Lindsey Clancy Reflections
First, this case is a call for a change in practice. “Having a plan” is not a reliable indicator of risk for someone having intrusive thoughts with suicidal thoughts.
Next, I heard Dr. Drew Pinsky saying this case calls into question physician extenders, and I think the opposite is true. The Nurse Practitioner Lindsey saw was the only person who correctly identified the bipolar features; the LMHC described using evidence-based approaches to therapy (CBT, DBT, and EMDR), and she recognized her real risk for suicide and referred her for more intensive treatment. The psychiatrist Lindsey saw did not see the bipolar risk, despite Lindsey reporting days without sleep and other indicators; when asked about what therapy she provides, she said she “listens and offers hope.” My view is the psychiatrist was the weakest of all Lindsey saw.
I see it as a call for dedicated training in therapeutic techniques and psychological science for all psychiatrists. As-is, psychiatrists are trained through standard medical training and mentoring in psychiatry. The quality of training then depends on the individual providing the mentoring. This creates too much risk of variability and, therefore, risks to patients.
Weigh in, if you wish.