My new psychiatrist is making me do neuropsych testing

February 10, 2017 3:00 PM

After half a year of successful medication treatment for my ADD, my wonderful psychiatrist left, and the newly-joined nurse practitioner is insisting on formal neuropsychological testing, because people are "savvy" these days at gaming the system to get drugs, even though I didn't seem to be doing that in her view. Now I'm worried that all of the amazing progress and changes to my life will go away because I won't pass the testing.

My previous psychiatrist was great. She met with me for two hours worth of interviews where she asked me all kinds of questions, and shortly thereafter concluded that I have "moderate to severe" ADD of the inattentive variety. She thereafter put me on a small dose of adderall, which drastically improved my ability to function at work and in other areas of my life. While nothing like a magic bullet to solve everything, it's still been nothing short of life changing. After a lifetime of not being able to meet deadlines and not being able to last at jobs for very long, I finally found something that made things a lot better, and in the process a lot of my self-esteem/anxiety/depression side effects had been vanishing as well, so I felt like a new person.

Then that psychiatrist left the in-network practice, and to my knowledge hasn't moved elsewhere yet. She gave me the option to wait a few months to see a new MD (and provide me with prescription renewals until that time), or see a nurse practitioner the next month, and (perhaps unwisely) I chose the nurse practitioner.

Yesterday I met with the nurse practitioner, and she seemed uninterested in my story about my work and executive function problems, and didn't probe at anything further. She asked me a bunch of questions ticking off a checklist she had, that had nothing to do with my particular form of ADD (have I been physically or sexually abused, do I have any gender or sexual identity issues, etc.) She then said that, because many people are just drug seeking and know the right things to say to get drugs, she's going to make me do neuropsychological testing instead of continuing with the diagnosis I had obtained (though she will refill my prescription for this month, at least). I had no idea what this testing was, and, because I was already worried about appearing drug-seeking, didn't question it or push back but instead made sure I seemed OK with it.

But researching this testing has made me worry. It appears to be 5-8 hours of a battery of testing, including some computer testing, such as pressing a button when an "X" appears on the screen and various other things. These computer tests sound like simple video games or puzzles to me. I can push a button to shoot an enemy when it appears on the screen, basically. I'm good at and enjoy puzzles. And testing environments are unreal situations where I know I'm being tested and will be able to focus on things very well to get the short-term outcome I need under the pressure. Further, knowing that how I do on the tests will be the difference between getting the important medication, or not getting it, will mean I'll be tempted to "play to the test" somehow, so I might try to play up inattentiveness in an unnatural way. I'm smart and good at tests, and I feel like that will hurt me for the desired outcome here.

I don't see how any test can emulate the real-world executive function problems I have, such as "Here's a big, overwhelming 30-hour project. You have a full month to do it. Why did you spend 29 days distracted and feeling like it was impossible to even start, and then spend the final 24 hours in a hyperfocused pressured rush to complete? Why do you do this for every project?" or "you needed to pay this one bill for months and keep getting notices about it and it's now gone into collection and is affecting your credit score, you have the money and could pay it, why haven't you gotten around to doing so?" etc. I'm worried I'll fail the test because I have ADD but not the particular kind that the test will reveal.

What are my options? Do I go to another practice that won't insist on oppressive, symptom-deaf objective testing? Bring up my concerns to the nurse practitioner? Try to change to that MD instead (and maybe go a month or two without medication if need be)? Are the tests something I shouldn't worry about? Help me out here.

posted by naju to Health & Fitness (42 answers total)

I would just see somebody else; the tests are pretty expensive, or at least they were when I had to do them, and it's not worth the stress.

But for what it's worth, I test extremely well and was still told, after completing the test (and doing very "well"), that I was as textbook a case of ADHD inattentive as the psychologist had ever seen in his life. Something about the difference between my IQ and my "processing speed," which was as far below average as the rest of my IQ was above average. (Where I was tested they also ran me [and my parents, through the mail] through a series of surveys that asked me questions that were basically about whether the symptoms described by an ADHD diagnosis had affected me throughout my life.)
posted by Polycarp at 3:11 PM on February 10, 2017 [7 favorites]

Response by poster: My insurance has indicated that they would pay 100% for the testing, fwiw, so I don't think the price is an issue per se.
posted by naju at 3:14 PM on February 10, 2017

The neuropsych tests aren't like, if you score below 100 points you have ADHD, otherwise you're fine. You'll likely get several attention/memory games, an IQ battery, and some self-report questionnaires - the final report is a holistic review of the whole shebang. I had a very similar experience to polycarp: I "passed" the attention games, but my scores were low relative to the other dimensions they test, and that (along with responses to self-report questions and a conversation with the neuropsychologist) resulted in the eventual diagnosis.
posted by theodolite at 3:27 PM on February 10, 2017 [2 favorites]

Best answer: Find another doctor, and call the psychiatrist to get an interim Rx. The NP is being absurd and ignoring your needs to fit her own agenda. Your livelihood is at stake.
posted by action man bow-tie at 3:29 PM on February 10, 2017 [29 favorites]

I have mild ADD but have never been through the testing.

My son has fairly severe ADHD and went through a battery of neuropsych testing when he was 8.

I was overall quite impressed with how well the combination of tests described his symptoms. He spent about 6 hours with maybe 20 different tests. He wound up being described as highly intelligent with some hellacious attention deficit issues - which is about spot-on from my perspective.

I would encourage you to be open-minded about the testing, but do a little research into the the testing facility and who's going to be interpreting the results. In my son's case, the tests were administered by a clinician, with a psychologist interpreting the result and giving us a 30-page narrative report at the end. This report has been key - I would make sure I was referred to a well-regarded testing facility.
posted by pantarei70 at 3:30 PM on February 10, 2017 [3 favorites]

Response by poster: In the abstract, theoretical sense, this testing sounds interesting and potentially incredibly informative, and I'd welcome a clear picture of what I have in such a way. I guess this butts up against the real-world, practical reality of "getting the medication you know works for you, vs. not getting it" which is inextricably bound up in the outcome, that has me so on edge. As action man bow-tie suggested, my livelihood is at stake. I literally think the medication is the difference between me being fired (again) or not, and I need to take this situation exactly that seriously.
posted by naju at 3:41 PM on February 10, 2017 [3 favorites]

I'm smart and good at tests

This is common for people with ADD / ADHD, so, the testers know what to look for. Like, the "press a button when you see an X" test, if it's the one I'm thinking of, goes on for 22 hideous minutes, testing you every two seconds. If you can power through that without showing signs of your attention wavering -- and you're being measured to the teensiest part of a second -- then, hey, great! Maybe you actually don't have ADHD!

So don't worry about accidentally testing yourself out of the diagnosis. There might be other things wrong with this situation, but I don't think that will be a problem.
posted by The corpse in the library at 3:42 PM on February 10, 2017 [4 favorites]

Best answer: I would call the doctor's office back, and ask to speak to your old doctor. She gave you the option to see a new MD and you clearly need to see a new MD. This NP is really not working to serve your needs. You may be able to explain this to the receptionist, as well, but first I'd ask to talk to the original doctor to see if she can help you until you see a new MD in the practice.

I'm sorry you're going through this. How utterly stressful.
posted by sockermom at 3:45 PM on February 10, 2017 [13 favorites]

In your shoes (and I've been in similar situations), I would call your prior prescriber and ask for an interim refill until you can see a new psychiatrist. If she asks, tell her you did not feel confident in the NPs approach or tell her directly that the NP would not refill the prescription and you think that will undermine your ability to function at work.

Good luck. This is pretty stressful.

(I have no opinion or advice on the testing)
posted by crush-onastick at 3:47 PM on February 10, 2017 [5 favorites]

Best answer: Also, how is the test going to work if you are taking your script still? That seems really strange, and this NP is not making clear choices about your diagnosis or treatment here. Stopping a drug like this cold turkey is usually not a good idea, either. Frankly, this is ridiculous of the NP and I would want to see someone different altogether after being essentially accused of drug-seeking. If your were drug-seeking, your record would clearly show things like "keeps losing medication and asking for new scripts" or "says dosage is not working, upped dosage for third time." Mentioning drug seeking to you is so offensive and out of line. I am really angry on your behalf.
posted by sockermom at 3:48 PM on February 10, 2017 [25 favorites]

Response by poster: Another question: if the test comes up as negative, will all psychiatrists in the future see that as definitive and reject a diagnosis? Or would I still be able to go elsewhere and get a prescription?
posted by naju at 4:11 PM on February 10, 2017

This is incredibly unprofessional of the NP. Is there no other doctor in the practice that you can insist on seeing? You have an existing file and history with this practice, if what you've been doing ain't broke there seems to be no legitimate medical reason to fix it. I would push back.
posted by vignettist at 4:12 PM on February 10, 2017 [11 favorites]

Who cares how awesome and accurate the test is? You don't want to risk your livelihood on it and you sure as hell do not want to un-medicate yourself to show what you're like when you're unmedicated. Pay your old psychiatrist out of pocket. [Edit - I would never ever risk doing a test like this that might put an entry in your record that you don't need the meds.]
posted by fingersandtoes at 4:12 PM on February 10, 2017 [7 favorites]

Don't forget, doctors' offices get paid for the testing they do and the follow up visits. On that alone I probably would push back, but to address your question about the results following you, I don't know the answer to that, but the question alone would make me push back with a big hell no.
posted by vignettist at 4:13 PM on February 10, 2017 [2 favorites]

You are getting caught up in headgames!! Do not play this game!!

Call your original psychiatrist for Rx and for rec's for a new MD. Forget forget forget this silly person and their AGENDA that has zero nothing nix to do with your medical care and current wellbeing.

Why would you ever for a moment throw away your progress to play along with this person's power trip??

You can shrug off the guilt she laid on you, you are not a drug seeker. Also please please please report to your old psychiatrist how this person she is referring treated you! How dare this person undermine your treatment plan. You did not ask for a second opinion, you were fine. Continue to be fine by ignoring this blip and return to working on yourself.
posted by jbenben at 4:35 PM on February 10, 2017 [10 favorites]

Adderall is a really short-acting drug, so it wouldn't be necessary for the OP to be unmedicated for any longer than the day of the test.

Having said that, I think you should do everything in your power to be under the care of a psychiatrist who works with people with ADD. If it's your psychiatrist's clinical assessment that you need neuropsych testing, that's fine, but that's a determination that should be made by a competent professional, not by someone who's covering their ass because they aren't really qualified to deal with your condition or the meds you need. If your new psychiatrist agrees that you need the testing, then you can ask that person how the tests handle the problem of hyperfocus, which is a phenomenon with which they should be familiar. It's common for people with ADHD to be able to focus very intensely in certain circumstances, and there's no way that current diagnostic tests would misdiagnose everyone who has that trait.
posted by ArbitraryAndCapricious at 4:39 PM on February 10, 2017 [9 favorites]

Also, the NP was disinterested in your treatment history? That's strike Number One. There is no Strike Two! Being concerned with your treatment history and symptoms IS HER ONLY JOB!

She blew it. Report her behavior so your old psychiatrist can stop referring her.
posted by jbenben at 4:39 PM on February 10, 2017 [15 favorites]

Now I'm worried that all of the amazing progress and changes to my life will go away because I won't pass the testing.

Toxicologist here. On the surface, I focus on statements like this. You haven't taken this test yet, but you're worried that you might not pass muster. You're anticipating events that haven't happened. Posing this same question after a test with results you don't agree with would be a different situation, but you've been asked by a trained medical caregiver to engage in a routine assessment practice.

By all means bring up your concerns with the NP, but your causes for concern--tests aren't real world, testing environments aren't the real world--betray your lack of trust that these methods have gone through validation processes that have very real, very objective measures in medicine. And, again, the test hasn't taken place yet. You and your NP stand to learn from tests, and that means you may find that the results lead to even better treatment regimes. Or possibly even no change from the status quo, but with baseline record of your situation at the time you switched to a new provider. Caregiving transition is an ideal time to take measurements of progress over time, and it adds to a long term record of your care that will further help you as you move through other caregivers in the future.

Be well.
posted by late afternoon dreaming hotel at 5:19 PM on February 10, 2017 [1 favorite]

I am not anti-testing or exploration by any means, but it sounds to me like the NP is being unnecessarily paranoid and pushing back on your diagnosis and established effective treatment without reason other than "many people are drug seeking." I suggest contacting your old doc to ask her for the prescriptions you refused and recommendations for a new in-network doc. A documented psychiatric history at the same practice should be more than enough to "prove" you need your medication. This is a shitty position to be put in and, for that alone, I would look for a more supportive, personalized treatment provider, even if that person has different ideas or approaches. I think it's easy to lose sight of how difficult it is to find a life-changing diagnosis and effective treatment and how precarious acess to that treatment is when it comes in the form of a highly controlled substance. It may seem like small potatoes to some people, but when you've been through it, the very thought of losing what works is terrifying, which doesn't mean you're an addict, just that you are being successfully treated. Good luck!
posted by katemcd at 6:06 PM on February 10, 2017 [13 favorites]

"-betray your lack of trust that these methods have gone through validation processes that have very real, very objective measures in medicine."

I'm no doctor but I have AD/HD, have been around the forums for more than a decade, and this is nowhere near as true in the psych world as it is in toxicology. Particularly since the NP expressed ahead of time that her goal is to re-prove an existing diagnosis with an eye toward exposing drug-seeking malingering. I've had a professional throw drugs at me without a second glance due to my existing diagnosis, and another string me along for four months because they believed I was subconsciously afraid of dying from a different chronic medical condition and didn't have AD/HD -- only fessing up at the end, admitting their prior skepticism and that they now believed my diagnosis.

The boards are full of stories of insurance companies, doctors, psychologists, pharmacists, whoever; screwing us over when we depend on them because of their own biases and preconceptions -- like the psych version of "you just need to lose some weight".

Having psych tests done by a professional I already trust, fine, no problem. Have done so several times. A new one who's expressing skepticism? Dump them and move on.
posted by traveler_ at 6:19 PM on February 10, 2017 [25 favorites]

I don't know what privileges nurse practitioners have, but is it possible that she is doubling down on the testing because she simply doesn't have the authority to prescribe medication on an ongoing basis without the quantitative backup the test would provide?

If that's the case, then the testing isn't about you, it's about the fact that your mental health providers are understaffed and are trying to make NPs do MD-level stuff, with resulting inconveniences to the patients.

If that's the case, their staffing issues should not be your problem. Please contact your old doctor, explain what is going on, and insist on being seen by an MD as soon as possible. Personnel problems should not be allowed to derail your quality of life. Best of luck.
posted by delight at 6:21 PM on February 10, 2017 [4 favorites]

I have been though the testing, though my assessor broke it up into two appointments. It was tiring, but not difficult, and it was enlightening to learn where my deficits actually were, according to the tests. In my case, I have issues remembering strings of more than 5 numerals, lists with more than 4-5 items on them, and I fumble with figuring out things *quickly* like, "Which complex shape is the same as this other complex shape?" Where one of them is rotated. I can do it, it just takes me a little longer than average, apparently.

I don't really see how you would be able to "play to the test" since these things aren't really cheat-able. One of the tests I took was where you listen to a voice saying 1 or 2, and you click a button every time you hear 2. You can't really cheat on that. Another was, "Here's a string of numbers: 1 8 3 2 6 3 9 4 0....repeat them back to me. Here's another string, repeat them in reverse." Only one of the tests was a questionnaire where you answered questions about how your mind works. I think my favorite one of those, the one that sums up my issues for me, was: "I forget to remember things." I forget to remember things. That's it in a nutshell.

Anyway. If I were you, I'd take the tests. I think you'll find it interesting and helpful to know where your strengths and weaknesses are. And remember that even if you have to stop taking Adderall for a while, you're not going to "lose ground". You've no doubt developed coping skills before you were on it, and you still have those. If a stimulant helps you, and it sounds like it does, you could drink coffee, or even buy some caffeine pills from Vitamin Shoppe or similar, and use that as a substitute until you complete your testing. Or, you can just not take anything. Adderall's effectiveness isn't cumulative--just the opposite, taking a break from it makes it MORE effective and keeps you from developing a tolerance. A lot of people don't take ADHD medication on the weekends or whatever for that very reason.

I took Adderall for almost exactly a year, but found that the benefit that I got from it didn't really outweigh the expense and side effects, so I stopped taking it.
posted by Autumnheart at 6:26 PM on February 10, 2017 [1 favorite]

In terms of why you feel overwhelmed and procrastinate until you are on the very precipice of your deadline, or leaving bills unpaid and neglected until they're long overdue--I think you know medication doesn't help those things either. For me, Adderall *tuned* me. I compared it to feeling like I was listening to a radio station that was just off signal, and Adderall put me on signal so that I could receive messages clearly. I remember how that felt.

But I also realized, having gone through a period of enormous stress where I had way too much on my plate, and then recovering from it when my workload dropped down to a downright easy load instead of a killer one....it's a hell of a lot easier to focus when you don't have a million things to do.

So in the meantime, I would recommend not stressing about the testing, because from my perspective, I found it interesting, informative and helpful. Secondly, you know there are other tools to help you out besides medication, and even if your NP didn't renew your prescription, there is no reason you couldn't seek out a psychiatrist that specializes in ADHD and have them help you. You said yourself that Adderall isn't a magic bullet, and I agree, it isn't. It's a good tool, but it's not your only tool.
posted by Autumnheart at 6:42 PM on February 10, 2017 [1 favorite]

IAAD but IANYD.

Get a new psychiatrist. Make sure your records from your prior MD are sent to the new psychiatrist. This is silly. Even if you did the neuropsych testing--which can certainly be useful but is not warranted in this case--do you want a long-term relationship with this provider? And I'm obviously biased, but I'd look for an MD over NP.
posted by namemeansgazelle at 6:59 PM on February 10, 2017 [10 favorites]

Testing aside, I find it weird that a nurse practioner feels able to set aside a psychiatrist's diagnosis. I have the greatest respect for nurses but psychiatry is a specialised field and requires a heck of a lot of years of training. Medicine is very hierarchical, I would not have thought they could do this unless there was a dangerous situation in which case they could help by raising their concerns to another psychiatrist to get you a second opinion. Where I live, a GP wouldn't presume to act in place of a specialist, they would refer you. It doesn't sit right with me that a non MD would.

I would recommend finding another psychiatrist.
posted by kitten magic at 8:21 PM on February 10, 2017 [11 favorites]

I literally just did this testing last week and had all the exact same fears you did - I test well, I'm good at puzzles. After I wailed "you mean I have to sit here for fifteen whole minutes?" at the beginning of the X test, I cheated and put music on to help me focus. I tried really hard. I kept missing the stupid X.

Results came back yesterday and I'm off the charts ADHD. I don't think it will work against you as much as you fear.
posted by annathea at 8:41 PM on February 10, 2017

That said, I do agree with other posters who recommend you change psychiatrists.
posted by annathea at 8:44 PM on February 10, 2017 [2 favorites]

Best answer: IAAD. I also have pretty significant inattentive type ADHD that wasn't diagnosed until I started medical school. I did neuropsych testing two years after my ADHD dx to check if I had other learning issues, and as per the doctor's instructions I did the tests while on my stimulants. The tests pretty resoundingly concluded I had ADHD, manifesting in (unsurprisingly) poor executive function, and moderately well compensated by my meds. The report was very comprehensive and instructive in analyzing how I learn and work. If your insurance will cover the testing, which is long and expensive, I would highly recommend it. I had interviews and tests with two psychologists and the neuropsychiatrist during the full day of evaluation, and got a twenty page report at the end. If you have ADHD, no matter which sort or how small, a good neuropsych eval will find it. If you don't have it, it'll turn up the deeper underlying condition and you can target that directly to make more and better progress than you have with stimulants.

I would also highly recommend seeing another psychiatrist, because this NP has set a very poor start for what needs to be your most trusted medical relationship. No matter what the test results say, you already feel like she doesn't trust you and isn't interested in your well being, and since you have the option of finding another provider there's no reason for you to try to work around that right now.
posted by demons in the base at 9:00 PM on February 10, 2017 [15 favorites]

My doctor is not in my insurance network, so I just pay her out-of-pocket $25/month for the prescription, which is usually mailed to me. My insurance covers the cost of the prescription. Could this be an option with your doctor?

(We've had this arrangement for years. I had been taking Adderall for 5+ years when my previous doctor retired. She referred me to my new doctor and I took my records to the first appointment. Since then, I've called her every month to request a refill—sometimes we chat a couple of minutes, but usually I just leave a message.)
posted by she's not there at 10:45 PM on February 10, 2017 [1 favorite]

Best answer: i say this in every adhd thread but there is no way i would ever trust my adhd med prescribing and treatment to anyone other than a neurologist who specializes in adhd. no neurologist has ever tried to talk me out of stimulant meds for overblown hysterical reasons with no basis in reality.
posted by poffin boffin at 11:07 PM on February 10, 2017 [5 favorites]

Best answer: Dude, I don't even really believe in my own psychiatric diagnoses and I've been known to say things like "What if there's no such thing as ADD, there's only modernity?" and I would nope the fuck out of this NP's entire time zone and into the practice of a doctor who did not open our very first meeting with "A lot of people in your position are lying criminals."

It's not even about the validity of the testing, per se, which might be useful for identifying specific deficits or treatment ideas. It's the combination of awful bedside manner generally, setting you up for an adversarial relationship with your practitioner where you have to "prove" that you are sick enough to access treatment specifically, not trusting or respecting the opinion of your previous doctor, and finally, being completely willing to change a well-managed course of treatment on which you are stable and high-functioning for no real reason and without knowing much about you. Psychiatric conditions are tricky to manage, and I think it's unwise to fuck around with meds when things work. Like, I would want the justification to be something like, "It will make your left leg fall off," not "I like everyone to take these tests because drug-seekers haven't figured out how to game them yet." I would politely thank her and then find a doctor who did not want to fuck around with the medication that kept shoes upon my children's feet and food in their mouthes.
posted by Snarl Furillo at 12:06 AM on February 11, 2017 [16 favorites]

Best answer: Disclaimer: I am a physician but not a psychiatrist.

When taking over a patient's care, I obviously need to form my own opinion about their case. That's a given. BUT, the right way to do this, IMO, is to continue current treatment while getting to know the patient and finding out as much about their situation as I can. Not by treating the case like an empty slate. IF I then discover some new facts, or if I form a different opinion from the other doc, then of course I'd be recommending a change. But this?

It's a different thing to say, "As I am taking over your care, I would like to know more about your condition and how you are functioning, in as much detail as possible, so let's do some additional testing".

It's quite another to say, "I assume the previous diagnosis is likely to be wrong and you might be a liar, so I need you to undergo this testing so I am satisfied that your diagnosis is correct".

As a doc, I would like to know if a provider I referred a patient to acted this way. I would not want to send another one their way again - I do not want a possibly vulnerable person to be bullied.

And as a patient, I'd find this offensive and unnecessarily adversarial, as noted above. I'd also feel very unsafe and vulnerable with this provider. I wouldn't want to deal with this kind of power trip.
posted by M. at 1:56 AM on February 11, 2017 [19 favorites]

Find a doc you are comfortable with. This is so important in general, but specifically with mental health.
posted by kbbbo at 8:01 AM on February 11, 2017 [1 favorite]

Find another heath care provider.

Sounds like the new person is scared to death of the DEA. Practices are told to limit the amount of Rx drugs the give out (eg anything with a recreational value), and they do this any way they can. Same thing happened to me when my old doc retired. The head doctor at the new practice I went to told me "we do not give anyone narcotics". I told her she was full of shit and walked out. What I didn't realize is she stopped all my Rx's without telling me. The withdrawal was awful, but I survived. Finally found a new doctor and I'm still with her today.

It was a blessing in disguise as my new doctor tried a different approach and I take very low doses of the narcotic, along with two other non-narcotic drugs. Doing grand.
posted by james33 at 8:48 AM on February 11, 2017 [2 favorites]

The nurse practitioner is not being unreasonable. Adderall has a high potential for abuse and a high street value. For every good psychiatrist like your old one who did a thorough psychiatric evaluation, there's a lazy or indifferent one who prescribe adderall to anyone who can rattle off a list of ADHD symptoms.

A neuropsychiatric evaluation could provide you with valuable information about your strengths and weaknesses. All the tests they perform have been studied and proven to measure the things they're supposed to measure, so if you have a weakness in a certain area it will show up on the test just like it would in the real world. I did a neuropsych evaluation after a concussion and it was both informative and an interesting experience. There was no gaming the tests. It was actually often hard to guess what areas some of the tests were measuring, since they give you no explanations and minimal instructions.

That being said, if getting the testing done would be a hardship for you then don't do it and find a new provider. If you don't feel comfortable seeing this nurse practitioner then find a new provider. I've taken controlled substances for sleep and most doctors don't make a fuss over this, especially if they have your old records or consent to speak to your previous psychiatrist. Contact your old psychiatrist, explain the situation, and he'll probably be more than willing to write your prescriptions for another month or two until you can see a new MD.
posted by fox problems at 10:01 AM on February 11, 2017 [1 favorite]

Response by poster: Thanks so much, everyone. On Monday I'm going to call the office, see if I can get the contact information of my old psychiatrist, and speak to her about my concerns and about seeing the MD rather than the NP. And see if she can prescribe until I'm able to see the MD. If for some reason I can't contact her, then I'll tell the receptionist about my concerns and try to switch to the MD. And plan C if that fails, just part ways with these offices and look elsewhere. I'm convinced it's entirely the wrong approach to be seeing an NP (or at least this particular, newly-hired NP) instead of an MD with confidence in making a diagnosis and with the professional intelligence and awareness to learn about my situation and suss out that I'm not just trying to get my jollies. And the latitude in their position and training to be able to prescribe without being forced to get quantitative external evidence.
posted by naju at 6:59 PM on February 11, 2017 [1 favorite]

Best answer: If for some reason I can't contact her, then I'll tell the receptionist about my concerns and try to switch to the MD.

OK, so this is perhaps a little paranoid on my part but I wouldn't tell my concerns to the receptionist. I'd try to schedule an appointment with the MD maybe but I'd be wary of telling the receptionist why. For all you know your concerns might be repeated to the MD as "they couldn't get Adderal from the NP so they want to switch to you". In other words, I'd prefer to explain my concerns directly to the person who is both competent to make the distinction between drug seeking vs non-drug-seeking and has the power to resolve the situation. I wouldn't want them to hear it from the receptionist first.

Good luck!
posted by M. at 9:21 AM on February 12, 2017 [8 favorites]

Best answer: I would just say that you realized you'd be more comfortable being treated by an MD, not a NP. They may not love that, but I don't think they'll read it as drug seeking.
posted by ArbitraryAndCapricious at 9:23 AM on February 12, 2017 [3 favorites]

Best answer: If you do decide to get tested, do some research first on what exactly the specific tests you'll be taking will involve and how they deal with the issues you mention.
I had to go through this kind of evaluation once, at a center that specialized in ADD. The test I took was not at all like most of the descriptions here - it took about an hour (all in front of a computer), there were no other components to the evaluation, each of the tasks was very short, the results consisted of a list of all tasks and my performance as a percentile, with no explanation, and the testing definitely did not seem to take hyperfocus into account: I zoned out during part of the test, but did well on the rest of it and was thus told that I was completely normal. The psychiatrist who'd prescribed the testing was not interested in the possibility that the results might not be accurately reflective, or in asking many questions before the testing or any at all after.

So basically, when people say "the testing is definitely [whatever]," take it with a grain of salt because apparently there's a wide variety of tests and a wide variety of ways in which doctors interpret the results. (It also seems that there's a variety of types of attention deficit problems and it's not clear to me that enough is actually known about the extent of that variety to create truly comprehensive testing, but that's not a point that's likely to get you anywhere.)

This doesn't mean testing might not be helpful. But before any exam you should be able to get answers to your concerns that satisfy you, and that show the doctor in question is familiar with the issues you bring up. (And frankly, if you can find a doctor who either won't require testing or won't regard it as gospel, that would probably be best.)
posted by trig at 3:32 AM on February 13, 2017 [2 favorites]

Response by poster: OK, so this is perhaps a little paranoid on my part but I wouldn't tell my concerns to the receptionist. I'd try to schedule an appointment with the MD maybe but I'd be wary of telling the receptionist why.
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I would just say that you realized you'd be more comfortable being treated by an MD, not a NP. They may not love that, but I don't think they'll read it as drug seeking.

Absolutely right, thanks. I'll keep it to the barebones as such when talking to the receptionist. Anything beyond that is frankly confidential and not their job/business!
posted by naju at 11:51 AM on February 13, 2017

Response by poster: I stopped by the psychiatry office to speak with the receptionist, and it went smoother than expected. While she wasn't able to connect me with the old psychiatrist no longer employed with them, she was able to transfer me from the nurse practitioner to the MD psychiatrist. While that psychiatrist won't have an opening for a new patient until April, the office will renew my prescription in the meantime. So, all seems good, and I'm cautiously optimistic that I'm at least moving away from a patient-provider relationship that seemed unduly adversarial, uninterested in my situation, and suspicious of my intentions from the outset.
posted by naju at 4:21 PM on February 13, 2017 [7 favorites]

I am so glad to hear about this outcome. It is always smart to move away from and adversarial, suspicious, uninterested healthcare provider. Taking charge of a situation like this can be super hard, so it's awesome that you did it promptly and handled it so well!
posted by sockermom at 5:13 PM on February 13, 2017 [1 favorite]