Rate your Doctor

I made the mistake of reading about myself on Rate Your Doctor.  

1. I really appreciated the positive reviews and am very thankful.

2. The reviews were either 1 out of 5 or 5 out of 5. 

3. I am an addiction specialist and find in the office that the patients that are upset with me are normally in denial about the effect of their drug and alcohol abuse on their brain chemistry.  A week doesn’t go by when I inform a person that their diagnosis is Cannibis Dependence or Substance Abuse or Alcoholism.  Commonly they disagree. They also have other diagnosis such as Bipolar or PTSD but these diagnosis don’t ‘offend’ them.  Too commonly other doctors who have presecribed medications for their anxiety and depression have not told them of the effects of combination of the drugs with psychoactive substances like cannibis, alcohol, cocaine, fentanyl or crystal meth. Often they are also seeing naturopaths who are giving them psychoactive substances and have not questioned them about the party drugs they are using.  90% of the time I am the first person to record the drug and alcohol abuse and discuss it with the patient.   Many people who are on disability have become angry with the diagnosis yet they have DUI’s and score high on CAGE and AUDIT and other addiction tests.  I’ve done lab work that shows their liver enzymes are incredibly high and some I’ve referred for liver transplants but they think there’s something wrong with me for suggesting they drink ‘too much’.    They are incensed that my consultation will go to their GP and even more so if the insurance company paying for them to be off work might learn that they smoke cannibis all day and drink a bottle of wine or two a night and do cocaine and mushrooms with their friends on weekends. 

4.  I tell stories. I was a hypnotist.  Colombo was my favourite psychiatrist.  Patients who see me on consultation are beyond the Gp or previous psychiatrist or psychologists care. I’m no longer a primary care doctor. I did that successfully for a decade or more.  I was a family physician.  Rational questioning is of limited benefit with patients with psychosis, psychopaths, and sociopaths.  Traditional community psychiatry was most helpful with the so called ‘neurotic’ persons not the personality disorders. Counsellors tend to take the ‘cream’ of psychiatry , the neurotics and the worried well, and those folk that originally might have been seen in psychoanalytic psychiatry. I miss my psychoanalytic patients , the weekly in depth therapy I did for years.  I listened and rarely spoke.  

With addiction the ‘traditional counselling and even conventional counselling’ have been ineffective and likely worsened the condition.  The only really good therapies are Motivational and 12 step facilitation.  Transactional analysis was also pretty good and today in groups dialectical behavioural therapy is showing value.  To assess a person in Motivation therapy you do a ‘willingness to change’ assessment to determine if a person is ‘precontemplation - they get angry and want to destroy you if you raise the issue of the real thing that needs too be changed but wax poetic about wanting to change.”  In the past horrendous amounts of limited resources were wasted on these people who wanted to not change but talk ad infinitum about wanting to change or anything about their real problem.  Contemplation phase is a person who is ‘open’ and presented with options will be thankful for the information and come back with questions and thoughts about a plan.  Determination phase is about the person who wants to change and now is willing to make actual plans. Action phase is the person who is actually doing something about the problem, not just thinking about it, not talking about it, but actually doing something and making changes.  

I’ve been trained to be ‘outcome focussed’.  I’ve spent tens of thousands of dollars of my own money beyond the psychiatry residence I trained in learning various psychotherapies . In counselling there’s no real demand to ‘cure’.  In my upper class psycho analytic based practice the multi millionaires and celebrities were successful in all aspects of their life especially according to Maslow but were still ‘unhappy’.  Listening to such a person and being a sounding board helped them find ‘joy’ or some self actualization or spiritual awakening.  Too many of my patients today are referred to me and they’re ‘lost’ and performing very poorly in life. So many need a social worker or occupational therapist or family therapist but all that is covered by MSP and hence ‘free’ is a psychiatrist who the government advises should priorize consultation, diagnosis and psychopharmacology. I always do that and do it very well. The problem arises with my continuing to do psychotherapy regarding psychosocial aspects of their care. I’m now called a ‘full service psychiatrrist’ and my other older colleague and I laugh at this designation which is kind of a put down at times for what we thought was good medical care.  Increasingly people are seen in ‘part’ and not holistically and the psychiatrist who is liked plays a ‘mini neurologist’ and avoids discussing their affairs , criminal behaviour and anything dubious that might not be ‘liked’ by the patient who just want ‘drugs’ and their disability form signed.  Indeed I often sign the disability forms but piss the patient off by suggesting alternatives that they then are astute at saying ‘yes, but’ to.  I most appreciate the young man who asked me me how few times he could see me before he could get the free heroin. I love honesty as there is hope 

Mental health is the ability to love , work and play.  Increasingly MSP psychiatrists are referred patients who aren’t working, are alone, and no fun.  Listening to such a patient does them a disservice especially when most of these people have a history of having seen very good colleagues, psychologists and counsellors who have already done that.  

At one point I was the psychiatrist of last resort seeing the dangerously insane, in asylums, and jails and specializing in the non compliant.  I have been thankful to have the heads of neurology, psychiatry, family medicine, endocrinology etc refer to me. Historically seeing the families of colleagues, word of mouth and referral from the leading doctors were the criteria that defined a doctors worth.  Rate your doctor is a popularity measure. I was called Mr. Popularity in high school.  I know how to be popular.  The most popular doctor is a drug pusher for the multi nationals. The most popular doctors ‘rubber stamp your bullshit’.  The most popular doctor in these cases is a lawyer advocate and indeed the gp is that or was when I was delivering babies.  Good physicians will always try to help you achieve potential and offer solutions to obvious problems. I diagnosed dozens of malingers who were stealing hundreds of thousands of dollars.  I stopped doing that years ago when the Minister of health of the day said that it was okay for people who could walk to have wheel chairs. The last time I objected to able bodied people parking in disability parking they laughed at me and pointed to their sticker an told me ‘the car is disabled’.  

I’ve identified about a dozen pedophiles and reported them.  They have never ‘forgiven’ me.  They told me what they were doing and what they wanted me to do more and I reported them or had them seek help.  I was doing my job and it’s interesting to me that other doctors who did the right thing, the conventional right therapy, what I would do if I was primary care and not tertiary care, ‘missed’ this.  As a psychiatrist I am required to intervene if a person is an imminent risk to themselves or or theirs. This doesn’t make me popular and most people opt for the sin of omission even though reports show a large portion or suicidal and homicidal have indeed told officials but nothing was done. People tell me they’re having sex with animals and are killings animals.  I have hundreds of times heard that people were doing massive amounts of drugs and alcohol and a real risk to themselves and others.  Victims and victimizers of domestic violence have shared with me what is going on when all that they’d been given before was anti anxiety or anti depressant medications. Not surprisingly the medications weren’t working.  They have told me this when I’ve been rambling on about something parallel.  In ‘story telling’ therapy you don’t speak directly because the person has ‘sophisticated’ defences against that but they aren’t immune to advanced techniques of interviewing which I’m thankful for having learned from the greatest teachers.  I’ve seen ten thousand patients and know I’ve done no harm. However today there’s emotional abuse and one of my patients reported an important man for ‘raping her’ but it came out that he ‘raped her with his eyes’.  Language is no longer what it was.  

5. Harm reduction and the two tier system of abstinence and labour intensive therapy for abstinence used with doctors, judges , the wealthy , pilots , etc versus the often ‘palliative care’ of in expensive harm reduction is a shift in care. MAiD and euthanasia are a shift in care.  Increasingly the government does not see people as gaining freedom and self determinations, the traditional goals of psychotherapy but more as ‘not complaining.’  We called it ‘band aid’ medicine and it was often in effective.    I do psychopharmacology as well, my undergrad in biochemistry and competence in wilderness medicine with medication and age and experience make this a ‘skill set’ much appreciated today .  We don’t talk about ‘you changing’ but triangulate discussion about the ‘pill’s.  My colleagues who solely do that are understandable to the average physician because the therapy is ‘rational’ and there’s no such thing as ‘paradoxical intervention’ or ‘homework therapy’ or ‘testing insight’.  All the treatments for non compliance are not addressed .  Psyvhiatric patients however have the greatest ‘non compliance’ and their lack of success is mostly they don’t follow suggestions regarding medication or what ever.  The common psychosis is “I’m well, you’re not well. “ ‘I’m well, the psychiatrist is crazy. “  The personality disorder seeks a lawyers or mob to ‘kill the messenger’.  I do ask people specifically what they want, and not in terms of ‘feelings’ only but ‘show me’.  Do you want children. Do you want a job. Do you want friend.  I remember one woman saying I have a friend.  i said that you told me they were your drug dealer .  They are but they’re my friend.  

6 .  I was told when I left family medicine for psyvhiatry , where I was called Dr. Kildare’ and was highly sought after and widely acclaimed that if I was a good psychiatrist I would be unpopular and need to be unpopular. Indeed in psychoanalytic training I had to learn to sit through the ‘negative transference’ of the patient.  So many are developmentally delayed with so many caught emotionally adolescent while physically adults.   As a gp   I referred a half dozen patients to the psychiatrist and they were the most difficult in practice. I also was interested in non compliance because a patient died after lying about taking his medication. The family lied too . 30% non compliance is common in all areas of medicine. It’s the elephant in the room everyone avoids talking about.  There’s 80% non compliance in some psychiatric populations.  I eventually was glad to sub specialize in addiction because they were the sickest and least likely to respond to treatment. I liked the challenge all the while I was asking why do bad things happen to good people.  I’ve described my work to friends as doing overhauls or tune ups on Ferrari’s . 

My colleague a forensic psychiatrist has been demanding for years that ‘rate your psychiatrist’ be removed as ‘rate your judge’ is removed. I’ve had guns pointed at me when I refused to give people opiates, and had my dog killed when I refused to say a drug dealer was clean.  I’ve been threatened countless times in psychiatry but wasn’t as a gp except when I worked on ‘wet reserves’ where doctors wouldn’t go and even the RCMP wouldn’t . I’m thankful I did because I stopped a meningitis epidemic. I’ve worked with the poor and marginal and yes, I’ve helped the LGBT population especially transgendered because they’re bullied .I’ve fought countless battles on behalf of patients, all un paid, though often I’ve had the benefit of working with great lawyers who were getting paid.  I’ve done a lot of pro bono work too.  It’s silly. In the end I often explain it as I’m Christian and was raised Christian and this is what Christians do. I’ve commonly found that the doctors and nurses working with me in the worst conditions were Christians.  I wish it were otherwise.  

6. I’m a front line doctor.  I’ve seen ten thousand patients. I know that administrative doctors don’t show up in Rate Your Doctor. I know that when I worked in government we saw the patients as a team and even at the university we had all the time in the world for patients. In the community I’m always late and always rushed seeing a full day practice and having emergencies for which there is no time allotted. I also know that one of the ‘favourite’ psychiatrists saw 40 patients for 40 years.  He was very popular and had all the time in the world to be involved in the politics of psychiatry. I’m exhausted at the end of every day overwhelmed.  Right now I’m doing consultation with limited follow up, often at 3 or 4 month duration.  The shortage of psychiatrists is horrendous. People waited 2 years to see me. People who should be seen weekly haven’t been able to get a family physician . Every patients I see is supposed to have a family physician.  The family physicians I work with are over worked and burnt out but really overall tremendous.   50% of my patients don’t have fanily physicians and rely on walk in clinics. Their doctors often don’t know them are thankful for my in depth assessments which tell them that the patients has children, a dog , a cat or works on the side as an escort. As one physician said he couldn’t understand why his patient had so many STD’s and has now taken the time to address safe practices.  I’m routinely thanked by family physicians who keep sending me patients which I assume means that they are thankful or at very least no one else is available. My gp friend said he was sorry but he had asked 20 other psychiatrist to see this person but when they heard their complex story they simply woudlnn’t accept the referral. My fiend felt badly as an was already seeing a half dozen of their borderline personality disorder with dual diagnosis anf felt it was unfair to me to ask me to see yet another highly demanding patient. 

7. I’m pissed that judges aren’t Rate your Doctor. I’m pissed that I”m told I have to ‘certify dangerously insane people’ and yet i have no back up or understanding or support. The wife of a pedophile still haunts me. A drug addicted employee I fired still haunts me.  I’m am still working with MSP on the front lines and the staff I work with are being threatened.  Last year a patient threatened to kill my dog and I was unprotected . They complained to the College and the College criticized me for upsetting him and not seeing him He threatened to kill his employers dog, and his lawyers dog and finally the PM himself.  Finally something was done about him.  At no point did the College or anyone express concern for me having been in the room with a dangerously insane persons threatening to klll me.  When I was held hostage by a murderer I got no ‘support’ from the College or colleagues but the RCMP was immensely psychologically supportive.  It’s weird. My colleague who had the same experience with the College expressing platitudes and saying there was a physician assistance lines felt like he was demonized and traumatized when he refused to see a threatening dangerous lying patient who then complained against them and were allied with the most dangerous powerful government agency who frequently destroy doctors and ally with psychopaths.  “It’s our mandate to protect patients, “ a safe conceited adminstratie doctor said .My colleague replied “doctors are patients to and you’re scapegoaing is not helpful as the problems today are systemic.’  Of course they were treated by the College as a ‘troublemaker’.  There is a very good physician assistance program but that’s predominantly thanks to the Canadian Medical Association, Canadian Medical Protective Association and some doctors in the College who care despite the nature of their job. 

8. I’m past retirement age and still working in the front lines. It’s a thankless lowest paid position.  I shoujldn’t say thankless because countless patients thank me. They come back decades later and tell me of completing university, marrying , getting a job or whatever. So many attribute these historically life changing positive events to having seen me and heard something I was saying.  I am blessed to get praise and thanks from referring gps and be thanked for seeing gps most difficult patients.  The ‘feel good’ medicine government based is all that counts today.  Mediocrity and doing the least are most celebrated. The grey men and women are best. I know though that I personally would not be a live if my physicians and my mentors hadn’t been human. The interchangeable robot which can be replaced with a machine is what is wanted. I’m certainly not that person.  

9. Soon I won’t work and will join my colleagues who loved practicing medicine but hated the environment.  If you don’t like me get another doctor.  I’m not government employee. I’m a private physician and private contractor.  I have won a law suit against the government saying I can refuse to see people. I like to focus care on those motivated. I have been inclusive and yet I wonder about making my practice exclusive. My colleague has done that very well, selecting only a very few people who she’ll see. She’ll do a consult but then won’t provide follow up for anyone unless she wants to work with them.  I know that when I tell patients that I will only work with them if they agree that their addiction is a contributing factor to their depression and anxiety and that their family and boss are not the sole problem they often ‘fire’ me. I’m thankful.  T’ve found that people whose doctors and family have colluded with their idea that their being an asshole is solely the result of some ancient trauma are most commonly able to get well when they accept that they have to treat their addiction before they can really move forward treating their trauma.   The ‘dual diagnosis’ movement did not develop in the pharmacologist psychiatrist division.  My subspevialization and internest in trauma began when I saw that ‘mood disorder’ diagnosis could ‘blame the viction’. PTSD was a comnpensatiable diagnosis and the ‘company doctor’ diagnosed ‘depressioh’.  I diagnosed PTSD and hundreds of patients were ‘compensated’ for their injures at war in the work place or elsewhere.   I was very unpopular with the ‘authorities’ when case after case we addressed the PTSD. I found that most commonly people before me had not done the history or explored these issues.  Today it’s politically correct to just write the chit and not ask anything about the patient except about the preconceived diagnosis the patient wants.  Dr. Google is God.

10. I’m tired. I wonder what I will do next with the vast majority of [patients have been appreciative as have their families, doctors and insurance companies and Worksafe and the military and all manner of folk who now are involved in every patient I see. Doctors and psychiatrists are the most policed in society.  I get in trouble routinely for saying ‘fuck’ or ‘shit’.  My colleague whose mother washed his mouth out with soap more than mine couldn’t swear but he gets bad ratings on your doctor reviews too. I’m really suspicious of any psyciatrist who has ‘great’ reviews.  I know one who has their family write all the reviews and they approach pychiatry as a business and are closely networked with a drug company who they sell for. I was once a good salesman. I trained as a salesman. I say today I ‘sell’ life but my colleague who works with euthanasia is paid more and is kind of sexy. It’s not that I don’t approve of selective euthanasia but I get concerned with the flavour of the month.  For now I’ll continue .  There’s a tendency today for a small minority to mob. I’m really thankful for those who have said good things about me because we know statistically the angry and dissatisfied are most likely to complain.  I’ve never written a letter of praise for Costco or Walmart or countless other services which have been okay.  I read a couple of complaints that were utter lies.  I have complained when I was falsely accused. Rate your Doctor doesn’t allow that. This whole society of decreased accountability and the increasing number of false allegations and the unwillingness in general in Canada to address deceit is concerning.  It seems no one cares until some actually shits on the bed. 

11. So many of my colleagues are retiring or retired or took early retirement but they don’t like this and they don’t like administration and they don’t feel that medicine is human any more. I guess we’ve become dinosaurs.  I will become extinct one day. Everyone loves Dr Google and even administrators think the world of these sexy apps but sadly the data shows that their accuracy of diagnosis remains less than 50% whereas I continue despite age to have a 90% accauracy based on history.   For now I’ll continue to muddle along hoping that I die before we are all expected to behave like politicians or robots.  Admittedly I’m aware 80% of doctors are burnt out and not too happy about false criticism and utopian expectations too often from people who hide and take potshots.  We do ourselves know whose working on the front lines and some like me who have been indeed outside the wire. Increasingly the leadership hasn’t that kind of experience and it shows.