Diagnostic Procedures

This topic contains 12 replies, has 5 voices, and was last updated by  Skypark962 3 weeks, 2 days ago.

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  • #112282

    NolaDD
    Participant

    Newly diagnosed, 39 yo male. Exploring the literature (scientific and clinical studies) trying to assess what treatments might be appropriate. Psychiatrist is not open to questions about treatments other than stimulants. When seeking additional details on what criteria the diagnosis is based on, and which traits are present, which subtype, etc., I got a “I know it when I see it” response. Didn’t outright say he didn’t use a diagnostic protocol (of which there are at least three used internationally that I’ve read about), but deflected and diverted when I asked for which measurement tool he was using so I could look more into it.

    He claims he wants to be my partner in treatment, but he doesn’t want to share information so I can look into things independently. In my mind this is a relationship that only encourages dependence (in perhaps more way than one), not cooperation and collaboration. I’m not inclined to accept statements that rest simply on authority. I need to understand.

    Should I be concerned about a psychiatrist that can’t tell a patient what criteria and measurements they use to come to a diagnosis? Am I asking too much to expect a psychiatrist to be open my views, and being willing to discuss treatment plans and diagnoses with me? Or should I just settle for an expensive monthly appointment to either renew or increase my medication dosage?

    • This topic was modified 4 weeks, 1 day ago by  NolaDD.
  • #112316

    ADHDmomma
    Keymaster

    Sounds like it’s time for a new clinician.

    Penny
    ADDitude Community Moderator, Parenting ADHD Trainer & Author, Mom to teen w/ ADHD, LDs, and autism

    • #112393

      NolaDD
      Participant

      Wasn’t sure if that was just the MO for psychiatrists. I understand consumption of physical medical services quite well (I’ve got enough ailments), just not sure if there are different kinds of experiences in the consumption of psychiatric services. The medication seems to be having some effect, but I feel like I need something more than a blanket mask for some of my symptoms.

      Thanks for the feedback.

  • #112468

    Dr. Eric
    Participant

    How is your delivery?

    I know that I have a very different response to what feels like sincere information seeking questions versus comparing what I say to Dr.Google.

    Poor or overbooked clinicians hate to be questioned, so that is a red flag.

    However, I know a lot of quality folks in practice that will be more than happy to invite patients to seek treatment elsewhere if they feel like everything they do is being compared to internet experts.

    • #112531

      NolaDD
      Participant

      I’m not sure how my delivery comes across. I am try to present it sincerely and respectfully. I have been upfront that I approach all things analytically. I have PhD, and am relying on peer-reviewed scholarship, and only studies published in international journals since 2000. I have asked 3 times for insight into his approach,hoping for a starting point to dig into the vast literature. He dismissed my first question based on a brain imaging study that I found through PubMed. He criticized me for not using reputable sources and exhibiting scepticism to the point of absurdity (I was asking for his thoughts on the conclusions of the study and its implications for treatment). He said he had never heard of PubMed, maybe saw an ad for it on Facebook but never looked at it himself. I tried to explain what PubMed was, but it still didn’t click. His only suggestion in my third visit (other than to be aware that there is some disagreement in the literature, in general, not on any specific topic), was to seek out the work of Joseph Biederman.

      I am a very active consumer of medical treatment as I have several chronic physical conditions, and have been burned by passive acquiessence to first plans by a physician. I refuse to accept unjustified treatment. I try to be respectful but assertive.

      I have had (long suspected, never diagnosed) ADD my whole life. It was never a major problem until recently when I started experiencing a major depressive episode. I’m trying to find a path back to the type of functionality I had where I had learned to use the unique strengths of the condition to accomplish intellectual tasks and move my unit forward. Several things about my daily routine have changed in my job, and it seems reasonable that the exaggeration of the mismatch between my mind’s organization and the requirements of my job could cause a secondary depression. I do not want to have my mental identity stimulated out of existence. I want help getting back to functional. I want to be able to give informed consent to a treatment plan. I’m doing a lot of heavy lifting bringing myself up to speed, and I hope that I can find a provider that will help me on that journey, not resist me, or try to belittle me. I have read more than 50 articles (journal articles in ranked scientific publications) in the last 3 weeks on evenings and weekends instead of working on my own research. To assume I’m incompetent and incapable of identifying reputa9and authoritative sources of information is not going to win my confidence. All of my other doctors will spend time to justify their recommendations and contextualize my questions within their expertise. I’m not trying to be the expert. I’m trying to be informed by the expert in the only way I know how.

  • #112547

    Skypark962
    Participant

    I’d too get a new Dr. If you are paying him, you have a right to information—sounds like he’s got an ego & his willingness to help sounds like CRAP.

    • #112549

      NolaDD
      Participant

      Definitely leaning that way. Have to find an alternative, but not sure how to assess other potential providers. Getting the impression this is not typical of the field. Hoping for better luck with my next shot in the dark.

    • #112559

      Ranma
      Participant

      When I hear of someone having problems with a Doctor I tell them (don’t remember where I heard it) “what do you call someone who graduated last in their class at med school? Doctor” I’ve had a few gems myself, one was visibly annoyed that he had to see patients.
      I would look for another Doctor.
      Hope you have good luck and find a much better one.

  • #112656

    Dr. Eric
    Participant

    I don’t know what to advise.

    If I was not a fan of the sources that you were getting your info, I would steer you to the ones that I would want you reading.

    For example, I would tell you right now to look at Russell Barkley’s work. However, he does not do direct research. He reads everyone else’s and looks for common trends and real-world implications. The benefits to this is that he is not beholden to one technique over others. His comprehensive expertise is his product. If you want direct citations, steal his bibliographies. I don’t know how recent these are in his retirement as a professor.

  • #112692

    Dr. Eric
    Participant

    The one other thing to consider is, instead of saying you found it on PubMed, cite the specific Journal.

    PubMed is just a clearinghouse to access the journals.

    I haven’t looked at the breadth of quality in them, but obviously, JAMA or New England is going to get more positive attention than an opensource or low-quality journal.

    • #112752

      NolaDD
      Participant

      The first time, I was not ready with the citation at hand, but was hoping for a discussion or context. I then forwarded him the citation (it was published in Brain, impact factor hovers around 10 and top 20 journal in neuroscience). I have since found articles with similar findings from a range of journals, including Lancet Psychiatry, JAMA. I specifically requested sources to start reading, but he just told me there were thousands and reference Hypocrites descriptions of ADHA being similar to clinical descriptions today.

      So now, I am back on the market for someone to help with a full and detailed assessment that is capable and willing to discuss and justify their decisions.

  • #112760

    Skypark962
    Participant

    Look into Dr. Amen’s books. He talks about the 7 types of adhd and his books are all backed by science (ie the spect scans). There shouldn’t be any guesswork in psychiatry, but if a dr. doesn’t actually see the organ their treating–they’re just giving their best guess.

  • #112848

    Dr. Eric
    Participant

    Amen’s books may be a good personal reference, I am not sure how convincing it would be to discuss with this MD. Amen can be a divisive person in the medical/clinical community. If a practitioner is not swayed by peer-reviewed research, I doubt a book from Amen is going to be more persuasive.

    He and his clinic are local to me. Although I am not a fan of his cost and infomercial-style marketing, I have had few issues with him or his clinic. Their reports are as useful, but not really better, as any quality neuropsych’s. They also provide a milieu of supports from evidenced-based to emerging/cutting-edge to some that are not supported/contradicted by evidence (this is where my peers tend to not be a fan).

    They have also been a good partner to me when I have consulted with them.

    I do get frustrated when I have a parent who is convinced that he is the only one that can help them or crying out of guilt when they cannot afford their comprehensive line of supplements when, for the same money, they can pay for similar supplements + cognitive behavior therapy from a decent provider.

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