ADHD

ADHD: What Does It Take To Be Taken Seriously By Doctors?

This post by the infamous (heh heh) Tom Nardone won’t leave me alone.

What DOES it take, to be taken seriously? What will it take for public opinion to be righted in the direction of ADHD existing…and when will the power of faux “ADHD awareness” personalities on the internet be diminished? When will the medical community, even the mental health community become more widely literate in identifying and helping adults with ADHD and its comorbid conditions? What can we do to better disseminate scientific information – or to discredit the baseless supplements peddlers – or both?

It’s frustrating to hear story after story of folks who suspect that ADHD might be an issue for them, only for them to be told that (as in the case of a friend of mine) despite family history, and significant impairments in areas of their lives, they “can’t” have ADHD because they don’t meet an outdated definition. They must simply have bipolar disorder/depression/anxiety/stress…but gee, we can’t quite figure out why you’re really still not feeling better. HMMMMM.

I feel like the information is out there. We know that ADHD is real. We know that adults have it. We know that women have it. We know that people with ADHD who live untreated experience miserable outcomes – many of which wreak negative impacts on other people.

Perhaps it’s the diagnostic criteria? Maybe they just aren’t definitive enough for a large portion of practitioners to feel comfortable with? Or is there another factor?

One pattern that perplexes me, is that general practitioners will prescribe psychiatric medications without referring people to a specialist. On the one hand, this may be beneficial to some folks, who may have actually been turned back at the psychiatrist stage – after all, many psychiatrists are also reluctant to diagnose ADHD in adults. On the other hand…my own general practitioner would not dare to speculate as to the nature or source of my neurological symptoms, and I had to wait two months to talk to a neurologist. She referred another member of my household to an orthopedist, and then to a rheumatologist, for relevant symptoms. However, she prescribes ADHD medications to one of my children. Overall, we have been satisfied with the service we receive from this practitioner…but do you see what I mean? This doesn’t make sense. (Note: I already had a mental health provider before I started seeing this GP, and have maintained that relationship.)

It seems like a major inconsistency in protocols and I think it’s one that happens a lot. What ARE the protocols for a GP in this type of a situation? I have friends whose GPs prescribe all kinds of mental health medications. On the one hand – I love this idea, I mean mental health IS health. On the other hand, general practitioners cannot be expected to be specialists. With the brain being the most important organ in the body, why do we not take the treatment of its ailments more seriously than this?

Why are people with mental health issues getting 15 minute appointments with non-specialists and why does anyone think that this is adequate health care?

And on top of this – once we get past the general practitioners, why do so many specialists in the field of psychiatry still express disbelief at the symptoms of a well-documented syndrome? Even if we are able to get to a specialist – we then have to contend with skeptical specialists? Arrogant specialists? Inept specialists? I’m not sure what to think. I want to think that doctors are an important resource…but even with what I consider good specialists, I’ve had to be persistent, because indeed, treatment is an individual experience and not a perfect process. It has to be an informed and active process for both practitioner and patient. When I witness other people, with less-skilled, less-knowledgeable practitioners, and a lower sense of personal empowerment, having to fight to have their concerns taken seriously…and then internalizing the professional skepticism…or ending up feeling their questions were silly because their specialists aren’t current in the knowledge of their field…I’m very upset by this.

It’s NOT okay.

I expect mental health care that is current, and conscientious.

Wake up, America. How do we fix this? If this is the best that “the best” country in the world has to offer, we’ve got problems.

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11 thoughts on “ADHD: What Does It Take To Be Taken Seriously By Doctors?

  1. Hey Katy Thanks for the back link and I was not aware of most of this. I went to the doctor and and then to another doctor and they prescribed the medication I am still on today. Sad that so many people make the effort to just get off the couch and go to the doctor only to be asked to jump through hoops. You are awesome my dear.

  2. A very relevant question. At its heart, it can be asked about the treatment of many conditions and more so about the attitudes of physicians to different groups of patients. ADHD treatment highlights the these issues very well. Doctors who are not current, disregard/lack of protocol, dismissing or misinterpreting patients symptoms based on age and gender. These are some of the biggest questions in healthcare today.

    • Yes, I thought about that as I was writing…that this isn’t just an “ADHD” issue, though it is a huge problem for people who happen to have ADHD. We all need to be more informed and empowered consumers of healthcare but that’s a many-layered issue that probably requires a many-layered approach. Something I think about a lot.

  3. Oh boy, where do I begin with my comment. First, thank you for sharing this Katy. Confession time. Despite having ADHD myself, I have mixed emotions about the DSM criteria, how people self-identify as having ADHD, the negative/unhealthy behaviour of some people who have ADHD, the non-medical model used to treat a medical problem, and how society views ADHD and those with ADHD.
    Too many thoughts, observations, and experiences to cover in a comments section. I do often wonder why GP’s treat diagnosing and treating ADHD different from the way they diagnose and handle Depression. To be diagnosed with Depression where I live, one only has to go to a GP and say I feel (sad, mad, no longer glad) and BAM! You’re diagnosed, prescribed, and sometimes placed on stress leave. ADHD on the other hand, the doctors here don’t want to touch it if you are an adult. Then there are people I see who say they have ADHD and it baffles me because they are clearly presenting symptoms of Autism or some type of developmental delay. Because of this I sometimes think that this is one of many reasons why GP’s don’t want to deal with diagnosing and treating possible ADHD. Where I live we also have a serious shortage of psychiatrists and GP’s are reluctant to clog our system with “something like ADHD” as I’ve heard some of them say (seriously!).
    This is long already, so I’ll stop here. I know this is not the type of stuff most people with ADHD want to hear, but I don’t write these things casually.

    • Gaaaaaaaaah…yes to all of that there. Or should I say “noooooooooooooo!” to all of it because that’s exactly the stuff I’m talking about. There are serious problems in how these issues are handled. Serious, serious problems.

      I see the DSM criteria as a pretty accurate reflection of the current general understanding of ADHD…which is to say that they just barely scratch the surface and aren’t always totally useful 🙂 How’s that for diplomacy!? So in that regard, they are certainly “of interest”. Of course, maybe the criteria are inadequate for billions of other disorders too. Not that that’s a good thing…just that it’s probably not just an ADHD thing. I mean…let’s take bipolar disorder as an example. Those guidelines are a little colorless and rigid too. I might be bipolar to some degree (that’s something my prescriber and I are still sorting out) but I’m not running off to Vegas a binge gambling instead of paying my mortgage. In the spectrum of bipolar and mood disorders, however, there are more subtle forms being acknowledged. Cyclothymia is probably a closer description of what I experience: A milder form of bipolar disorder, it might be just the right description for my less-than-manic highs and my searing irritability, as contrasted with my truly insidious depressive periods. And I’ve had these for as long as I can remember (yes, childhood too, or at least young adolescence). Those criteria are not “medical” either, but I tell ya what…they seem to be pretty accurate, lol. And the medication I’ve been given to temper it? SPOT ON, I feel like a person, regularly, for the first time in years. This is why I have a hard time totally discounting them…even though I don’t necessarily feel like the ADHD DSM criteria are very “medical” or subtle.

      But…we’ve got a long way to go on this stuff…GO SCIENCE!

      Thank you so much for weighing in…

      • The DSM is not subtle for a reason. According to the APA the DSM is one tool “…used by a wide range of health and mental health professionals, including psychiatrists and other physicians, psychologists, social workers, nurses, occupational and rehabilitation therapists, and counselors. It is also a necessary tool for collecting and communicating accurate public health statistics.” For some of these professionals the DSM can be used to clearly articulate their observations of an individual to a more specialized professional. A counselor or social worker might refer a patient or client with signs/symptoms that are a close fit for a DSM diagnoses of ADHD. A psychiatrist on closer examination may find that the social worker was close but the ADHD symptoms are being caused by depression. This quote from the APA description of the DSM should be kept in mind “…it is important to remember that these criteria are meant to be used as guidelines informed by clinical judgment and are not meant to be used in a cookbook fashion.”

      • Good point. Your reply made me realize that I’m so uncomfortable with professional opinions these days that it’s easy to slip into a mindset where “GUIDELINES MUST BE SPECIFIC”. So then…if we backtrack, what will make clinicians better informed, so that THEY are better able to make the kinds of judgment calls that non-subtle guidelines (and individual patient quirks) demand?

  4. We must fit all neat and tidy into the algorithyms of the dictating insurance company and managed care big shots. Bottom line is it is all about money and NOT about peoples health care. A doctors hands are basically tied anymore. The patients lose. Get the greedy insurance industry out of this and retun to old fashion doctoring. Check out Pamela Wibble, MD and Ideal Medical Practice!

    • Ah yes…the insurance companies. I’m getting pretty tired of their shenanigans. I got a rejection of a claim the other day…looks like they made a clerical error that forces me to duplicate my efforts and resubmit the claim. Hard not to wonder if it was intentional, and they hoped I wouldn’t notice. Nope, sorry guys, that $230 means a lot more to me than it does to you, you bet your butt I’m going to keep petitioning for it…

  5. Hello Katy.

    Sorry for replying an old topic but this seems the most interesting one I found on the web 🙂

    I’m a 31yo Adult ADHD diagnosed over two years ago. I live in Malaga, Andalusia, Spain.

    I’m waiting for my disability degree, I already had a diagnosed as Adult ADHD by Public Mental Health service of Andalusia.

    Here in Spain the situation isn’t so much better. Despite we have a somewhat okay public health service, mental health isn’t taken too seriously and you can wait months to get a date with the doctor.

    Therapy is a no go in public health and private professionals are too expensive for our bad economy. I’m unemployed and very hardly struggling with studies. It’s an electronics vocational school course and the syllabus isn’t so hard, but I have been accumulating homework in a absurd way. These days I’m agoraphobic and didn’t go to school for nearly three weeks 😦

    The issue is that local support group of my city are a bunch of sealers that just want to get money from public subsidies and members. The one I was had a shady agreement with a psychological + pedagogic consult and lots of stupid behaviors about using me to get information about the TDAH Malaga association. Then they later made a consult and put a psychologist woman in the consult, it seems she didn’t finish the psychology grade (WTF?) and changed to another one and this happened twice times at least until I lost my contacts.

    I’m really tired, bored and desperate. I really want to finish both years, then there’s 6 months of practices and want to do it overseas. I prefer a native English country, it’s the only non-native language I’m somewhat able to communicate.

    Everything is very expensive, even the prescription drugs 47eur of Vyvanse/Elvanse that works better than the rest, but my mother perceived a widow wage that isn’t so high and our home has lots of costs to pay, despite my father gave it to her.

    I usually write a lot better, but these days I have lots of typos and this is even worse in English. I fixed a lot of them, now I’m tired.

    What’s the country with the best public health service for ADHD people like me? Mars? North Korea? Anthartida? I’ll go whatever place where they help me with this crap.

    Kind regards.

    • Hey there, no problem about it being an old post that you commented on. I’m sorry to hear how frustrated you are!

      Have you thought about trying Canada? Unfortunately I don’t know much about their healthcare system but they do have a national system, and they do speak English 😉

      The system I know the best is, of course, not a system at all – it’s our ridiculous United States health care offerings. This much I can tell you – there are community health centers in many communities here, where you can get health care based on your income. If you research an area online, look up “community health centers” in that area to see what’s available. This is often how I got health care when I was in college or uninsured.

      The other thing that you really need to look at is the special programs that drug companies offer. I don’t know what is available to you in Spain, but here in the US, Shire, the company that makes Vyvanse, offers an income based program where you can get free Vyvanse. Pretty sweet. My husband did this for a while when he didn’t have insurance (because without insurance, Vyvanse is quite expensive, as I’m sure you know). I take Vyvanse myself, my but insurance pays for it – if I didn’t have insurance, I would sign up for the program through Shire.

      Hang in there – research your options – make a plan!

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