Anybody who has been part of the mental health system for any period of time knows that diagnosis is a complicated and not always a permanent situation. I’ve blogged before about how despite recognising myself as Bipolar, because this is the diagnosis most often used by my various psychiatrists, I have been given other diagnosis at different times and it often depends on which psychiatrist I have, what they read in my notes, what questions they ask, and what symptoms I’m experiencing at that time. Currently my notes are glowing with Mood Instability which is the defining feature of Bipolar Disorder which is what they always go back to eventually *sigh*.
So, given the difficulty that fully trained Psychiatrists have difficulty diagnosing psychiatric conditions, imagine my surprise when a friend said to me that their GP, yes their GP, had diagnosed them with Borderline Personality Disorder (BPD). Now, don’t get me wrong, I’m quite impressed this friend has a GP who is interested in mental health. One of my biggest pet peeves is that GP’s don’t pay enough of an interest in the area. That said surely diagnosing conditions like BPD should take more than a few ten minute consultations and a far bigger understanding of psychiatry than a GP is going to have.
I have a GP who is fantastic and looks after me very well, but she always defers my mental health care including any med changes back to my psychiatrist. She talks to me every time I see her to keep involved with how I am feeling and how my moods are, she gets regular reports from my mental health team which she always reads. But she makes no decisions about my care without their initial say so. I even have physical issues which my mental health meds are affecting and she is waiting on my psychiatrist to advise before she proceeds with any decisions.
I’ve always understood the diagnosis process to be that GP’s will look after their patients for mental health conditions such as depression, anxiety and so on when they first go in to see them. But if they suspect there is something more complicated going on such as BPD, Bipolar, Psychosis, an eating disorder etc. then they should refer their patient to mental health services for a psychiatric assessment and if necessary a diagnosis and care plan.
I do understand that after a diagnosis is made the patient may be referred back to the GP’s care as this happens quite frequently if the patient is stable enough given mental health services don’t have funding to look after everyone who needs caring. But that initial diagnosis should come from them. A GP shouldn’t be making a diagnosis, it really concerns me that a GP is making calls like this.
When I was diagnosed with Bipolar, the psychiatrist explained to me what it was, why he had come to that conclusion, gave me literature. Then I had a review a week later to ask questions and was given further information (bear in mind I was diagnosed pre-the internet really kicking off so there was very little information available online)!
My friend was told by their GP they were diagnosed with BPD and then sent home. No literature, no explanation, nothing. This is the biggest danger of a GP diagnosing, they don’t truly understand what they are doing, the psychological damage they are causing by just announcing a diagnosis which someone doesn’t understand. People need to have their diagnosis explained to them, to understand treatment plans, what it means for their life moving forward.
If you are a GP and you are reading this, please think before diagnosing a mental health condition. You may think you are helping but you could be tipping someone past their psychological breaking point.