Book Review: Against Depression (Peter D. Kramer).

Introduction:

Cover of "Against Depression"
Cover of Against Depression

Against Depression by Peter D. Kramer is an astonishing volume. It is not your standard work on a mental disorder – in fact, the title is both misleading and exactly on point. Against Depression is not so much about explaining and treating depression as it is a polemic literally against depression. Kramer effortlessly skips across a wide variety of knowledge clusters to formulate his argument, as comfortable delving into artistic exegesis of paintings to literary analysis of any of a variety of authors – modern and past, and then again into the depths of history and the cutting edge of scientific discovery – especially in the arena of the biological and physiological nature of depression.

Synopsis:

Kramer argues that (a) humanity has a bias against the curing of depression because (b) we are afraid that some positive traits/activity will be lost if the depressed are cured (e.g. moody, brooding literary and artistic works; a deep understanding of pain; alienation (against tyranny); hope for a better world) but that (c) the result of curing depression would be a fuller humanity, not a lesser one.

Literary Merit:

Kramer’s work is a piece of art. Kramer shows an almost infinite capability to string together diverse topics and observations to make cognizant arguments. He is as comfortable discussing literary and artistic analysis as philosophy, psychotherapy, and the latest cutting edge science relating to the biological and physiological nature of depression. There is the unfortunate fact that someone’s editor didn’t do the best job proof-reading in two or three chapters1The number of errors in these several chapters are almost stunning, especially in comparison to the rest of the volume. I am wondering if these chapters were inserted at the end and did not receive the same rigorous process as the rest of the book, though the chapters themselves are interspersed throughout the book, not appearing chronologically at the end.. Besides this, Kramer’s writing is much more a philosophical work than anything else and it carries a philosopher’s tone. It is not the easy reading one has come to expect from lay-illness volumes – not only in its vocabulary but in the concepts it communicates and the time and space Kramer dedicates to these concepts. Still, the volume is extremely well-done and the task which Kramer has undertaken is a massive one, which we will discuss a little later, and as such one can lend little criticism against a volume that undertakes such as an impossible task.

Do We Fear The Cure?

Kramer is able to convincingly argue that we do fear a cure for depression. We believe that depression is part of our humanity – while it may not be in every person we cannot imagine some people without it. We wonder if by curing their depression we are in fact simply muting a portion of their personality, forcing everyone into a standard definition of humanity with little room for differentiation. Kramer reports repeatedly receiving the question, “What if prozac had been available to…?” (Nietzsche, van Gogh, Poe, Woolf). In other words, would we not lose the intellectual and artistic drive that this depression caused?2Neither Kramer, nor I in my agreement with him, believe that treatment can be pursued without any consideration for its effect on the personality. In fact, Kramer acknowledges that treatment can affect the personality – but suggests that this is because we have blunt treatments, not the fine surgical ones we need. His polemic indicates a desire to carefully advance the treatment of depression with consideration for the larger dangers of affecting personality. At the same time, he (and I, following after in his shadow) would suggest that depression itself is a disease and that the treatment of a disease with the right tools is the right thing, without question.

But It Isn’t Honorable…

Kramer goes on to argue that we don’t give other diseases this distinction – we don’t suggest that individuals should keep their cancer or their heart disease. We don’t claim that there is something inherently valuable that adds to a person’s personality in the illness. Yes, there may be something that the individual learns, but this is not inherent in the illness itself. He suggests that we can ask the question if illness is every useful, but that this question cannot be posed to depression specifically, but must be posed across the board to all diseases. In other words, it is unfair to pick out one group of sufferers who we choose must suffer so that humanity can benefit from the lessons they learn, while all other sufferers are treated.

Kramer goes on to demonstrate from cutting edge research that depression does not advance a person’s abilities to think and create but rather dulls them and that the research indicates long-term, irreversible damage to the physiological structure of the brain is caused by depression.

A Better Future…

Kramer attempts to draw a picture of a future without depression and suggests that it would create a better humanity, not a shallower, more bland humanity. He suggests that the fullness of personality is restored in healing from depression, not caused by depression. That the characteristics we see in the depressed individual while sometimes admirable in and of themselves (e.g. unrest with the current life situation) are not valuable when they come from disease rather than a person’s own personality.

Conclusion…

A fascinating philosophical read that at its deepest asks what it means to be fully human and what role depression plays in encouraging or discouraging humanity, as well as evaluating our historical literary and artistic preference for works created by and about depressive themes to those of more brightness – and whether this indicates an inherent greater value in these works or a taint to humanity that we desire such.

Surviving the Darkness: A Crash Course in Muddling Through Anxiety, Depression, and So On.

A painting with Job sitting naked in the dirt.

Introduction

[I originally published this post in April of 2013. Since then it has undergone a few minor revisions. Today I am doing a more extensive review – rephrasing things that might have been obtuse and sometimes expanding upon what I have said in order to clarify  certain topics. Additionally I have added an additional resources section which includes links to other resources I have created since 2013 for those in torment.]

A painting with Job sitting naked in the dirt.When was the first time my life ground to a halt, anxiety slammed me to the ground, and hope disappeared like the stars from the sky on a stormy night? I don’t know. The first time I can remember I was five.

Sometimes it has been episodes – intense, short-lived. Other times it has been prolonged, desperate, hell-fire-is-burning-in-my-brain suffering. Oftentimes it is a mixture of both – the fire that doesn’t go out and the worms that never die punctuated by times of absolute torment when death seems like my best friend and I wish it would embrace me and take me home.

I’ve spent all of my conscious life struggling with an assortment of mental illnesses – OCD and Depression being two of the most vicious. I’ve read a lot of books, been through a lot of counseling, taken a lot of medications – and I still do all these things. I’m not a mental health expert – but I have been through the ringer a few times. I try to document what I have experienced and learned in a systematic way – usually on one of my other sites OCD Dave.

Today I’d like to talk a bit about when you are in the midst of it. I mean when it goes from inconvenient, annoying, painful, to life-stopping, productivity killing, death-wish inducing. I can’t promise you that anything that works for me will work for you…and some of this is certainly not “best practices” from the medical establishment – but it is the best way I have learned to cope thus far…So, for what it’s worth, here is what I’ve learned about going through the darkness.

Clarifying Parameters

[I don’t like this section. Not because I don’t think it is important, but because I think it is so important. I have been unable to speak what needs to be said here in a way I feel is strong enough, persuasive enough. For the time being I capitulate to my inability, thankfully, there is someone else who has written exceedingly well on this topic – Peter D. Kramer. If you doubt that mental illness exists, that is a valid type of illness, etc. I would humbly urge you to read his amazing book, Against Depression.]

There are different kinds of mental illness. Some of us get ill because situations in our life are horrible (situational or environmental illness). Remove the situation (via passage of time, geography, physical intervention, legal action, etc.) and we get better. This is probably the most common form of the illness. Even though the illness is situational or environmental and thus in theoretically of a temporary nature, if the situation/environment never changes, it becomes in experience a permanental illness.  I’ll explain why I use the term “illness” to describe something caused by a situation a little bit later.

Then there is mental illness which comes about at a specific period of one’s life1That is, a limited duration of time in one’s life, it can be at any time, just of limited duration. with no known cause.2This does not mean there is not an originating cause – environmental, situational, biological, etc., just that we have been unable to connect the dots…and we should be wary of too quickly connecting the dots, the easiest explanation is not always the right one. We are okay one day and the next we fall into a deep hole of depression or anxiety. What happened? With medication, counseling, and/or time we come out of the illness – it is limited in duration. This is probably the second most common form of the illness.

The last form, and the least prevalent, is chronic. It oftentimes begins in childhood and the prognosis for full recovery is dim and distant. Others may get better, but our illness stays the same. It gets worse when it likes and a little better when it likes. On occasion we can even feel “normal” – but that comes and goes without rhyme or reason.

This article is meant to be of assistance to anyone in the midst of the darkness from any of these types of illness – but it is especially focused on the last group – of which I am a part.

Is It Really An Illness?

All forms of mental illness are truly legitimate illness in the sense that the normal functioning of the body has stopped and a dysfunctional operation has begun. This is usually what we mean by illness, is it not? That for some reason the body – due to internal or external factors – has stopped functioning correctly?

But what about situational illness? Can that truly be an illness? Isn’t it the situation? Well, it is the situation – like black lung disease is situational to miners. While the situation may be the cause, this doesn’t reduce the severity of the physiological effects, nor should we assume that the individual in that situation is independently capable of removing themselves from the situation any more than many individuals working in toxic environments are capable of simply picking up and moving to a different location and taking a different job and making a different life.

I know that we can affect our body chemistry through our surroundings, our actions, our thoughts – but we must also acknowledge that our body chemistry influences these same surroundings, actions, thoughts. If I am lacking in certain brain chemicals I will not feel the desire to enter into certain good situations (e.g. relational interactions), I will not have the energy to participate in certain good actions (e.g. exercise3BTW, I’ve tried this…and at least for me, there was no appreciable difference in mood. Now I have chronic issues with my legs that make it pretty much impossible to do what I used to do – a lot of biking. I also have experienced some of the most intense forms of the illnesses while working manual labor jobs – such as a crew member commercial fishing for salmon.), and I may find thinking certain good thoughts impossible.

If we think rationally about how all other illness works – why people have allergies, diabetes, heart disease, and so on – sometimes we can point some of the finger at the individual, but we usually point most of the finger at their biological makeup. It is no different with the mind.

When the Storm Hits

I think of my “episodes” as similar to an old-fashioned frigate sailing the open waters. When the storm rushes in, the waves grow high, and the lightning snaps across the sky. The captain orders the sail taken down, all the hatches fashioned shut, and the crew below decks. Let the storm whip around as it may, there is nothing that can be done until the storm passes.

When the darkness hits with mental illness – the real depths of the abyss – there is no imminent escape. Sure, we can get counseling – but that isn’t going to make the pain go away right now. Sure, we can take medications – but most of them aren’t going to vanquish the darkness. Sure, we can practice our cognitive-behavioral techniques, but right now we can’t think and we can’t feel anything beyond the pain.

So what do we do? We batten down the hatches and wait the storm out. There is no use scurrying around the deck – let the storm roll over, let it take its course, and then when it passes, come out into the sun and survey the damage – make the repairs and prepare better for the future.

Medications

There are some medications which can provide relief in the midst of an attack. Accidentally and incidentally4When I’ve suffered some sort of systemic over-reaction, e.g. to poison ivy, which has happened to coincide with a storm. I have discovered that steroids works this way for me. I hear Xanax (alprazolam) thrown around as a common medication used to treat these intense periods of darkness – but have never taken it myself. Klonopin (clonazepam) is another option – though, at least for me, this just makes me fall into a deep sleep (which is an enviable comparison to consciousness in this living hell). Talk to your doctor about your options – if you are a chronic sufferer, it might be worthwhile to have something when the storm hits so that your life doesn’t have to stop for quite as long…, people begin to wonder where we’ve gone and, especially family members, can mistakenly assume that they have done something wrong to cause this withdrawal.

For me, storms are oftentimes intense events lasting a day or longer and surrounded by other lesser storms. I recently [in 2013[ went through a two week period where halfway through was the worst storm, but for which there was an intense buildup and a prolonged winding down. I don’t know about you, but I really can’t afford to randomly have two weeks of my life vanish into thin air.

[So let’s take a quick journey through the methods I have found helpful…]

Passive Distraction

For recreation I oftentimes read – but that doesn’t work when I’m in the midst of a storm. I have no ability to read. I can speak the words, but my mind has no comprehension (and no interest in comprehending). I can read over and over, but the words are still lying like dead things on the floor. I need passive distraction – I need something that will distract me without requiring any effort on my part.

I keep a document called “Bad Day Movies.” It contains movies and TV shows that I REALLY want to see, usually that I’d have to pay to view (e.g. Amazon Instant Video), and that I don’t pursue until a bad day hits. When it hits I shell out a few bucks and slip into a passive dis-consciousness. Sometimes this will go on for hours – but heck, anything that takes my mind off the pain is better than sitting there as each agonizing minute passes.5This would be one of those times when I’m suggesting something that isn’t considered best practice. The recommended road is usually an inward searching – dig into your feelings and figure out what the cause of the feelings are. This is great advice oftentimes, but is completely useless if the storm is primarily biological. I’m not saying everything is biological, just that there are multiple causes of the storms – and we can’t use one prescription for every illness.

You might think I’d watch comedies during these times – but I don’t. Maybe that would work for you, but I don’t find many comedies funny even when I’m feeling well – when I’m in the darkness, comedies are inane boredom personified. I tend to watch intense thrillers, dramas, and sci-fi. One exception was Monk – which because it satirized my illness allowing me to laugh at it.

Conversation

Sometimes a good conversation can be cathartic. But it needs to be the right kind of conversation – and usually this will only work for a limited duration. Few people are really safe to talk to in this manner.6An interesting, older, quirky book on this topic from a Christian perspective is J. Grant Howard’s The Trauma of Transparency. If you wonder why someone doesn’t come to you when they are struggling in this manner, it might be time to look at yourself and ask if you are safe for someone to be around in this time of crisis.

At these times, you can’t fix me, you can only travel with me. You can only walk for an hour or two alongside me and view from the outside the ravages of the storm within. This is helpful – but this is all that can be done. It is not that you are incapable, it is that I am incapable. You cannot remove me from this storm any more than you can make the sky shut its floodgates and the lightning turn off its brilliance. This is a situation which must be weathered, not escaped.7It is often the case that those who help need to help. Be careful if you feel it is your responsibility to make someone else better, this will cause you to resent the individual you are attempting to help when they don’t recover. It oftentimes results in the helper placing an even greater burden on the “helped.”

Reading

I shared earlier that most reading is not useful, but there is some reading I find useful – though I must say that it is also of limited duration. Movies/TV I find to be the longest lasting distraction. Find the books that touch you and keep them around – then read them for as long as is useful during the midst of your suffering. For me, this is George MacDonald’s Diary of an Old Soul and Unspoken Sermons, Mark Rutland’s Streams of Mercy,8This book is awesome no matter where you are at life – one of my all-time favorites! some of Max Lucado’s writings,  and a book like The Boy Who Couldn’t Stop Washing His Hands which is filled with case studies of people suffering like me which tells me I am not alone, I am not crazy, and I can survive.

Acceptance

We oftentimes begin by thrashing against the storm. We try to fight it, to shorten its duration or intensity – but I have found no way to shorten it. Sometimes it lifts suddenly, but there is no rhyme or reason. What causes it to lift one time will absolutely fail another. When something would have worked this time, nothing will work the next time.

It is a hard place to be, but in the midst of the storm we have to accept we are in the storm, batten down the hatches, and wait it out. I don’t mean that we should passively stay in this place forever – and we should seek proper medical treatment – but at some point we have done all that and it still comes on us…and, friend, I have simply found no way out. So get ready for hell and hold on – it is going to be a nasty ride – but every storm does end, every ride does stop, and sometime, somewhere, the storm will at least lull and you’ll have the opportunity to do something about your suffering, but right now – it is just here.9I know, there are the times when it feels like it will never stop. Since writing this post I have been through times when the emotional pain became so intense that I felt it should kill me. I didn’t understand how it was possible to feel so much. During those times I listened to Art of Dying’s song Get Thru This hundreds of times.

Pacing

Alongside of acceptance is pacing. This is especially true for those of us who suffer from mental illness in a chronic fashion. We do not demand that a one-armed man be a good juggler, that an amputee win the Olympics, that a blind man read a book, that a deaf man critically analyze music – yet for some reason we still demand of ourselves productivity and speed as if we  had what others have – and we do not.

It is not that we have to be less than other people, but that we can be fully who we are if we pace ourselves. I do not enjoy my illness – but it has forced me to learn and grow in many uncomfortable ways – ways that (I think) allow me to maintain levels of productivity similar to others, but in my own way.

I know that if I spend x amount of time with people I will burn out for x * 3. I know other people can spend x amount with other people without issues. But I can’t. Maybe I should be able to, but I can’t. So, I pace myself. I do x – 1 and am able to do x – 1 for multiple days in a row, instead of doing x for one day and then 0 for multiple days thereafter.

I have to take naps.10This is no longer the case, one of my doctors found a medication that reduces my insomnia significantly which greatly increases my energy during the day. I don’t like that. I don’t like that exhaustion washes over me like a tidal wave and my eyes shut against my will. But its okay, I do things at my pace and my life is different than others – but it works. Some days I sleep every x hours throughout the day and the night. Most people just go to bed (at night) and just stay awake (at day), but I don’t. I cycle between the two.

The latter I really try to avoid – but when it happens, it happens, and I accept it. In the past I wouldn’t, I’d fight it. I’d end up exhausted all the time and unable to accomplish anything.

Music

Over time I’ve collected a large selection of songs I find to be helpful when I am suffering. Depending on what sort of suffering I am in, I will listen to different kinds of music. There is the JJ Heller and Rich Mullins kind of suffering and then there is the Skillet and Thousand Foot Krutch kind of suffering – the latter I prefer at full blast (perhaps with ear protection) so that I can feel the bass pumping through my body. You can find more of the songs I listen to during times of suffering here.

Sleep

If sleep will come, take advantage of it. This is one nice thing about TV/movies, they oftentimes are passive enough to lull your body into sleepiness. When it comes, don’t refuse it. Let it carry you away, when you awake, go back to passive distraction if the burden remains.

Keep Searching

I’m not fatalistic, cynical, or pessimistic. I consider myself a realistic optimist. We cannot simply do nothing with our lives and I have never given up hope that someday, somewhere I might find the cure – or at least a partial cure – for what ails me. I continue to read, continue to try to improve my habits (my sleep routine, my schedule, my thoughts, my relationships, and so on). I don’t think we should ever give up hope – but we also can accept at times, as the sailors do, that the storm is upon us and there is nothing to be done right now but wait.

And God?

I’m a Christian – so what about God? If I was perfect I think I would find all of my joy in God in the midst of this suffering. I would need nothing else, but I am not perfect, I am human.

I don’t ask you to refuse Novocaine as the dentist drills out that rotten tooth or cuts through your flesh – yet I think that if we were perfect we would experience this even with joy in the midst of the suffering. Please don’t ask me to do something you can’t or won’t do yourself. I might not be bleeding on you at the moment, but my injuries are just as real.

For some, there may be comfort in prayer during this time. For me, there is agony. God knows I try, and after an hour has passed in my mind and a minute in reality I am exhausted, too weary for words. I cannot speak aright. I cannot feel aright. I cannot think aright.

I do find comfort in Scripture – though it must be select Scriptures.11See John Bunyan’s Grace Abounding for a powerful portrayal of how some Scriptures can bless and others curse the soul of a mentally ill individual. At these times I do not need to know about God’s judgment, but about His love and grace. I do not need to know about victorious saints but about suffering servants who wrestle with the misery of incomprehension  of God’s purposes in this torment.

What About?

What I’ve described here may seem similar to the way others struggle through hard times – alcohol, drugs, illicit sex, gluttony. The last of these is a struggle for me during these dark times. What is the difference between what I advocate above? Do not all of them have the common factor that they do not rest on God alone? Yes, they do. But some forms of coping are less damaging than others.

Find legitimate ways of coping, or the illegitimate ones will find you.

Your Coping Strategies?

If you suffer from mental illness and have developed coping strategies when in the midst of the storm, I’d love to hear what they are and how they have helped you.

A Few More Resources

Since 2013 I have created several additional resources for those going through suffering. I compiled a number of paintings and images of suffering – most by great artists.

There is also a significant list of Scriptures expressing torment of individuals within Scripture towards God, the Scriptures of Suffering. Similar is the Scriptures for the Suffering which consists of Scriptures of comfort.

Note

[This is from original article in 2013] The timing of this article is coincidental to Matthew Warren’s suicide, but my heart goes out to the Warren family and all those who loved and knew Matthew. May God give you everything you need to continue through this dark time.

Finding the Best Medical Professionals Using the Internet in Six Steps

Image of Medical Professionals Research Spreadsheet

Introduction

This topic is close to my heart. There are those I love who really really need to get medical attention but have been frustrated by the ineptitude of some medical professionals. I’m writing this for you – yes, I really mean you! Pretty Please???

I’m also writing this to you, passing traveler on the information highway, because I want to see you find the medical care you need as well. I know you may be frustrated by multiple negative experiences, but I hope you’ll try using the method I outline below – I have been repeatedly satisfied with the results.

1. Finding Medical Professionals Covered By Your Health Insurance

The first step is to pull up your health insurance website and find the directory of providers covered by your insurance.1If you don’t know the website of your healthcare provider type it into a search engine like Google or DuckDuckGo and it should appear in the results. Here are links to those directories of providers on several of the largest health care insurer’s websites:

To get accurate results you’ll need to enter information about the health insurance plan you have (see your health insurance card) as well as the geographical locale in which you live. You should see a list of providers once you have provided the necessary information. Found it? Great!

2. Creating a List of Medical Professionals

Your next step is to create a list of medical professionals covering the sort of care you require. At this point I recommend creating the list without concern for who will be best or worst – instead, look at how close they are geographically to where you live.

I find that it’s best to add all of these individuals to a spreadsheet, and I’d recommend using Microsoft Excel,3If you don’t have a copy of Excel available, you can use the free online version. Google Sheets, or AirTable. I’ve created a list provider spreadsheet template/example you can use.

Image of Medical Professionals Research Spreadsheet

In the first row you can place your column headings, which describes what will go in that part of the listing. I recommend starting with Provider Name, Distance (from your location), and Location (city).

Once all of the potential medical providers are listed in the spreadsheet, we are ready to move on to the next step…

3. Adding Health Professional Reviews to Your Spreadsheet

The next step is to go to a search engine (Google and Bing both work well) and to type in the title and then name of one of the providers followed by the city they are located in. This helps ensure that you get results for the correct practitioner – oftentimes multiple providers share the same name – even unusual ones!

In the image below you can see the results I received when entering “dr michael looney delmar” into Google. Notice how there are stars next to some of the results? These are the ratings the people on these review sites have given Dr. Looney–just like a product review on Amazon! You can visit the sites to see more details, but usually what we need is available right on the search results page. We are looking for the name of the review site, the rating the provider received, and the number of reviews the average is based on.

Image of Google Search Results

Now the spreadsheet you’ve created will need additional columns- two for each health review site we want to use. I have found the following to be among the most helpful review sites:

  • Healthgrades
  • Vitals 
  • Zocdoc – The nice thing about this one is that you can set up appointments through the web and there tend to be numerous reviews for doctors who participate in Zocdoc.
  • RateMDs
  • UCompareHealthCare
  • Wellness
  • PatientFusion – Good resource, but reviews seem to be largely limited to practitioners who use PatientFusion.
  • WebMD – They got into the game quite late, and while I expect them to continue to grow in quality, it’s hit or miss whether there are reviews of any given practitioner.

Here is a screenshot of the example spreadsheet I mentioned previously:

Image of Medical Professionals Research Spreadsheet

Note what I’ve done:

  1. I’ve shrunk the size of each column relating to the review sites as small as I can. This allows us to see all/most of the relevant rating info at once instead of needing to scroll right and left.
  2. I’ve shrunk the names to fit within the columns by using an abbreviation.
  3. I’ve created a column on the far left that explains the abbreviations I’ve used, for example, HG means HealthGrades.
  4. For each review listed on the Google Search results, I added the rating to the first column for that review site and then the number of reviews to the second column for the same review site.
  5. I also created another column that covers sites that I’ve found don’t usually have reviews of practitioners, but when they do can be a helpful source of information – in this case Facebook and Yelp.

I usually look at the first 2-3 pages of results to see what review sites/ratings show up. You’ll note that a number of the review sites columns are empty – this is because the review site/rating did not appear in the search results I’m seeing. That is perfectly okay!

You’ll then repeat this process for each provider on your list.

4. Picking the Best Medical Providers from Our Spreadsheet

Once we have our spreadsheet filled in we can begin to analyze the list of providers. Look for those with the highest scores across the most sites and from the most people. Soon you should have a few stand-out choices. If you don’t come up with any good choices, you can go back to the health insurance site and look at other providers further away. I know that isn’t what you want, and in most cases you shouldn’t need to, but it does happen sometimes – especially if you live in rural areas.

A couple tips on choosing the best providers:

  • I like to bold scores / number of reviews that are particularly high, this helps certain providers to stand out – especially if they have good reviews across several sites.
  • I like to italicize reviews that are particularly low, especially if they come from a high number of reviews. Again, the providers who have consistently poor scores across sites should begin to stick out as well.
  • While searching you may notice news articles or other helpful sites outside of review sites about a given provider, these can be of significant value.
  • Because you are looking at the consistently highest rated providers you may run into a few who have full schedules or for some other reason can’t see you, that’s okay, just move to the next person on your list.

5. Additional Things to Consider When Choosing Healthcare Providers

  • Don’t abandon the tried and true ways of finding a provider – talking to friends, family, co-workers, and neighbors! Their advice can be golden and you can then validate their recommendations by adding them to your list. You may find there is significant overlap between who people local to you recommend and who seems the best based on online reviews.
  • Don’t forget to talk to any medical providers you currently have that you do like. They are often more than willing to make referrals to other providers who can meet your needs. Once again, you can validate the recommendations by adding them to the spreadsheet and comparing them to the providers you have looked at on your own. Hopefully you’ll see significant overlap!
  • Remember that we humans tend to review services we feel strongly about – positively or negatively. Just because a doctor has some bad reviews doesn’t mean they are a bad provider overall. This is why I recommend looking across multiple review sites. In general, the more data you have, the more accurate the results (which providers are best) will be.
  • In my experience, some professions have generally lower scores than other professions. For example, you may find pediatricians who have 5 stars on multiple sites from multiple reviewers, whereas for psychiatrists or oncologists you might find that the highest scores are 4’s. There are various reasons for this, one being that some professions deal with more intractable problems than others.
  • Just because the reviews say so, doesn’t mean the medical provider is perfect or infallible. Use your own best discernment to determine whether the provider is a good fit for you.
  • Some really good practitioners are eccentric or abrasive. You have to decide if their particular type of eccentricity / abrasiveness is something you are comfortable with. For me, I don’t mind a practitioner who lacks social graces and is a bit abrupt at times, but this may not work for you – and that is okay.

6. Getting the Care You Need at the Appointment

Some medical professionals will walk you through the care process from beginning to end. Others will do so only if you specifically point out to them the issue you are having. Yet others will be effective in their particular niche but won’t provide any sort of overall support when multiple providers are involved. I think all of these types of providers can be good providers – but the way you approach them needs to be different. Don’t assume that the doctor knows what you need or want, tell them the information you believe is relevant (try to be as concise and specific as possible).

If the provider recommends a medication or treatment and there is another you’d prefer, tell them so, and ask them if that would be okay or if there are specific reasons they are recommending one course of treatment over another. Providers oftentimes have a “go to” treatment/medication that they have seen success with, but if you mention another treatment of equal quality, they’ll oftentimes be willing to start you off on that medication/treatment.

Don’t be afraid to leave a provider that you feel is not meeting your needs, or who is not willing to work with you to get those needs met in some practical way–even if other people have had a good experience with that provider. Sometimes things just don’t work out, and that’s okay–but it shouldn’t hold you back from receiving the care you deserve.

Your Thoughts?!

What are your thoughts on this article and process? How do you find quality medical care providers? Is there anything unclear in the article? I look forward to your feedback!