Kim Palchikoff: When your primary care doctor passes out the Prozac

By Kim Palchikoff

Most patients don’t choose their primary care physician based on their doctor’s knowledge of mental health. Usually they ask whether the physician is taking new patients and accepts their insurance.

But for Nevada, a state with a notoriously severe shortage of psychiatrists, primary care doctors can be a viable solution for our state’s mental health crisis.

According to the 2017 University of Nevada, Reno Med Health Policy Report, “Health Workforce Supply in Nevada,” the Silver State ranks 47th in the nation for its number of practicing psychiatrists: 190.

And only three of them work in our state’s 14 rural counties.

Three.

Wow.

According to the report, to get on per-capita par with the rest of the U.S., 147 more psychiatrists would have to start working in the Silver State.

I’m not waiting for any miracles.

Which is why I think Nevadans with mental health issues should reach out to their primary care doctors. There are 2,673 of them.

I have bipolar disorder. If there’s one thing I’ve learned over the years, it’s that I hate to wait for mental health care. That’s why I frequently turn to my primary care physician.

I met her 11 years ago at the UNR Student Health Center, when I was a graduate student. It was four years before the Affordable Care Act which abolished discrimination against individuals like myself, who lived with pre-existing conditions. I could not obtain private health insurance for a doctor in the community.

She was a family practice doctor, who was a walking, talking medical school. She had a big heart and liked sports. She didn’t rush through our appointments. She always asked about my life and not just my medical issues. She laughed at my dumb jokes. As it turned out, she was well versed in depression.

After graduation, I moved to Washington, D.C. for a job. I found a new primary care doctor who was close to my house and took my insurance. He returned my phone calls quickly. The niceties ended there. He absolutely had no idea who I was, even though I was his patient for two and a half years. He didn’t know my name, never smiled or looked me in the eye. And as he put it, “I don’t do mental health.”

My D.C. doc wasn’t the only primary care doctor I’ve had who’s avoided any mental health talk. A lot of them just don’t go there even though it’s a big part of their three-year residency.

My job ended. I returned to Nevada and to my doctor.

Here are four reasons why your primary care doctor should be your next-best medical friend.

Accessibility: Good luck in finding a Nevada psychiatrist who’s taking new patients (and their health insurance) any time soon. Nevada's psychiatrists are in short supply and high demand. Most have busy practices and new patients might need to wait months for an appointment, not weeks. And don’t live in Nevada’s rurals, where they virtually don’t exist at all.

Blood pressure and other medical problems: Individuals with mental health issues frequently have additional medical problems such as high blood pressure or heart conditions. We tend to be sedentary. I have Type 2 diabetes, which my doctor monitors closely. She pushes me to exercise more. We talk about my diet.

Stigma issues: Psychiatrists can be scary, a reason many people avoid them. Primary care doctors often are less intimidating. There’s something soothing about discussing mental health issues in an office with a doctor who gives you a flu shot, listens to your heart, talks about your diet plan and prescribes Zoloft for your depression.

Early diagnosis: Primary care doctors often diagnose and treat patients for mental health issues even when they come in for something unrelated, like the flu. My doctor always takes the time to find out how her patients are feeling.

Thanks to Obamacare, I now have private insurance through the market exchanges, allowing me to see a psychiatrist when I need to. She is a specialist in bipolar disorder, and I sometimes have flare-ups that need her attention. Like me, she’s a big fan of primary care physicians when it comes to mental health care. At our last visit, she described teaming up with Nevada’s primary care doctors who send her patients with complicated mental health issues. She prescribes a course of treatment, monitors them and eventually sends them back with recommendations.

I’ve dealt with mental health issues for 30 years. They can be complex, but the basics are not rocket science. There are about 10 major psychiatric medications for depression or anxiety, the two main mental health problems. Too many Nevadans lack mental health; suicide is the leading cause of death among Nevadans aged 12 to 19, and our state’s senior citizens have the highest suicide rate in the nation. We might be short on psychiatrists, but let’s focus on our state’s mental health strengths: our family practice and internal medicine physicians who take up the slack and pass out the Prozac.

Have you had an experience with a primary care doctor and mental health that you would like to share? Please indicate whether you mind it being published as a letter to the editor in your local paper.

Kim Palchikoff lives with bipolar disorder and writes “No Stigma Nevada,” a bimonthly column. She can be reached at palchikoff@gmail.com.