View Full Version : A question for doctors

07-16-2008, 11:06 PM
If my character were to visit her GP or family doctor and show signs of mental illness would the doctor try to treat her for the illness or would the patient have to actually ask for mental health help? Would he recommend that she see a psychologist? If so, is that something she would have to agree to? How exactly does a general practitioner deal with a patient who may or may not have mental health issues? My story takes place in present day in Canada.

07-17-2008, 01:17 AM
What sort of mental illness are you talking about? There's a wide range.

07-17-2008, 02:03 AM
What Kryianna said. Can you be more specific?

07-17-2008, 03:30 AM
My character is suffering from psychosis. She has hallucinations, but does not see them as such. To her, they are reality. She also struggles with reality, so that she thinks various people (such as her neighbor) are out to “get” her (she is not clear on the how) even though there is no reason for her to think so. She talks very excitedly and nervously, with no real notion of how her behavior is perceived by others. Obviously, this makes her somewhat isolated, although she views her behavior as normal. She also has trouble with her thoughts (my research indicates this is formal thought disorder) so she has trouble maintaining a normal conversation. Her conversation switches topics mid-sentence and she veers off on tangents or onto other topics with no real notion that conversations have an ebb and flow. In the scope of the story, this character has been this way for years but has recently begun making threats and has been dishing out some verbal abuse to those who are closest to her.

So, in my story the protagonist's daughter has sent her to a GP for an evaluation. The character is exhibiting all of the above and now I’m not quite sure how the doctor would realistically react. The plot does not hinge on what the doc says, but I would like it to be realistic. After the doctor’s visit, the story veers back to the daughter’s perspective, but I am having trouble wrapping up the scene. A lot of the information I am finding online is very general and does not tell me what would go on in the doctor’s office.

07-17-2008, 05:01 AM
zen - the doctor would first give the patient a complete physical. If there is no medical explanation for the psychosis and hallucinations (ie brain issues), then the doctor would send the person to a psychologist. As a therapist, the first thing I would need to do before accepting a client is to send the client to get a full physical and bring back the results. Therapists are required to rule out any medical issues that might bring on symptoms that would appear to be a deterioration in mental health. Does this help?

07-17-2008, 05:09 AM
Hi Skyraven,

Thank you – that does help a lot. If the patient is sent to a psychologist when the physical turns up no medical explanation, what would happen if the patient did not want to go? My character thinks she is “normal” and therefore would not react well to the idea of a psychologist. I guess I am just wondering how that conversation would take place, since my character does not see her behavior as “symptoms” or as abnormal in any way, if that makes sense.

Would it go something like this:

Doctor: “There are some symptoms that I am worried about. I would like you to see a specialist that comes highly recommended?”


Doctor: “I am worried about some of the behavioral symptoms you are exhibiting. My tests have ruled out a medical explanation but I would like you to see a colleague of mine…”


Doctor: “I am worried about some of the symptoms I have observed during our last visit. I have not been able to find any physical causes, but I would strongly urge you to speak to a psychologist…”


I have developed a nice doctor character but because I am having trouble picturing the scene, everything I try to get him to say sounds weird and stilted.

07-17-2008, 05:16 AM
dr: "well I got the results back from the physical and you're healthy. The things is that your daughter seems to be worried about other things going on. I would like to refer you to a psychologist.
PT: But nothing's wrong with me.
dr: I know that everything's okay, but go so that your daughter won't be so worried about you. Then if you still don't want to go, at least you gave it a chance. "

how's that?

07-17-2008, 05:23 AM
Hi Skyraven,

Thank you again. I get it – so the doc would be pretty upfront about the need for a psychologist and wouldn’t try to tiptoe around the issue? I could do that. If the patient refuses or gets insulting with the doc, is it ultimately up to her to not go to see the psychologist or would the physician try to compel her to go?

07-17-2008, 05:45 AM
No, as long as the doctor practiced due diligence to get her the help she needs and documents it, then the doctor is okay. No one is allowed to pressure anyone into therapy unless the person was mandated through court or in-patient hospitilization. In the chart the doctor would write "Patient refuses referral against pcp's advice" to cover him or herself. Now, if mom really gets out of hand, daughter might be able to have her hospitalized if she is the health proxy for mom.

07-17-2008, 06:37 AM
Thank you so much! That answers my questions and I am off to work on that story and finish that scene.

07-17-2008, 07:23 PM
... psychosis... hallucinations, but does not see them as such....she thinks various people (such as her neighbor) are out to “get” her...talks very excitedly and nervously, with no real notion of how her behavior is perceived by others....she views her behavior as normal....trouble maintaining a normal conversation...recently begun making threats and has been dishing out some verbal abuse to those who are closest to her. ..

I went to a med school that emphasized primary care. I was one of the few who became a surgeon. (This is also USA, not Canada, but anyway) If I was a primary care MD, (assuming the patient didn't already have a Psychiatrist) I'd suggest that I'd like to put her in the hospital for some tests to rule out a potentially dangerous problem. If she refused, I'd then pretend to check my pager and say, "excuse me, but I have to answer this, I'll be right back." Then I'd call the Psychiatrist on call for the local hospital and have them arrange for the men in the white coats to show up at my office to take her in for a mandatory 72 hr hold/evaluation. This is the law, if she appears to be a threat to herself or others and she sounds like a threat to me. While an in patient, I'd not only consult the Psychiatrist, but also a Neurologist. While in the hospital she'd get a wide battery of blood tests, X-Rays and at least a baseline EKG

07-17-2008, 07:26 PM
Zen, the GP would refer your character to a psychiatrist (M.D.) rather than a psychologist (Ph.D or M.A.). Based on the symptoms you describe, the character is in urgent need of medication (and possibly hospitalization)--this is a psychiatrist's area.

07-18-2008, 12:27 AM
Thank you, GeorgeK and TerzaRima. That gives me a whole new perspective on the story. I can't tone down the character's symptoms too much because of the plot, but I am now re-writing to make the doctor's response include a recommendation to hospitalize. Thanks again, everyone, for replying with such detail. This is really helpful.