Should my friend complain about his psychiatrist?
March 22, 2010 2:10 PM Subscribe
Should my friend file a complaint against his doctor and, if so, how?
My friend has just returned from a visit to a psychiatrist who denied giving him prescription for what we think is his ADHD (inattentive one) - which I assume she (the doc) has full right to do.
However, she was also rude to the point of alleging my friend is a pot smoker (not true) and is looking to improve his performance without ditching the habit (also not true). He says he was thrown off balance by her questions which included gems like "If I was to test you for marijuana right now, what would the results say?" and "You do know that smoking pot makes people less organized and gives them ADHD-like symptoms?"
In the end, she refused to put him on medication because he did well in school - that is grade school through high school, mind you, not university, where he is struggling. She also mentioned that once she prescribed some meds to a student she didn't think had ADHD and that student ended up being hospitalized with psychosis.
So she based her decision on her assumption my friend was a pot-smoker, her fear of having a second case of psychosis, and his performance in school as a kid, overlooking the abundance of symptoms that manifest in his everyday life and make him struggle.
My friend is now going to get tested at a different facility but he isn't sure how to deal with the psychiatrist he just saw. Obviously, she caused no real harm and it's not the kind of mistake a doctor should get sued over, but is there something he can do to tell her employer he had an unpleasant and off-putting experience with her?
If so, how should he go about it?
Or maybe we both are overreacting and we should let this thing go and he should concentrate on getting a more qualified second opinion. What say you, hivemind?
My friend has just returned from a visit to a psychiatrist who denied giving him prescription for what we think is his ADHD (inattentive one) - which I assume she (the doc) has full right to do.
However, she was also rude to the point of alleging my friend is a pot smoker (not true) and is looking to improve his performance without ditching the habit (also not true). He says he was thrown off balance by her questions which included gems like "If I was to test you for marijuana right now, what would the results say?" and "You do know that smoking pot makes people less organized and gives them ADHD-like symptoms?"
In the end, she refused to put him on medication because he did well in school - that is grade school through high school, mind you, not university, where he is struggling. She also mentioned that once she prescribed some meds to a student she didn't think had ADHD and that student ended up being hospitalized with psychosis.
So she based her decision on her assumption my friend was a pot-smoker, her fear of having a second case of psychosis, and his performance in school as a kid, overlooking the abundance of symptoms that manifest in his everyday life and make him struggle.
My friend is now going to get tested at a different facility but he isn't sure how to deal with the psychiatrist he just saw. Obviously, she caused no real harm and it's not the kind of mistake a doctor should get sued over, but is there something he can do to tell her employer he had an unpleasant and off-putting experience with her?
If so, how should he go about it?
Or maybe we both are overreacting and we should let this thing go and he should concentrate on getting a more qualified second opinion. What say you, hivemind?
He should concentrate on getting a more qualified second opinion.
If she gets the impression from him that he's seeking narcotics, then she has a right to be cagey. Obviously she somehow got that impression. Who knows what happened?
posted by anniecat at 2:15 PM on March 22, 2010
If she gets the impression from him that he's seeking narcotics, then she has a right to be cagey. Obviously she somehow got that impression. Who knows what happened?
posted by anniecat at 2:15 PM on March 22, 2010
refusing to believe he has ADHD because he did well in school strikes me as being borderline incompetent, for a psychiatrist.
You can't really prove someone has ADHD since the symptoms are so subjective. There aren't any real signs. She doesn't think he has it and is seeking drugs, and a lot of people do seek that class of drugs. That class of drugs has a high potential abuse rate. He asked for her professional opinion and she doesn't want to prescribe it even though he thinks he has ADHD and wants a prescription to the point of considering suing her for not prescribing it?
I'm not sure you have any basis for complaint, but IANAL and you should probably consult one.
posted by anniecat at 2:20 PM on March 22, 2010 [1 favorite]
You can't really prove someone has ADHD since the symptoms are so subjective. There aren't any real signs. She doesn't think he has it and is seeking drugs, and a lot of people do seek that class of drugs. That class of drugs has a high potential abuse rate. He asked for her professional opinion and she doesn't want to prescribe it even though he thinks he has ADHD and wants a prescription to the point of considering suing her for not prescribing it?
I'm not sure you have any basis for complaint, but IANAL and you should probably consult one.
posted by anniecat at 2:20 PM on March 22, 2010 [1 favorite]
Agreed with anniecat. Move along and find another doctor. If the second doctor also balks, your friend needs to consider what he is doing or saying that arouses such concern in two different doctors.
Your assumption that the doctor is incompetent or unethical seems unwarranted.
posted by dfriedman at 2:20 PM on March 22, 2010 [3 favorites]
Your assumption that the doctor is incompetent or unethical seems unwarranted.
posted by dfriedman at 2:20 PM on March 22, 2010 [3 favorites]
I say report her. I don't know where since you don't mention where your friend is, but there are State boards and the AMA if you are in the States.
I was once lectured about "living in sin" and read a poem by the Pope and accused of being molested by my father (WTF??) when I went into a GP for an anti-depressant prescription as recommended by my counselor. I was in no emotional state to deal with it at the time, but I often regret that I didn't report him because who knows how many other people got the same kind of treatment from him.
posted by Kimberly at 2:21 PM on March 22, 2010
I was once lectured about "living in sin" and read a poem by the Pope and accused of being molested by my father (WTF??) when I went into a GP for an anti-depressant prescription as recommended by my counselor. I was in no emotional state to deal with it at the time, but I often regret that I didn't report him because who knows how many other people got the same kind of treatment from him.
posted by Kimberly at 2:21 PM on March 22, 2010
Putting in a complaint can be stressful and combative, depending on the procedures where you are. Find out from someone local exactly what it would entail for him - you'll need local knowledge as to how things work there.
That said, the questions then are - is this doctor's behaviour likely to harm other people in future? And if so, is the harm enough to justify the added stress to your friend that putting in a formal complaint will do?
Everyone I know who has had contact with psychiatric services has had a psych who has made them cry by being a bastard. There are some great people in mental health, and there are others who are in mental health because they really wanted to be another kind of doctor but didn't make the grade and take out their frustrations on patients. Nasty to be on the receiving end of, but important to remember that it's not you, and you need to find one of the nice psychs. Focus on that if nothing else.
posted by Coobeastie at 2:21 PM on March 22, 2010
That said, the questions then are - is this doctor's behaviour likely to harm other people in future? And if so, is the harm enough to justify the added stress to your friend that putting in a formal complaint will do?
Everyone I know who has had contact with psychiatric services has had a psych who has made them cry by being a bastard. There are some great people in mental health, and there are others who are in mental health because they really wanted to be another kind of doctor but didn't make the grade and take out their frustrations on patients. Nasty to be on the receiving end of, but important to remember that it's not you, and you need to find one of the nice psychs. Focus on that if nothing else.
posted by Coobeastie at 2:21 PM on March 22, 2010
My experience is that nine out of ten psychiatrists are complete shit. Purely subjective, mind you, but that's what I've found.
Here's how to file a government complaint against a psychiatrist in Massachusetts.
posted by koeselitz at 2:21 PM on March 22, 2010 [2 favorites]
Here's how to file a government complaint against a psychiatrist in Massachusetts.
posted by koeselitz at 2:21 PM on March 22, 2010 [2 favorites]
Oh, and I think you should report this psychiatrist. If we don't respond when psychiatrists are crap, nothing will ever change. It won't be hard - the form is a simple one, only two pages, and you can fill it in and turn it in and let it go that way, knowing you've done everything you can officially for the situation.
posted by koeselitz at 2:24 PM on March 22, 2010
posted by koeselitz at 2:24 PM on March 22, 2010
Ah - sorry, there's no form for a psychiatrist. You just send a letter to the Board of Registration in Medicine. Just as easy, anyway; write it out, send it in, and you're done.
posted by koeselitz at 2:25 PM on March 22, 2010
posted by koeselitz at 2:25 PM on March 22, 2010
Before going to State boards, etc., check the employer for people who are in charge of patient relations. Try to get an explanation in or complaint heard before going with the "nuclear option."
Then, for your second try, have your university student friend look into what services are available through the university. The clinical staff will be used to working with students, and the service may be cheaper.
posted by whatzit at 2:30 PM on March 22, 2010
Then, for your second try, have your university student friend look into what services are available through the university. The clinical staff will be used to working with students, and the service may be cheaper.
posted by whatzit at 2:30 PM on March 22, 2010
I really don't see what the complaint is: the doctor's judgment was that she didn't want to prescribe meds for fear of instigating a psychosis. Her repeated questions about drug use are appropriate because it is common for patients to lie to their doctors, and it appears that ADHD drugs are contra-indicated in cases of marijuana use.
Indeed, if anything, it sounds more to me like she was overly conscientious than anything else. It's annoying to your friend, but he asked for a professional opinion and received one. He can see another doctor anytime he pleases. Why complain when there's been no harm?
posted by gabrielsamoza at 2:34 PM on March 22, 2010 [9 favorites]
Indeed, if anything, it sounds more to me like she was overly conscientious than anything else. It's annoying to your friend, but he asked for a professional opinion and received one. He can see another doctor anytime he pleases. Why complain when there's been no harm?
posted by gabrielsamoza at 2:34 PM on March 22, 2010 [9 favorites]
Once when I had a bad experience with a doctor's office (obstetrician), I wrote a letter to my referring GP and insurance company suggesting they stop sending patients to that doctor's group because they were rude and couldn't provide care timely. I got an ostensibly persuasive letter back suggesting they were too busy to do better. I took a copy of it, and again sent a letter to the referring GP and insurance company explaining that since this doctor was too busy to treat with respect the patients they were referring (enclosing the letter), maybe they should refer fewer patients. I then got a simple, concise letter of apology from the doctor.
A process like that might certainly make the psychiatrist doubt her immediate diagnosis of your friend as a pothead. But other than that, move on - doctors are not prescription vending machines. I don't know you, your friend or your doctor, but I do know that we expect doctors to make judgment calls about these kinds of issues. They should absolutely do it politely and professionally, but not every doctor will agree on the same diagnosis or treatment as the self-diagnosing, lay patient.
posted by bunnycup at 2:34 PM on March 22, 2010 [1 favorite]
A process like that might certainly make the psychiatrist doubt her immediate diagnosis of your friend as a pothead. But other than that, move on - doctors are not prescription vending machines. I don't know you, your friend or your doctor, but I do know that we expect doctors to make judgment calls about these kinds of issues. They should absolutely do it politely and professionally, but not every doctor will agree on the same diagnosis or treatment as the self-diagnosing, lay patient.
posted by bunnycup at 2:34 PM on March 22, 2010 [1 favorite]
anniecat: “You can't really prove someone has ADHD since the symptoms are so subjective. There aren't any real signs. She doesn't think he has it and is seeking drugs, and a lot of people do seek that class of drugs. That class of drugs has a high potential abuse rate. He asked for her professional opinion and she doesn't want to prescribe it even though he thinks he has ADHD and wants a prescription to the point of considering suing her for not prescribing it?”
Er. First of all, if you'd read the question, you'd have seen that the poster said distinctly that they did not want to sue over this, that this is clearly a situation where the doctor shouldn't get sued. And secondly, more importantly, this is flatly not true. ADD has objective, definitive, very real symptoms which can be clearly identified. To say that these symptoms are "subjective" is to misunderstand or misrepresent ADD for what it is. Here is the criteria matrix from the DSM-IV for ADD. It's very clear and precise; there can be no misunderstanding as long as you're careful.
The trouble in this case is that a psychiatrist seems to have the same misunderstanding as anniecat about ADD. And that simply should not be.
posted by koeselitz at 2:39 PM on March 22, 2010 [2 favorites]
Er. First of all, if you'd read the question, you'd have seen that the poster said distinctly that they did not want to sue over this, that this is clearly a situation where the doctor shouldn't get sued. And secondly, more importantly, this is flatly not true. ADD has objective, definitive, very real symptoms which can be clearly identified. To say that these symptoms are "subjective" is to misunderstand or misrepresent ADD for what it is. Here is the criteria matrix from the DSM-IV for ADD. It's very clear and precise; there can be no misunderstanding as long as you're careful.
The trouble in this case is that a psychiatrist seems to have the same misunderstanding as anniecat about ADD. And that simply should not be.
posted by koeselitz at 2:39 PM on March 22, 2010 [2 favorites]
I'm not making excuses for the doctor's behavior as it seems it was very unprofessional, but maybe she's been burned with patients claiming ADHD to just get Adderall and she's now taken her methods to screen her patients way too far. You mentioned her employer - if she does work for a medical group, I think it would be smart for your friend to write them a letter of complaint detailing her actions.
If your friend finds the next psychiatrist to be trustworthy and understanding, perhaps he can get their opinion as to whether the complaint should be sent to the regulatory board.
I hope your friend has better luck with the next doctor. There are terrific psychiatrists out there - I've got one.
posted by cecic at 2:39 PM on March 22, 2010
If your friend finds the next psychiatrist to be trustworthy and understanding, perhaps he can get their opinion as to whether the complaint should be sent to the regulatory board.
I hope your friend has better luck with the next doctor. There are terrific psychiatrists out there - I've got one.
posted by cecic at 2:39 PM on March 22, 2010
Just as a side note, for your friend's next facility he should absolutely insist on the use of a CPT (Continuous Performance Test) or a TOVA (Test Of Variables of Attention). If the people in that facility do not know what these are, he might be well-served by moving on. These procedures, which are not subjective, are useful titrating your medication to an appropriate level. Basically, these computerized tests (rather than personal inventories, questionnaires, etc.) test your attention (which has multiple dimensions to it) in an abstract manner. You respond to a computer; it's automated. Your friend's performance will be compared against a body of others in his age bracket and sex.
Take these not-infrequently. By adjusting the type, amount, and release pattern of medication in conjunction with these tests, he can find the best bang for his buck. Too little medication and he's not being helped. Too much and he may have side effects. These tests can help him find the top of that inverted-U curve and stay there.
Behind titration, I have seen these tests in a practice be useful in the "no, you don't have ADHD, so let's figure out what is going on" sense.
posted by adipocere at 2:40 PM on March 22, 2010 [5 favorites]
Take these not-infrequently. By adjusting the type, amount, and release pattern of medication in conjunction with these tests, he can find the best bang for his buck. Too little medication and he's not being helped. Too much and he may have side effects. These tests can help him find the top of that inverted-U curve and stay there.
Behind titration, I have seen these tests in a practice be useful in the "no, you don't have ADHD, so let's figure out what is going on" sense.
posted by adipocere at 2:40 PM on March 22, 2010 [5 favorites]
It's hard to advise you whether your friend should file the complaint. What I mean is, it's hard for me to take the facts as given at face value.
I have a problem with this part: "So she based her decision on her assumption my friend was a pot-smoker, her fear of having a second case of psychosis, and his performance in school as a kid, overlooking the abundance of symptoms that manifest in his everyday life and make him struggle."
This sounds very subjective and second-hand. Do you know this for sure? Or is this your friend, in a very agitated state, relating his side of the story? How does your friend know he has ADHD and should have been given the meds?
If you are asking if a psychiatrist that refuses to prescribe medication should be reported, then I would think probably not. It sounds like your friend is getting a second opinion from a new doctor, and that is a good course of action.
posted by jabberjaw at 2:45 PM on March 22, 2010
I have a problem with this part: "So she based her decision on her assumption my friend was a pot-smoker, her fear of having a second case of psychosis, and his performance in school as a kid, overlooking the abundance of symptoms that manifest in his everyday life and make him struggle."
This sounds very subjective and second-hand. Do you know this for sure? Or is this your friend, in a very agitated state, relating his side of the story? How does your friend know he has ADHD and should have been given the meds?
If you are asking if a psychiatrist that refuses to prescribe medication should be reported, then I would think probably not. It sounds like your friend is getting a second opinion from a new doctor, and that is a good course of action.
posted by jabberjaw at 2:45 PM on March 22, 2010
The psychiatrist did the right thing. I'm not sure she handled the intake session as others might, but her decision, even if it was based solely on his performance in school as a child, is a very correct and courageous stand to take. ADD does not develop as an adult. Adult ADD is diagnosed with specific markers showing a pattern since childhood. In other words, Adult ADD is simply ADD discovered and treated late. It's sudden appearance at a late age calls for a completely different diagnosis. Many psychiatrists will go ahead and hand out the drugs. The fact she did not, under the circumstances described by the OP, shows she is a conscientious psychiatrist. She was right.
posted by Gerard Sorme at 2:55 PM on March 22, 2010 [4 favorites]
posted by Gerard Sorme at 2:55 PM on March 22, 2010 [4 favorites]
I hate it when I do this.....grrrr..."Its sudden appearance..."
posted by Gerard Sorme at 2:57 PM on March 22, 2010
posted by Gerard Sorme at 2:57 PM on March 22, 2010
Agreeing with those who say that the doctor did the right thing, even if it wasn't in a manner that your friend appreciated.
I have seen 14 psychiatrists in the last 13 years. Not one of them would have taken me at my word for my diagnosis and medications. They would only incorporate previous medical opinions into their own, which they set out to form in the initial meeting. This meant that I went through 14 separate 1-3 hour intakes. In my case the diagnosis (bipolar) was the same for each and every one, but if even ONE doctor had thought it was incorrect, I sure as hell would have wanted to know about it.
If your friend went in saying "I have ADD and I want a renewal of medication X", he should not have had any expectation that he would walk out of there with a script, if the doctor was any good. He would have been assessed anew, and then given the opinion by that doctor. And yes, requesting a particular medication will send up a HUGE red flag for drug-seeking, as well it should.
Second opinion, by all means-- but a review of the diagnosis (especially given what Gerard Sorme rightfully points out above) is in order-- for your friend's own good. It certainly can't do any harm.
posted by mireille at 3:24 PM on March 22, 2010
I have seen 14 psychiatrists in the last 13 years. Not one of them would have taken me at my word for my diagnosis and medications. They would only incorporate previous medical opinions into their own, which they set out to form in the initial meeting. This meant that I went through 14 separate 1-3 hour intakes. In my case the diagnosis (bipolar) was the same for each and every one, but if even ONE doctor had thought it was incorrect, I sure as hell would have wanted to know about it.
If your friend went in saying "I have ADD and I want a renewal of medication X", he should not have had any expectation that he would walk out of there with a script, if the doctor was any good. He would have been assessed anew, and then given the opinion by that doctor. And yes, requesting a particular medication will send up a HUGE red flag for drug-seeking, as well it should.
Second opinion, by all means-- but a review of the diagnosis (especially given what Gerard Sorme rightfully points out above) is in order-- for your friend's own good. It certainly can't do any harm.
posted by mireille at 3:24 PM on March 22, 2010
jabberjaw,
This phrase makes me doubtful:
"...a psychiatrist who denied giving him prescription for what we think is his ADHD (inattentive one)"
Who are "we"? And why do "we think" this friend requires medication for ADHD?
posted by keep it under cover at 3:25 PM on March 22, 2010
This phrase makes me doubtful:
"...a psychiatrist who denied giving him prescription for what we think is his ADHD (inattentive one)"
Who are "we"? And why do "we think" this friend requires medication for ADHD?
posted by keep it under cover at 3:25 PM on March 22, 2010
A doctor is well within their rights to make a diagnosis, and prescribe, or not, accordingly. But if the doctor was rude, accusing and unprofessional, the patient can write to the employer, if there is one, can ask the insurance company not to pay for services, and can give the doc a bad review.
Every state has a License Review Board, which is usually part of the Attorney General's office, and can be found on the state's website. You can complain to them. This is not an issue that would affect licensure, but they do keep a record, and if there are a bunch of complaints, will initiate some action.
And, it's good to take action when someone shames you. It helps you stand up straight again when you get knocked around. The action should be calm and polite, even if the shrink wasn't.
posted by theora55 at 3:54 PM on March 22, 2010
Every state has a License Review Board, which is usually part of the Attorney General's office, and can be found on the state's website. You can complain to them. This is not an issue that would affect licensure, but they do keep a record, and if there are a bunch of complaints, will initiate some action.
And, it's good to take action when someone shames you. It helps you stand up straight again when you get knocked around. The action should be calm and polite, even if the shrink wasn't.
posted by theora55 at 3:54 PM on March 22, 2010
I can really sympathize with feeling unfairly accused by a psychiatrist (I see a lot of people who are diagnosed with all kinds of stuff I don't agree with, and as a kid I was misdiagnosed too).
But it's also really difficult for psychiatrists--because the stuff they prescribe can, at times, be rendered quite dangerous when combined with recreational substances, and so it's really important to have accurate info about a person's current state. I also want to say that AD/HD is only one potential cause of struggling in school, and she may have been seeing another set of symptoms that made her suspect something else (depression, anxiety, learning difference, sensory issue, something else neurological, whatever). Being that AD/HD is the most overmedicated thing in young people, it's perhaps a prudent decision on her part not to have just thrown pills at him without a second thought.
It's not ok to be rude (not helpful to any patient, certainly), but it's also not a breach of ethics to be rude. And it's not a breach of ethics to fail to confirm a self-diagnosis. It's probably best to pursue a different psychiatrist with better people skills, and try to just move on from here.
posted by so_gracefully at 3:56 PM on March 22, 2010 [1 favorite]
But it's also really difficult for psychiatrists--because the stuff they prescribe can, at times, be rendered quite dangerous when combined with recreational substances, and so it's really important to have accurate info about a person's current state. I also want to say that AD/HD is only one potential cause of struggling in school, and she may have been seeing another set of symptoms that made her suspect something else (depression, anxiety, learning difference, sensory issue, something else neurological, whatever). Being that AD/HD is the most overmedicated thing in young people, it's perhaps a prudent decision on her part not to have just thrown pills at him without a second thought.
It's not ok to be rude (not helpful to any patient, certainly), but it's also not a breach of ethics to be rude. And it's not a breach of ethics to fail to confirm a self-diagnosis. It's probably best to pursue a different psychiatrist with better people skills, and try to just move on from here.
posted by so_gracefully at 3:56 PM on March 22, 2010 [1 favorite]
And secondly, more importantly, this is flatly not true. ADD has objective, definitive, very real symptoms which can be clearly identified. To say that these symptoms are "subjective" is to misunderstand or misrepresent ADD for what it is. Here is the criteria matrix from the DSM-IV for ADD. It's very clear and precise; there can be no misunderstanding as long as you're careful.
I'm making a distinction between symptoms and signs that you failed to pick up on. Symptoms are subjective. A patient can have a headache, but you can't test for a headache. A patient can say he feels light headed but you can't test his blood or bodily fluids for it. Signs you can verify through tests.
You're entitled to your opinion on the matter, koeselitz.
posted by anniecat at 4:04 PM on March 22, 2010
I'm making a distinction between symptoms and signs that you failed to pick up on. Symptoms are subjective. A patient can have a headache, but you can't test for a headache. A patient can say he feels light headed but you can't test his blood or bodily fluids for it. Signs you can verify through tests.
You're entitled to your opinion on the matter, koeselitz.
posted by anniecat at 4:04 PM on March 22, 2010
If she's so scared of inducing psychosis she shouldn't be a psychiatrist--many psychiatric meds can induce psychosis.
I suppose this is like any side effect: there are time when it is worth it and times when it isn't. This doctor decided this case was in the latter category. That's all.
posted by gabrielsamoza at 4:07 PM on March 22, 2010
I suppose this is like any side effect: there are time when it is worth it and times when it isn't. This doctor decided this case was in the latter category. That's all.
posted by gabrielsamoza at 4:07 PM on March 22, 2010
So she based her decision on her assumption my friend was a pot-smoker, her fear of having a second case of psychosis, and his performance in school as a kid,
Even if the doctor cited these reasons for not prescribing, she may have actually based her decision not to prescribe on her opinion that your friend doesn't have ADD.
Obviously, she caused no real harm and it's not the kind of mistake a doctor should get sued over,
Thank you for not suing over what amounts to rudeness. Overly litigious patients are one of the reasons US health insurance is as expensive as it is.
but is there something he can do to tell her employer he had an unpleasant and off-putting experience with her?
Write a letter of complaint to the doctor's employer. Even if it by itself does nothing, it's a written record of an unhappy patient. If the doctor makes a habit of being rude, it may help to lay (or add to an existing) foundation of negative feedback about this doctor for the employer to consider in future performance evaluations.
What your friend needs is a second opinion. His experience is the reason for the existence of the phrase.
posted by ImproviseOrDie at 4:13 PM on March 22, 2010 [2 favorites]
Even if the doctor cited these reasons for not prescribing, she may have actually based her decision not to prescribe on her opinion that your friend doesn't have ADD.
Obviously, she caused no real harm and it's not the kind of mistake a doctor should get sued over,
Thank you for not suing over what amounts to rudeness. Overly litigious patients are one of the reasons US health insurance is as expensive as it is.
but is there something he can do to tell her employer he had an unpleasant and off-putting experience with her?
Write a letter of complaint to the doctor's employer. Even if it by itself does nothing, it's a written record of an unhappy patient. If the doctor makes a habit of being rude, it may help to lay (or add to an existing) foundation of negative feedback about this doctor for the employer to consider in future performance evaluations.
What your friend needs is a second opinion. His experience is the reason for the existence of the phrase.
posted by ImproviseOrDie at 4:13 PM on March 22, 2010 [2 favorites]
I wouldn't complain about her refusing to prescribe drugs. I would focus the complaint only on the repeated accusations of marijuana use and of him trying to just use her to get drugs. Those are the things to be most concerned about, not her refusal to make a certain diagnosis or prescription.
posted by ishotjr at 4:18 PM on March 22, 2010 [1 favorite]
posted by ishotjr at 4:18 PM on March 22, 2010 [1 favorite]
The doctor acted unprofessionally; if you think someone is drug-seeking, you don't accuse them of drug seeking and attack and attempt to humiliate them. If you think someone has a marijuana problem, you try to discover their frequency of use, whether it is getting in the way of school and relationships and whether the person themselves thinks its a problem. This can help you determine whether they have a diagnosable addiction and if so, how to help. The most effective way to reach drug addicts is to be compassionate and ally yourself with them: attack and dismiss leads to the type of results we are discussing here.
A large percent of people with ADHD *do* self medicate by using marijuana-- this is exactly why psychiatrists *should* prescribe for them before they start self-medicating with cocaine or street amphetamine. Having both ADHD and addiction is at least as common as having either condition alone.
This person is not doing any kind of service to the people with substance misuse problems who are undoubtedly a large percent of those who walk in the door (50% of people with all types of mental illness tend to have co-existing substance misuse). Reporting her may help others avoid being driven underground when they should be receiving compassionate help.
Even if your friend *was* smoking pot and seeking stimulants to get high, this is not the way to deal with it. When someone seeks help, they should be given the benefit of the doubt and suspicions of drug use should be dealt with in a compassionate manner.
posted by Maias at 5:34 PM on March 22, 2010 [1 favorite]
A large percent of people with ADHD *do* self medicate by using marijuana-- this is exactly why psychiatrists *should* prescribe for them before they start self-medicating with cocaine or street amphetamine. Having both ADHD and addiction is at least as common as having either condition alone.
This person is not doing any kind of service to the people with substance misuse problems who are undoubtedly a large percent of those who walk in the door (50% of people with all types of mental illness tend to have co-existing substance misuse). Reporting her may help others avoid being driven underground when they should be receiving compassionate help.
Even if your friend *was* smoking pot and seeking stimulants to get high, this is not the way to deal with it. When someone seeks help, they should be given the benefit of the doubt and suspicions of drug use should be dealt with in a compassionate manner.
posted by Maias at 5:34 PM on March 22, 2010 [1 favorite]
Many people who have ADHD do fine until they hit the newly challenging and less-structured environment of college. There is an entire chapter in the excellent book "Delivered from Distraction" about this very thing. I don't think you can say that her diagnosis was right OR wrong.
That's a controversial position, frankly. ADD but no signs of distraction and performance troubles until college? Everyone is entitled to their own opinion, but I think what science there is in the area of Adult ADD overwhelmingly shows patterns from ages 5-8 or so.
IFDSSN9: We don't get into heated debate here at AskMe. You have stated your position. I have stated mine. Others have their own. That should be respected. As for asking for answers to contain sourcing and citations in a skeptical effort to devalue the opinions of others is not part of the culture here.
posted by Gerard Sorme at 5:37 PM on March 22, 2010
That's a controversial position, frankly. ADD but no signs of distraction and performance troubles until college? Everyone is entitled to their own opinion, but I think what science there is in the area of Adult ADD overwhelmingly shows patterns from ages 5-8 or so.
IFDSSN9: We don't get into heated debate here at AskMe. You have stated your position. I have stated mine. Others have their own. That should be respected. As for asking for answers to contain sourcing and citations in a skeptical effort to devalue the opinions of others is not part of the culture here.
posted by Gerard Sorme at 5:37 PM on March 22, 2010
It speaks to some sort of weird issues on her part to bring up someone else's psychotic episode out of the blue like that.
I just don't think it's very out of the ordinary for a psychiatrist to explain her diagnosis by reference to other cases. She's being quite honest about her experience and telling a probably demanding patient why she is not going to prescribe him the medication he diagnosed himself as needing. Sounds like good medicine to me.
posted by gabrielsamoza at 5:41 PM on March 22, 2010
I just don't think it's very out of the ordinary for a psychiatrist to explain her diagnosis by reference to other cases. She's being quite honest about her experience and telling a probably demanding patient why she is not going to prescribe him the medication he diagnosed himself as needing. Sounds like good medicine to me.
posted by gabrielsamoza at 5:41 PM on March 22, 2010
Indeed, if anything, it sounds more to me like she was overly conscientious than anything else. It's annoying to your friend, but he asked for a professional opinion and received one. He can see another doctor anytime he pleases. Why complain when there's been no harm?I think that's kind of bullshit. She accused of being a liar and a drug addict based on, what, the way he dressed? How is that a "professional" opinion? Because she got paid for it?
People shouldn't need to put up with crap like that.
posted by delmoi at 6:26 PM on March 22, 2010
File the complaint about the pot smoking thing, but not about the ADD thing.
Why? Because it's their job to listen to your symptoms, ask questions, run tests if necessary, and make a diagnosis. THEN you discuss treatment options. And especially with something like ADHD and the inherent risks of the medications, unless it is a slam-dunk case of it, non-medicinal solutions ought to be considered.
In the first place, they have their license (and ethics) to consider. And in the second place, professionals don't usually like it when you put the cart before the horse. And asking for speed is doing that.
(The psychosis mention, taken charitably, was probably meant to scare your friend off of trying to get speed somewhere else. Because it IS a real concern if someone doesn't need it and/or over medicates. And maybe she was trying to steer the conversation away from the suspected case of ADHD as the cause of the problems and trying to discover if there might be some other cause.)
(Also, an ADHD diagnosis requires one to have had the symptoms since childhood. One can do well in school despite having ADHD, but it isn't easy.)
posted by gjc at 8:25 PM on March 22, 2010
Why? Because it's their job to listen to your symptoms, ask questions, run tests if necessary, and make a diagnosis. THEN you discuss treatment options. And especially with something like ADHD and the inherent risks of the medications, unless it is a slam-dunk case of it, non-medicinal solutions ought to be considered.
In the first place, they have their license (and ethics) to consider. And in the second place, professionals don't usually like it when you put the cart before the horse. And asking for speed is doing that.
(The psychosis mention, taken charitably, was probably meant to scare your friend off of trying to get speed somewhere else. Because it IS a real concern if someone doesn't need it and/or over medicates. And maybe she was trying to steer the conversation away from the suspected case of ADHD as the cause of the problems and trying to discover if there might be some other cause.)
(Also, an ADHD diagnosis requires one to have had the symptoms since childhood. One can do well in school despite having ADHD, but it isn't easy.)
posted by gjc at 8:25 PM on March 22, 2010
Purely anecdotal, but in my experience, the majority of psychiatrists I have encountered lack a certain social finesse when it comes to dealing with patients. I think it has a lot to do with how they approach the world and mental health in general. This doesn't necessarily make them bad doctors or unprofessional, but it can make liking them and developing a rapport difficult. The situation you describe sounds like a prime example of this.
Asking about marijuana use and approaching the idea as a possibility in more than one way is diagnostically sound. Explaining that based on her personal past experiences with patients, psychosis is a very real concern (as long as no identifying, confidential details were disclosed), and identifying a pattern of behavior that she thinks is a contraindication of ADHD, even if you disagree or she is wrong, are also examples of good medicine. Making your friend feel like he was being accused of being a liar and a drug addict is not, but it may have more to do with lack of social graces than malice. It also sounds like she did not offer other alternatives in terms of diagnosis or treatment, which I would also say is poor doctoring, but it sounds like the exchange deteriorated pretty quickly, and if your friend only seemed interested in a particular script, it would be understandable that other possibilities were not discussed.
It's good your friend is getting a second opinion, and I understand the desire to complain, but I don't know if it is necessary or will accomplish much of anything. To me this type of behavior is endemic to the profession, and while not all psychiatrists are this way, it's pretty common and basically comes down to personality not professionalism. I think your friend's energy is better spent finding solutions to his current difficulties. Best of luck to him.
posted by katemcd at 9:57 PM on March 22, 2010
Asking about marijuana use and approaching the idea as a possibility in more than one way is diagnostically sound. Explaining that based on her personal past experiences with patients, psychosis is a very real concern (as long as no identifying, confidential details were disclosed), and identifying a pattern of behavior that she thinks is a contraindication of ADHD, even if you disagree or she is wrong, are also examples of good medicine. Making your friend feel like he was being accused of being a liar and a drug addict is not, but it may have more to do with lack of social graces than malice. It also sounds like she did not offer other alternatives in terms of diagnosis or treatment, which I would also say is poor doctoring, but it sounds like the exchange deteriorated pretty quickly, and if your friend only seemed interested in a particular script, it would be understandable that other possibilities were not discussed.
It's good your friend is getting a second opinion, and I understand the desire to complain, but I don't know if it is necessary or will accomplish much of anything. To me this type of behavior is endemic to the profession, and while not all psychiatrists are this way, it's pretty common and basically comes down to personality not professionalism. I think your friend's energy is better spent finding solutions to his current difficulties. Best of luck to him.
posted by katemcd at 9:57 PM on March 22, 2010
delmoi: She accused of being a liar and a drug addict based on, what, the way he dressed? How is that a "professional" opinion? Because she got paid for it?
People shouldn't need to put up with crap like that.
This is assuming we can trust the poster's second-hand account of what happened to the poster's friend in a conversation the poster was not a part of, considering this friend was upset about not being prescribed medication based on a self-diagnosis.
It is every professional's job to investigate any reasonable suspicions in order to ensure that all of the important facts are uncovered.
"Do you smoke marijuana?"
"No."
"Never?"
"Well, I haven't smoked it in quite a while."
"If we tested you right now, what would the results be?"
"I just told you I don't smoke pot!"
"It's just that a trend today is people who smoke pot try to get prescribed ADHD medications because of its side effects, so I get suspicious when somebody is asking for an ADHD medication prescription."
I'm not saying that's how the exchange went. It could clearly have also been: "Are you a pot-smoker?" "No." "I don't believe you. You are a pot smoker trying to get prescription medications. You will become psychotic if you do so."
If the psychiatrist was wrong, then she was wrong. But if she was right, the stakes are much, much higher for her professionally than having her patient upset about the question. It's possible she was recently reprimanded for prescribing medication in a similar situation, so she made a judgment call based on that. If she has bad beside manners, and acted like a jerk about it, that's not something I would recommend complaining to the state board about.
posted by jabberjaw at 1:39 PM on March 23, 2010
People shouldn't need to put up with crap like that.
This is assuming we can trust the poster's second-hand account of what happened to the poster's friend in a conversation the poster was not a part of, considering this friend was upset about not being prescribed medication based on a self-diagnosis.
It is every professional's job to investigate any reasonable suspicions in order to ensure that all of the important facts are uncovered.
"Do you smoke marijuana?"
"No."
"Never?"
"Well, I haven't smoked it in quite a while."
"If we tested you right now, what would the results be?"
"I just told you I don't smoke pot!"
"It's just that a trend today is people who smoke pot try to get prescribed ADHD medications because of its side effects, so I get suspicious when somebody is asking for an ADHD medication prescription."
I'm not saying that's how the exchange went. It could clearly have also been: "Are you a pot-smoker?" "No." "I don't believe you. You are a pot smoker trying to get prescription medications. You will become psychotic if you do so."
If the psychiatrist was wrong, then she was wrong. But if she was right, the stakes are much, much higher for her professionally than having her patient upset about the question. It's possible she was recently reprimanded for prescribing medication in a similar situation, so she made a judgment call based on that. If she has bad beside manners, and acted like a jerk about it, that's not something I would recommend complaining to the state board about.
posted by jabberjaw at 1:39 PM on March 23, 2010
Those links are mainly old and do not reflect any "new trend" whatsoever. And the thing is, many, many people with ADHD self-medicate *by smoking pot*. The way to deal with this is not to confront the person and make them feel bad. If you as a psychiatrist know your stuff, you know that this is *not* what the research shows to work best with addicts and you know that you are going to be dealing with a lot of addicts in your practice.
If you treat people with dignity and respect, you'll generally find that they treat you the same. If you treat people like crap, you'll generally find that they try to 'get over' and thus you have a surprisingly large number of encounters with drug addicts who lie to you in order to seek drugs. And then you'll decide that yup, addicts meet the stereotype, they are all liars and manipulators.
Want to avoid that? Want to actually practice medicine? Want to actually help people? *Listen* to the patients and don't react as though they are all conniving scum. Some people will, of course, always try to con you but most people-- even most addicts-- will not if you show them that you want to help them, not degrade and humiliate them.
posted by Maias at 5:37 PM on March 24, 2010
If you treat people with dignity and respect, you'll generally find that they treat you the same. If you treat people like crap, you'll generally find that they try to 'get over' and thus you have a surprisingly large number of encounters with drug addicts who lie to you in order to seek drugs. And then you'll decide that yup, addicts meet the stereotype, they are all liars and manipulators.
Want to avoid that? Want to actually practice medicine? Want to actually help people? *Listen* to the patients and don't react as though they are all conniving scum. Some people will, of course, always try to con you but most people-- even most addicts-- will not if you show them that you want to help them, not degrade and humiliate them.
posted by Maias at 5:37 PM on March 24, 2010
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There's probably a state medical board you can complain to.
posted by MexicanYenta at 2:14 PM on March 22, 2010