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4 tips to help you discuss mental health with your doctor

You talk to your friends about your life, your frustrations and they offer advice. Your friends know you well, and it’s easy to find comfort in talking about your deepest fears and troubles with people you trust.

As a psychiatrist, patients enter my office with some awareness that they may need assistance to get unstuck. But a visit to your primary care doctor may provide an opportunity to identify issues sooner. Sure, seeing the doctor can be intimidating, but it’s important to mention all the things that may be troubling you, and that includes your mental health or any substance use issues.

Here are a few tips to help you talk with your doctor if you are struggling with feelings of depression or substance use.

Before the visit, write down your feelings

Everyone has bad days.

It’s easy to feel overwhelmed with life’s daily tasks and our schedules are busier than ever.

Visiting your primary care doctor for annual visits is a great time for you to do a mental check-in with yourself.

Ask yourself these questions:

  • How am I doing?
  • Am I happy with my life?
  • How is my physical health?
  • Do I feel stressed?
  • What do I do to relax?

If the answer is “not so good,” “not so happy,” “I’m in poor health,” “I’m always stressed and never able to relax” – that is worth talking to your doctor about. If you feel uncomfortable, you can always bring someone you trust to your appointment for encouragement.

There are often pre-appointment screening questions that a provider asks you to fill out when checking in. That’s a great time to write down things that you want to discuss with your doctor.

If you feel as though the appointment is rushed, you can pull out your list of questions, and before the doctor leaves the room, just ask what you’ve written down.

Your primary care provider is equipped to listen, so don’t leave these important topics out at your next visit.

What can I expect from my doctor?

When you bring up mental health or substance use issues with your doctor, you can expect your doctor to listen and understand. Your doctor may ask questions to better identify the concerns. He or she may ask if any family members have had similar issues and if you have tried any treatments or other ways to address these issues.

Your doctor can present options for treatment to you. In general, treatment for mental health and substance use disorders includes talk therapy and/or medications. Most people can receive all their care close to home from an outpatient provider or by a telehealth provider like Teladoc Health. Treatment is effective and can lead to improvements in all your health conditions.

What if my doctor and I disagree on the treatment approach?

There are many ways to treat mental health and substance use disorders, and your doctor can help identify the right care for you. As the patient, you have every right to ask questions about your physical and mental treatment options. A one-size-fits-all approach never worked for any patient I’ve seen and it’s likely not the best treatment for you. If a doctor suggests medication you may be unsure of the side-effects or the effectiveness and impact on your life.

Here are a few questions to ask before beginning medication or any kind:

  • Is therapy vs medication a possibility?
  • What are the side effects?
  • Are there any alternative options to achieve the same result?
  • What are my treatment milestones?

In the world of behavioral health, we have many treatment options and look for the best fit based on what patients share with us. See, that’s the key, patients and doctors must have a relationship of trust established. That falls on providers too, they should ask these questions, but with heavy caseloads, sometimes appointments can feel rushed. When you visit a primary care doctor or a mental health professional, you can advocate for yourself by asking questions. Don’t be afraid – be empowered and take notes. You can always do research and get a second opinion.

If you are on prescribed medication, talk to your doctor about your usage

Substance use also can be difficult to talk about. People sometimes feel shame and guilt with addiction and it can be hard to share those habits or feelings with a total stranger. Most of us are private and don’t want our deepest fears or greatest weakness exposed, but when substance use creates issues at home or with work, it’s time to seek help. It can be hard to admit, but primary care doctors are there to help.

Here are some questions to consider:

  • Do I take more than my prescribed amount?
  • Do I miss activities because of substance use?
  • Do I spend a lot of time thinking about and obtaining substances?
  • Have I been in trouble with the law because of substance use?
  • Does substance use impact my professional or personal life?

When we talk about substances, we aren’t just thinking about opioids or illicit drugs. It could be an addiction to alcohol or tobacco. These types of issues can build over time.

Ask yourself:

  • Do I drink more than once to twice a week?
  • Am I drinking alone?
  • Do I blackout when I drink and can’t remember what I did?
  • Do I have physical pain from drinking?

Where to go for help

Okay, so you talked to your doctor and now he or she has referred you to a someone like me. A psychologist and psychiatrist offer different things in the world of behavioral health. A psychologist will provide counseling, but cannot prescribe medication. A psychiatrist can prescribe medications, offer therapy, and coordinate your diagnosis and treatment with your other medical conditions.

At Blue Cross NC, we are dedicated to helping our members access the care that they need. We are supporting primary care providers to identify and treat behavioral health disorders in their clinics – a setting that is often comfortable and convenient for patients. We also are building options for outpatient treatment with specialists treating mental health and substance use disorders.  We are using telehealth to increase access, especially in rural areas where there are fewer providers.

Behavioral health disorders can impact your total health. It is important to seek treatment. Your primary care provider is the right place to start.

Our Find Care tool can help you sort through in-network providers and find someone that is a good fit for you. If you are in immediate crisis, call the National Suicide Hotline at 800-273-8255 or text “NAMI” to 741741.

authors photo

Kate Hobbs Knutson, MD, MPH

Kate Hobbs Knutson, MD, MPH

Dr. Kate Hobbs Knutson was the chief of behavioral health at Blue Cross NC from 2018 to 2020.

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