment to talk on the telephone with my former pdoc at noon and my former t at 6, and I didn't pick up when they called. They texted, called again, left voicemails. And I didn't call them back.

I've struggled pretty hard with SI and am super responsible so they both freaked out. They both called my new podc/t, who is really busy and doesn't deal with ppl outside of session hours anyway so that didn't help. The former shrinks used to have phone #s for my roommates but obv I've moved and therefore have a new roommate whose number they don't have. So finally my former pdoc CALLED MY BOSS, who paged me. (Why the former psychiatrist has my boss's number is another long complicated story but it has to do with the fact that I'm a doctor in training and therefore insurance/privacy is extra weird and also I wanted to tell her about the depression so that if I needed to take time off or something she wouldn't be quite so blindsighted.) And of course when she paged me I called her back because I'm a freaking doctor and when people page me I hafta freaking call them back and she was like, "your psychiatrist and therapist are really worried about you" and I was just dying inside like *omg my new boss REALLY DOES NOT NEED TO KNOW exactly how bad my depression is and how I'm behaving like such a child and I don't even really know why*... and she was really good about it (when I said, "I'm so sorry they called you; I'll take care of it." She said, "I don't need you to take care of it; I want to make sure you're okay") but like MY PSYCHIATRIST CALLED MY BOSS WTF IN WHAT UNIVERSE DOES ANYONE EVER WANT THAT TO HAPPEN?!?!!

A few days later I apologized to pdoc and T. Pdoc was real understanding like "you must have been scared and upset." And in an email T said "Apology accepted, please don’t do that again. Let’s move on. And, stop hating yourself - it doesn’t help me and it doesn’t help you!" But they're both withdrawing from me. And I can't tell if it's because they've both finally spoken to pdoc/t and now he gets how sick I am and is going to be responsible for me and they don't want to get in his way... or if they're pissed/hurt/whatever?

I'm afraid it's because they're pissed/hurt. But holy crap I have patients lie to me and deceive me and try to get drugs out of me all the damn time and I still take care of them and have compassion for them. Why am I not allowed to do anything bad without all affection being withdrawn?

Gah. If you have read to the end, I am in dire need of perspective. (Is what I did that bad? Should the pdoc have called my boss? Why are they withdrawing?) Plz send halp.

How did they know who your boss is? I am confused.

It's because my insurance plan will only pay if I see a pdoc/t within the hospital system where I work. Obviously for psych care that is SUPER SUPER AWKWARD, so I told my pdoc it was okay to call the boss and ask her who I could see within the hospital system (like have her recommend someone who is good but who I was unlikely to interact with directly as a part of my job).

The awkward thing is that he and I definitely already have some shared patients (though he is managing their psych stuff and I am managing the stuff I specialize in).

If I had a patient that I thought was in immediate danger, and the only contact info I had was the boss, I would call the boss. Wouldn't you?

I'm not sure if they're withdrawing or if it just feels that way.

For heaven's sake. If you were well enough to stay out of the psych hospital, and in fact well enough to go to work, then you were well enough not to worry them out of their minds. No I don't think your pdoc should have called your boss--though it seems unclear whether that violates your privacy or not, from your odd insurance situation. But I don't think you should have let it come to that.

(As an aside, though, your new pdoc/therapist seems less than professional--or caring--to have a rule that you can't reach them outside of hours. Not even for a bona fide emergency?) That would be a deal breaker for me.)

They could be withdrawing, but not because of this episode, but just because you're someone else's patient now, and you need to forge your primary mental health connection with them.

And yes I would have called your boss too if you weren't responding and that was out of character and I had no one else in the area to contact.

I would not and I don't approve of the paternalistic approach of the western medical machine.

Why didn't you pick up the phone?

I would never scare my T or Pdoc like that. If there's something scheduled, and I don't show up or answer the phone, they're going to assume something is wrong.

What did you expect to happen?

I would have called your boss too. And if I had your address, I'd send police over.

Wow -some way punitive approaches we seem to have here. A client does not owe those people anything.

Can you find a different one to pay out of pocket and get them away from your job?

So both the former pdoc and the former t called your new pdoc/t and also your boss? If they truly thought you were in danger, wouldn't calling the police have been a more ethical, logical choice? No matter the reason for calling your boss, they certainly should not have identified themselves as being your therapist and psychiatrist and stated they were concerned for your well-being. To me, it doesn't seem like proper protocol was taken here. Perhaps that's the reason for the withdrawing -- they may realize their cahoots were out of line.

Speaking from personal experience, if your t calls the police, your name goes out over the radio, and people who like to listen to the police scanner will know that your t thinks you are suicidal and has sent the police to check. In my case, that resulted in several people that I know of now knowing that t thought I was suicidal, and there are probably others. I say probably others because they may have heard it over the scanner, or may have heard it from people who do.

I think I would rather just my boss know. And t1 would definitely call the police again if I was a no show. He'd probably try my H first.

I get that it might have been embarrassing for you to get that call from your boss.

What would you have preferred p/doc and T do?

Yeah I agree about the new pdoc/t. I mean I like him but he usually sees people for 20minute psychopharm sessions and not therapy (he used to do a lot more therapy and he's good at it but he's the head of the psychopharm dept at this huge hospital now so that's what he does)... so that means that his practice is not set up to deal with therapy patients and their needs. I mean I get it--I don't think it's because he's an uncaring jerk, I think it's because having the kind of practice where you accept calls/texts/emails from pts 24/7 is a big commitment and really a lifestyle choice and if I'm his only therapy patient I can see why he wouldn't want to change that. (I mean as a doc I get it too--I will work my *** off for my patients when I'm at work but when I'm home I want to be home and not think about/deal with pt stuff. It keeps me from getting burned out.)

The problem is that my former t and pdoc worked for three months to try to find me a new t and pdoc in my new town... and despite making a zillion calls and me interviewing 8 providers over the phone and one in person, no one would take me and my insurance except this guy. (It's for a variety of reasons--mostly because of insurance but also some of them thought my schedule was too crazy or my meds were too complicated or I need too much support and they didn't want to deal). I could pay out of pocket but I calculated it and even if I got a different tier of insurance, it would be 10% of my salary. I dunno, maybe I just have to bite the bullet and do it.

So yeah I'm not really sure why I did it. It was super super out of character for me--I always do whatever I can to minimize their worry b/c I've been in the position of caring for pts with really bad SI and I know how scary it is. I can think of some reasons... chaos-making to distract from internal turmoil, anger at them for not fixing me, sadistic desire to make other people feel as bad as I do, yet another ’test’ to see how much former pdoc/t care, desire to see if support/care would still be extended if I was acting horribly, an attempt to show how bad I feel so that I’m forced to make some sort of change/treatment decision, frustration with how much I extend myself to my own pts v how willing they are to make change... but I dunno if any of them are right.

And I don't know what I expected to happen--maybe calling the police (which I really really would have preferred). But I expected them to worry and then realize that I need more support, not get mad and withdraw support. I am so so sick of being A Good Patient, and I am so so sick of being in therapy and doing LITERALLY EVERYTHING THEY ASK OF ME and still I am so so sick. And like I work an avg of 60h/wk and I am keeping my life together and it is so so hard but it's not like you get awards for that--no one gives out ribbons for "Kept Going To Work And Taking Really Good Care Of Her Patients Even Though She Was Really Really Effing Depressed And Had Constant SI."

So I guess I was pissed and I guess I wanted something to change for the better... but that's not what happened.

It doesn't really matter to me that they had your boss's phone number...but what DOES get me is that they could have called, but they didn't NEED to identify themselves as your pdoc or therapist. If by chance your boss knew them by name, they still did not need to say that you were their client/patient. That's a breech of confidentiality in my book!

Chihirochild, it makes sense to me what you are saying - about how you feel so fed up with always doing your very very best but still feeling terrible. In a way wanting to say "Stop the ride, I need to get off?"

I think the truth is that the career you have embarked on IS very demanding, and doesn't leave a lot of space for prioritising your needs in terms of scheduling therapy (as you alluded to) or being able to have "off" days. That is really why people who work as doctors are perceived as successful - because it does take a lot - you have to work these 60 hour weeks, you can't just take a few days or weeks off if you're having a difficult time, if you are going to be a doctor you have to somehow be able to push through it and still be on top form in terms of work, never making serious mistakes, etc. You've done very well to get to where you are. no doubt it is a demanding thing to do and there's not a lot of space for not coping or not being ok.

I guess people who manage these things, along with coping with mental illness, work out where they can find some slack and what can be prioritised or deprioritusef in life. So for example you mentioned that at present, the only way to get consistent therapy (as your pdoc doesn't reallly do therapy) would be to pay out of pocket, 10% of your salary. Perhaps in the balance of needing to be stable in your mental health, AND achieving a career in medicine, the thing that has to give is finances and you decide to make that financial sacrifice in order to keep the other two things afloat.

I feel like I understand where you are coming from a bit, although I'm not a doctor, but I have friends who are. But I also work in quite a demanding career, which could be seen as high-stress, and I also struggle with anxiety, depression and complex PTSD. I think I got to where I am mostly through sheer willpower and pushing through - I've had times of going to work shaking and crying, or having not slept at all, which is far from ideal. Doesn't usually happen any more, thanks goodness. But I also spend 10% of my salary on therapy - in the past it used to be more like 20%. I reckon it is definitely worth it as it allows me to live the happiest and most fulfilled life I can - also in terms of my career, I wouldn't have got to where I am, I think, if I hadn't had therapy, so in purely financial terms I think it pays itself back over the long term. The other thing I have learned is to use annual leave to support myself - to schedule breaks and holidays for times when I am really struggling as far as possible - and then just to order my life to promote my health and relieve my stress as far as possible - always taking a lunch break, spending time with friends, that kind of thing.

I've also had the experience of wanting to communicate that I was really not ok. On one occasion, my T was on the verge of calling an ambulance for me. This would not have been the end of the world of course, and I think ambulances in the UK at least are very used to dealing with mental health crises nowadays. But it would have meant - I have to take time off work - I have to tell my boss what's going on since I have to explain why I'm not at work - I might get sent to see some mental health professionals on the NHS which means no choice over appointment times so more having to take time out of work and having to share info with my boss. As I said it would not have been the end of the world, but it's something I would rather not do, and I think the fact that I've always somehow managed to avoid this is good for my self esteem and therefore good for my mental health.

I hope it's useful but sorry if it's not useful or even annoying - what you wrote resonated with me which was why I wanted to share my thoughts.

Yeah, I really really don't understand why they didn't just call the police. My former t definitely has my new address--she's sent me bills here for some of our phone sessions.

And yeah I wonder if they're feeling like they've been too involved in my care. They've done a lot for me over the last two years... nothing inappropriate but definitely a lot of work (e.g. answering emails, seeing me on weekends when I was really bad, occasionally answering texts and making appts to talk on the phone). I dunno if that's standard practice or if they went above and beyond or if they're willing to do this for anybody and I happen to be a particularly needy patient? Or maybe it's because I was in medical school (just graduated, am now a new physician) and they identify with me as a care provider... or they feel guilty because they really have not shifted my depression like at all even through all this work. (I think the last one is at least a little bit true--one of the only times my t ever looked vulnerable to me was when she asked if I felt like therapy had helped me at all.)

I dunno I see how it's totally possible they're withdrawing appropriately (especially because this incident FINALLY prompted my new pdoc/t to call each of them and learn about my tx hx--maybe they feel like they've properly handed me off to a new doc so I'm not their problem anymore). But it still feels punitive to me, like I was bad and now they don't give a **** anymore.

(I wonder if I somehow manufactured that feeling--like I didn't pick up their calls because it's easier for me to say goodbye when I'm mad at them??)

"But I expected them to worry and then realize that I need more support, not get mad and withdraw support."

Would it be more helpful to verbalize what you want and need instead of assuming/hoping any of your therapists mind-read what you need? It is a lesson I am still learning, too.

Also, I used to work for a GP. He would see his employees as his patients at no cost and there were some other benefits that sucked me in. But it was a HUGE mistake to let my BOSS, the GP, be privy to all my medical care concerns as well as my psychiatric concerns. Huge.

Money is an issue but I would keep the roles of employee and client as far apart as you can. Take it from someone who didn't.

So that's a good point. I think the reason I didn't do that in this instance is b/c historically even if I am very explicit in verbalizing my wants/needs with former pdoc and T, their responses often doesn't make me feel any better.

Like when I text my pdoc and tell him I'm feeling really awful and I don't know what to do and I need help and he calls and it's useless because all he can really say is "yeah I know you feel really bad right now, I'm sorry" and it just makes me feel worse.

Or when I got up the guts to tell T that I really wanted her to put a hand on my shoulder or give me a hug every once in a while and she was basically like "that's not my thing." (I get it--everybody has their own boundaries, their own way of practicing... but it still sucked.)

And often I literally cannot think of anything that might help. I wish I could but I can't. I say every idea that comes to mind and answer all of their questions but honestly after trying everything I could think of for so long I've run out of ideas. They're supposed to be the experts in this crap; aren't they supposed to be able to help me figure that out?

So I guess in this instance I could have said to one or the other of them, "I feel really awful and I don't know what to do and I need help" but so so many times in the past, saying that exact thing has not resulted in them doing anything that actually made me feel better.

(The trouble is that I can't even tell if this therapy thing is helping at all but I don't know what to do so I keep trying but then I get mad when I put in all this time and effort and it doesn't work.)

No one can "fix" you though. They can give you tools, advice, and support. But there's no magical wand, no great book of knowledge.

Ive been with my t about ten years, and its been a long long time since we talked about "just" feeling bad. On the one hand, he says that nobody feels good all the time. I was like, well i need my baseline feeling to be higher than always sub-sub-sub-sub-sub-basement.

Being past menopause really helps, but you cant help that! Mood stabilizers also help. Exercise helps. Getting outside helps. Laughing helps. Coffee helps. Those lists that tell you to refer to a list of 50 things to do to help - i dont think those help; they just seem like another bunch of things im failing at, out of control, not part of my life.

To answer your thread title question, you played the boy who called wolf by not answering their calls. How bad was that? IF you want them back, not distant, you probably need to apologize. And ask them back onto your team, IF you want them. You deal with your ambivalence by treating them like humans who youve asked for help, and respecting that as you would like to be respected. For yourself, not for them.