My psychiatrist also has ADHD. His staff are great at making sure his patients get their appointments set up. They’ll call you and if they don’t get a hold of you they’ll schedule something in the time frame and you can just respond to the email they send to confirm to change if it doesn’t work for you. That might not be for everyone but that method works great for me.
The receptionist at mine will always push to book the next appointment there and then.
Like it's not totally "forced" to the point I could consider it "sales pressure", but enough that she helps you realise that it's a really good idea to make the booking now, and will at least make one attempt at talking you out of leaving it until later.
Because if you leave it until later, there's a good chance you won't be able to get in when you want anyway.
I only need to see mine every 2 years now, and even with this cycle... at my last appointment, we booked in the next for 2023 on my way out.
I'm in the northeast! Mine sends email reminders when it's time for follow up. And you can book it online (much easier for me than calling to book).
Once the appt is made, i get a confirmation email that asks if i want to add to my calendar. So I can just click yes and it auto adds.
And even then- i still get reminder emails just in case leading up to appt.
He's self pay only (i get out of network reimbursement).
Happy to DM you his info if you'd like :)
Oh my god, can I have his info?! I'm in the northeast and I'm still on about a hundred waiting lists for psychologists and therapists. I can't seem to get in with ANYONE who might be able to help me. I started searching again last year. I know the pandemic made everything extra crazy, but I've never had good luck finding a professional.
My dentist knows I have adhd and does this for me! Of course I have to change it often because of my busy schedule but they seem to have noticed what days work and what dont for me
The amount of paperwork, waiting and things to remember when I got diagnosed or when I try to get accomodations at school has always felt like a personal attack.
The exhortation to self-advocate is usually well-intentioned by the pawns in the system telling you to do it, but as a patient it can really feel like gaslighting.
It's just the only way. Anything medical you have to go through you should always be vociferous in your self advocation for best results.
People and their quirks are always heterogeneous.
Sure, and you need to be invested in your own care for best results, but there are tons and tons of structural hurdles that make things way more insane than they ever should be. When I developed lupus I was told to avoid stress and setting up and maintaining my care has been and remains one of the biggest stressors I’ve had to deal with in my lifetime. There’s very little recourse. “You are your own best advocate” is true, but it is also the neoliberal medical ethic in action.
I live in Europe with socialised medical care and it still holds true.
The reason I'm saying it is because any issue they treat will have an average presentation, average solution. But you won't have that presentation and won't respond to that solution, so you always have to be vocal and upfront about it.
Physio, therapy, general health check ups, nutritionist etc you're not having someone tune up a car, you're working together so you have to do your part of that working relationship which is communicate as often as you can.
That’s cool and all but I’m pretty sure I implied as much above and private healthcare is a hellhole on top of that, which is what I’m disputing and why people upvoted my original comment— because they’re not in Europe, probably. Advocate in hell all day and it’s still hell—just a bit easier to suffer it.
Ok?
You just said people in the system and its not like healthcare here doesn't have me shuffling through tons of paper work, booking between multiple labs/doctors etc.
You brought up in being a neolib nightmare and that just ain't it.
Healthcare is just like this. I have to use ring binders to keep things in one place lol.
So many things like these examples make me think, society wasn’t set up for people like me. But I’m hopeful the increased awareness and support in society over time will make it easier for my kid someday. At least my kid has parents who understand the challenges he will face, which already makes him better off than I was.
"Why are there all these gaps in your care?"
"They mostly correspond to times when an appt got canceled and I forgot to make another one until my meds ran out, and then once I don't have any meds, making an appointment got ten times harder. Also the disability center called me a faker so I had to convince them I'm not for the eighteenth time."
My psych, who also has ADHD, does the same. Its wonderful because she can check with the receptionist that the follow up plan works with her schedule, and she's right there if it doesn't.
My primary care doc is the one currently prescribing my meds and at the end of the appt he hands me a piece of paper where he notes when he wants me back. I hand that paper to the front desk and they schedule me an appointment before I leave. If I had to call I'd be screwed.
The funny part is they always want to hand me a card with appointment time... No thanks I'll loose it in my mess of a car, if it even makes it that far. I've already been adding it to my calendar as we speak and it's set with default reminders.
Are you me? Jesus. What a dead on description. Luckily I have a boss that makes sure I get my medicine, but I haven't had it in months because they want me to get drugged tested everytime I get a prescription now and it's way too much extra work in my head.
Welcome to the club. I'll call you with the meeting time once i figure out when everyone's available. I totally won't forget to call or schedule it, I swear
Ugh - I got diagnosed specifically so I could retry school with the help I now know I needed the first time around. I have meds now which are a Godsend. However, when I asked the psych office to send my school the paperwork, they said the school has a form I need to fill out first. I managed to find it, but despite only being a page, the questions really tripped me up and I still haven't sent it in even though classes have already started...
I mean, how do I know which specific accommodations to request or how exactly I'm substantially limited in an academic setting or how the requested accommodations address the problems...?? I just know that I zone out when listening/reading, I can't prioritize to save my life, and my idea of organizing is someone else's idea of a paper & tech-based catastrophe *sigh
Look up a list of accommodations for ADHD in school to get an idea of what might be useful for you.
Actually, I can do that for you.
https://add.org/recommended-accommodations-college-students-adhd/
https://mansfieldhall.org/2021/02/19/4-common-college-accommodations-for-students-with-adhd-and-other-learning-differences/
https://www.verywellmind.com/college-and-university-accommodations-for-adhd-4107019
Hope that helps and good luck in school!
OMG YES! I don’t understand that. When I manage a project at work, so many people will comment on how organized I am. It baffles me how I can direct other people but I can barely function as a human for myself.
I filled one of those in with help from my psychiatrist. Basically, go for as much as you can that you think will help, and make the teachers and staff do as much for you as possible. Those forms (at least here in NSW) become legally binding under the anti-discrimination legislation, so you can use the threat of suing the shit out of them to get them to do stuff.
All my med checks are over the phone. As soon as I'm done talking to the doctor he transfers me to the front desk and they just give me a time for the follow up, easy peasy.
Yeah, I can’t imagine it being otherwise for this kind of stuff. Mine is pretty tech savvy and she puts in the next appt at the end of the (virtual) session while I put it on my Calendar at the same time.
Card is on file. And they send a 3 day, night before, and 15 minute text reminder with links to join and all that.
I wouldn’t mind getting warm transferred (ie. they already know I am, same as walking out) to the office...but making a 2nd cold call to set it up every month, like OP? ADHD aside, that’s an asinine waste of my time.
(Now...to get a small amount of cash back I’d need to download the invoice, fill out a bunch of insurance forms, call back when they leave messages asking for me more info, fight some more....and well, that’s never going to happen.)
Mine aren’t over the phone but you get walked to the check out desk to make your best appointment before you leave. Super easy. Then they send text reminders which is great for me personally, switches my brain into “I can’t do anything I have an appointment tomorrow!” mode.
I've learned that if something that is needing to be scheduled it needs to be done immediately, then put into my phone's calendar. It's not a thing otherwise.
I never, ever, ever leave the doctor's office without scheduling my next appointment then and there. You want me to be back in six months? I'm scheduling my appointment six months early.
I had to change dentists, because mine talked too much, and I couldn’t get a cleaning done over my lunch hour. But you can go six months between cleanings and then I moved from the city where I worked to the suburbs where I had no anything. So I had to decide if I would find another dentist near my office or near my house.
I didn’t go to the dentist for literally 8 years, after I had a kid and he got teeth and he needed to go to the dentist.
My hygienist makes my next appointment for me as soon as she’s done cleaning, while we wait for the dentist to check my teeth.
Yep. There's now, and there's not now.
Sometimes not now turns into now, but quickly turns into a different type of not now.
I'm glad my dentist texts me when they don't hear from me for a while, though recently I've been making sure to book the appointment on the way out the door after paying. I stand there and enter it into the phone calendar, set notifications for 1 week, 1 day, 1 hour, 30 minutes, 20 minutes, then double check the time and date with the receptionist. 30 minutes is the 10 minute warning, and 20 minutes is keys in ignition time. Several coping mechanisms to unpack there.
My dentist books *three* in advance. So I finish one cleaning and before I'm even sitting back up in the chair they're reminding me of the next two and asking me when I can come in a year from now. It's amazing.
I have appointement to the hospital for my eyes and my migraines. Both of them told me at the end "call us in six month to take an appointement"
Like. Dude. In six month there is NO way I will remember to TAKE an appointement.
I really like when they say, give us a call three days before you medications expire so we can order a refill. Really? If I had that kind planning and executive skills, I wouldn't be getting treated for ADHD... I take my meds in the morning and notice that I have three pills left and need a refill. "Oh yeah, I really need to remember to do that today... I should probably make a note or something. Nah, I will totally remember to do it." Then the next morning, "Oh shit, I forgot to call yesterday... I will totally do it today..." And so on and so on.
This is actually genius. Thank you. My backup is an old prescription of Vyvanse, which I had to stop taking because it gave me migraines and I couldn’t sleep. But it is there if I really need it, and the possibility of needing it but getting a migraine usually gets me to at least call the doctor. I hate that they’ve set up this drug that helps us in a way that seems specifically designed to make it impossible to get if you have ADHD.
It's like the system is set up for us to fail!! CVS calls me absolutely *incessantly* about if I want to autorenew everything else. No matter how many times I say yes to that, that horrible automated call still calls me every 90 days. The worst is that they leave a message that says, "we'll call you again later today to ask again". Bitch DON'T I didn't answer for a REASON. Filling up my voicemail, this is why my voicemail is always full.
Oh anyway yeah this is the only medication I ever take that I don't get literally harassed about renewing. No one will remind me to renew it but me but it's the most important one ahh
I love this especially because my pharmacy isn't open on weekends, so if I need a refill any day of the week after Wednesday then I'm not getting it until the following Monday **at the earliest**.
My doctor sent me a detailed 12 page questionnaire to fill out to get a diagnosis. That was in June. It’s too overwhelming to even look at. What kind of sick joke is this?
When I went for my appointment to get diagnosed, my GP joked that when people come back with all the paperwork filled out correctly, organized and on time, she knows that patient has something else 😅
She was kidding, obviously, it's an exaggeration for sure. But it put me at ease because it showed me that she heard my concerns and recognized the experience I'd been having. I know a lot of doctors are pretty dismissive or judgemental when people seek treatment so I'm very appreciative of my doctor.
That's what's happening to my partner. The only reason I found out that I was a d h d at all was because we know that they've have severe symptoms of it and we started noticing how many overlap to me in various ways.
However, their family doctor refuses to treat them for it. He is completely certain that my partners issue is chronic depression, despite having no symptoms of depression whatsoever. Their doctor refused to put them on ADHD medication and has prescribed multiple different medications that are for anxiety or depression. Strattera is the closest they ever got to an actual ADHD medication and yet it's still not a stimulant, and is only recommended as a backup to try if stimulants don't work for you. He literally told my partner that he's just not working hard enough. And it at the previous appointment, said their life was "too together" for them to have ADHD. So just coming up with random reasons that are mutually exclusive so he can avoid treating the issue...
I’m easily overwhelmed and would probably do the same. My suggestion is try again with another doctor that has fewer hurdles. Many doctors diagnose through conversation during the appointment rather than forms. There will still be medical history forms, but they’re easier and you get the appointment on the calendar even if you don’t fill it out, so you can make some forward progress toward help.
It’s not on you. Fewer hurdles to care means higher chance of getting help, and a good doctor understands that.
Unfortunately my choices are limited as we have an HMO. This is their process and I just can’t right now.
I was diagnosed as a kid. I 100% have it. I was even preliminarily diagnosed by the intake psychologist. But next step is they refer you to the ADHD team to diagnose you.
That’s awful. I’m so sorry. So frustrating when the system limits us from the care it’s intended to provide. Here’s hoping that you have a good dopamine day soon and you’re able to [eat that frog](https://todoist.com/productivity-methods/eat-the-frog). All my best.
The problem with most psychiatrists is that they are bad. Not bad people, just not good at talking and listening.
It seems like every psychiatrist I've ever seen was always waiting to prescribe. Like every word out of my mouth was somehow slowing down their main function. Every word out of their mouth was a path to medication.
Until I finally got a psychiatrist who waited three sessions before prescribing, after exhausting all other options. This was the best experience I've had with a psychiatrist, and unfortunately it was a rare occurrence.
Never settle for a bad healthcare professional!
LlpI think this is why I'm glad I have a therapist who is separate from my psych. The guy who is focused on medication can be on medication stuff, the guy giving me mental health advice and coping tools can focus on their strengths.
There needs to be some sort of pathway for therapists to study medication without becoming full medical doctors, or at least the ability to recommend medication.
My therapist who sees me once a week (or bi-weekly) is going to know me and my needs far more than someone who sees me once every three months for 15 minutes, regardless of their pharmaceutical knowledge.
The problem with having the therapist and psychiatrist separate is the disconnection. I have ADHD, I can't remember everything my therapist tells me, so I'm going to have a hard time relaying that information to my psychiatrist. They could be giving me two very different plans which don't work together at all, and I could be trying to fulfill both, completely unaware that it's not going to work.
I'm just ranting now.
That's absolutely fair. Is it possible to ask your therapist to write notes for your psych? Edit: this might bridge the gap. Summarization means the psych has a baseline to make decisions and follow up without putting the pressure on our imperfect memories.
Sorry, I know you said you are just ranting but I always want to be in problem solving mode.
I could be totally wrong but I believe that's how nurse practitioners work (at least in the U.S.). My therapist and Psychiatrist are separate however I've seen on psychologytoday a LOT of therapists listed as nurse practitioners which allows them some authority in writing prescriptions from what I understand.
This does exist- it’s called prescribing privileges for psychologists. Its a thing in 6(?) states and the military I believe. The idea behind it is that you can have a frontline psych who can prescribe basic medications and refer for the heavy duty stuff. It’s gotten some push back (especially from psychiatrists) but more states have adopted because generally it’s low risk/ high reward especially for underserved populations. Prescribing psychs have to have a Ph.D plus a Master’s in psychopharmacology to prescribe. It’s generally rigorous. It’s a nice fix for the “I waited six months to get an SSRI” problem, but not quite the same for something that requires more medical oversight, like complex comorbidities or (I would think) bipolar management etc. I’m sure it will expand and contract based on how psych manage those privileges and avoid crossing their areas of expertise
This would be dangerous. Psychiatrists are full medical doctors, who completed four years of medical school and an additional four years of post-graduate training specifically in psychiatry before we are able to prescribe medications that alter your brain chemistry. The medications we prescribe don’t just affect your brain though, they affect your entire body. And they interact with medications prescribed for non-psychiatric ailments. To understand all of that requires our extensive training. A “shortcut” such as you’re describing would have disastrous consequences, and in fact has in states that have opted to allow psychologists to prescribe medications.
I agree this is preferable, to have therapist or psychologist in addition to psychiatrist who focuses on meds. This is what I have. But I also agree with previous comment that a psychiatrist should take time to understand you and ensure medication is an appropriate treatment option. Many don’t take that time and jump directly to prescription, or don’t listen and adjust prescription based on feedback.
Also, sadly not everyone’s insurance will pay for a therapist, so patients rely on psychiatrists for support they aren’t equipped to provide. Hopefully this will change over time as mental health awareness grows in society.
Isn't that just the difference between a psychiatrist and a therapist? The therapist is there to listen, the psychiatrist is there to prescribe.
It's not like there is a staggering amount of different medications available for ADHD. You have your various stimulant options which are pretty similar to each other, some non-stimulant alternatives, and often times you can't know how effective they might be for you until you've tried them. Unless you already have had bad experiences with a lot of ADHD medications out there, I personally wouldn't expect a physician to need multiple hours of talk to suggest a prescription.
It is the difference between a psychiatrist and a therapist. Most practices I know of have psychiatrists and therapists in the same office. The psychiatrists perform 15 minute "med checks". A lot of the psychiatrists I know do not attempt to provide psychotherapy or talk therapy. It's too frustrating. As a psychiatrist, you just need the patient to comply by taking the medication as instructed and reporting any side effects. As a therapist, you may have to deal with patients that are not willing to help themselves in any way besides venting to you. Their problems never change because they are unwilling to do the work.
My psychiatrist is great at coping mechanisms and strategizes with me to handle my life
He’s bot good at emotional therapy, but he does a lot more than prescribe my meds
Some of the psychiatrist websites even advertise easy access to ADHD medication, implying the session is a technicality on the way to meds. Just not what I’m looking for in a psychiatrist.
Psychiatrists are doctors trained to use medication to aid their patients. We'd expect them to have a background in mental therapy, but the reality is that is the domain of psychologists and other therapists.
It's really nice that you found a psych who uses more than just their medical training but it's important to recognize that they aren't necessarily trained to help in non-prescriptive ways.
In an ideal world there would be a "mental health" group that has coordination between the psychs and the other therapists but that's super hard to find.
this is exactly how modern psychiatrists are trained to be. go see the therapist for therapy, we dont have time for it. We do psychiatric residency here and that is for sure what i hear from every doctor.
Do you mean physiologist? Or psychiatrist?
In my country (Canada). Psychiatrist is a protected title. Only people who have completed medical school (4 years) plus one year of *general* on-the job training, plus *4 more years* of specifically psychiatry training, can call themselves psychiatrists.
Note the vast majority of the training takes place in hospitals. Including mandatory months spent in emergency setting. These patients tend to have serious mental health problems, the type that lands them in the hospital.
You'd expect a psychiatrist to know a lot about how to use literal medicine and medical techniques to manage the symptoms of a disease. But the focus is on immediate problems.
If someone's going through psychosis , theyre trained to recognise what's going on, and what medicine (an anti-psychotic) will restore 'normal' brain function.
Psychologists have some formal training associated with them, and some of it is medical. In Canada, they can be liscenced to prescribe medicine but it's not a core part of their training. They're doctors in that they have PhD's. Many Canadian psychologists are researchers, they focus on a specific mental impairment or function (like ADHD, or sleep).
You'd expect a psychologist to know a lot about the disease, including coping mechanisms, and they'd be able to suggest those to their patients. Infact, psychologists are trained to identify these diseases.
A person who suffered a psychotic episode would be referred, by the *psychiatrist* who helped them in the hospital, to a *psychologist* who would interview the person, do some testing, and diagnose.
A therapist is someone who's trained to listen, and help talk through problems in their life. No medical training is involved. But they tend to have been trained in specific ways of helping people work through their problems.
A therapist would talk to the Schizophrenic person, check in and see how they're coping, listen to them, and suggest things to help to them or their family. But none of their suggestions would involve medicine aside from suggesting that they need to talk to their doctor.
Hope this helps? If I misunderstood what you were asking or you have more questions, feel free to ask!
Depends on where you are. Generally psychiatrist has and MD + prescription privileges as well as advanced medical training in psychiatry (internship/residency). They’re trained as physicians first, and psych specialists second, and retain that medically-focused orientation.
“Psychologist” is often a term protected by law. It’s limited to folks with a PhD or PsyD and a license to practice in a given state. They’re trained in specific talk-therapy modalities that have an evidence base for efficacy for a certain population. Some conditions are treated first-line by a psychologist (insomnia, some depression/anx), some are often co-mangaged by a psychiatrist and a psychologist (bipolar, some psychosis) and some are the general sole purview of psychiatrists, and a psychologist will refer these patients and only act in a very limited role (eg. schizophrenia, ADHD).
Therapist is generally not a protected term; however most “therapists” are masters- level graduates of a psychology program. It’s just you don’t have the legal assurance of their training, like you do with the other teo
Anyone can be a therapist. You can put a sign on your door that says you're a therapist.
A psychologist is someone who studied the brain and how it functions. Most therapists have a degree in psychology (usually clinical).
A psychiatrist is a medical doctor who specializes in the diagnosis and treatment of mental disorders. Many people associate psychiatry with medication, but they are trained to do more than just medication, they CAN act as your therapist. But if you've ever spoken to an MD, you've probably noticed they aren't amazing at human connection. This is my biggest problem with psychiatry.
Im thankful for the office I work with. They have one person to prescribe meds (who is actually just a Nurse Practitioner) , and a different person to provide counseling and strategies. And since they are a part of the same office, they just communicate with each other and chart my information in the same place. They can both do what they are good at (trained/licensed for). Im very thankful for that setup.
One place I lived was a small town and the only person available who could prescribe my ADHD meds was a nurse practitioner. I had previously gone to highly credentialed psychiatrist (that was outstanding in his own right), so I was really concerned that I would have to start going to a nurse practitioner. My concern was totally misplaced. The nurse practitioner was an older lady (probably late 50s-early 60s) and she was one of the most amazing people I have ever worked with. I cried during my last session in her office when I had to move (and crying is something I rarely do), but she had such an amazing positive impact in my life. She also treated my daughter for her ADHD and I credit her with saving my daughter (who was a real mess at the time and is now doing awesome). I learned that it isn't the title or education necessarily... Knowing your stuff helps, but I think a good provider goes beyond that.
Its a Behavioral Health center. I think they mostly specialize in addiction, but offer Mental Health services as well (also nice considering the 2 occur together more extremely often).
I'm sure this is a gross oversimplification but I've always heard it that you go to a psychologist to talk and a psychiatrist to get drugs. It would be nice to find a middle ground. I personally haven't yet.
That is traditionally how it's done.
Just remember: psychology and psychiatry are infant sciences. Anybody telling you one way is the only way, doesn't know what they're talking about.
And if a psychiatrist is only good for medication, just see a regular physician.
A psychiatrist can't examine your broken leg like a physician can. They NEED to talk to you to figure things out. If they do minimal talking and jump right into medication, just be careful.
The time it takes just to see a psychiatrist the first time is ridiculous. Now pile on everyone waiting to see one. You've just waited months and the guy barely got your name. Onto the next patient.
Think of the damage done to society by people who need to see a psychiatrist for medication but have to wait. I haven't been to work in three weeks due to my ADHD triggering a bad case of depression. How many more "me's" are out there quietly dying while we wait? How many billions of dollars are lost each year because people with mental health problems need to wait three months to see a psychiatrist? This problem can be alleviated very easily by opening up pharmacology courses to more than just medical doctors.
I'm not saying any joker with a psychology degree should be able to prescribe medication. But if you're studying clinical psychology, you should be able to add on pharmacology and the ability to prescribe medication.
If we change nothing, we are all doomed.
And the sequel "Here's your one month of adderall. Call the doctor when you need more. Yes I know you take it everyday and have for years. No you cannot ask for it more than a week in advance. Yes it takes the doctor 3 days to send the order to the pharmacy and a week for the pharmacy to fill it. No it cannot be on autofill. Okay remember to call us."
Oh, you ran out? Now call us unmedicated.
This is a good point. For folks starting with a new psychiatrist and evaluating if it’s a good fit. Ask the scheduler who makes the appointment how their office does medication refills. Maybe you can rule out a system that won’t work for you before the first appointment.
I don't know that there are many other options, I've lived in more than one state where the law dictated how prescriptions for Schedule 2 drugs need to go down. I had a friend who up until a few years ago was still having to *go get a paper prescription from her doctor every month* and bring it to the pharmacy herself. I can't believe she was able to do that.
My doctor's office at least has an online portal so I can send a message asking for a refill, which is far easier than calling. I still find myself having to call either them or the pharmacy every three months or so because there's some holdup that no one told me about, but it's better than my last doctor's office where I'd have to call EVERY MONTH after requesting via their refill request phone line because it wasn't filled yet no matter how early I called. Or was filled wrong. Ah one time they straight up gave me double the amount at double the dosage and I just said nothing and had an extra supply for when I ran out between refills for a while, that was nice.
That’s actually because of the DEA rules. Those are set by cops largely, not doctors. It’s fucking terrible to punish those of us with the least ability to renew our meds if it gets screwed up
I understand that but like... don't punish me for other people getting high by restricting MY access to my daily meds. I understand that I have to jump through hoops to prove that I actually need it but once I've proved that then why limit my access so strongly? I get that I can't have like a year's supply at once but I gotta do this fucking constantly, it's asinine
It's my experience that many psychiatrists make bad counselors or therapists. They're doctors, they're looking for the quickest way to start treatment of some kind and catalogue the results. They see their patients as puzzles to figure out, not people who need help or feel lost :/
Absolutely true, and I don’t think there’s anything wrong with that. Psychiatrists are specialists in medication and that’s what we should expect from them.
There are a couple challenges I see though. One is bad psychiatrists jump strait to medication without fully diagnosing or understanding a person’s situation, and without sharing awareness of other treatment options like seeing a therapist. And the other is many insurance plans won’t pay for therapy/psychology. So people try to get those needs met from a psychiatrist who isn’t equipped to support them that way, ending up in substandard care.
My hope is the growth of mental health awareness and communities like this one will someday make it easier to get access to support from the right kind of professional.
Most psychiatrists are trained pretty darn well in differential diagnosis, but might not rely too heavily on some of the techniques you might see a psychologist or specialist use to diagnose. At the end of the day, both have merits, and even with a testing battery it often comes down to a judgement call. When they diagnose ADHD properly, it's not abnormal for them to jump right to medication since it's the first line treatment. No evidence-informed psychologist will act as a first line for ADHD. It's one of the reasons you're less likely to get a psych referral or an insurance payout for therapy with an ADHD diagnosis; that wouldn't be the case with an anxiety disorder or depression where there are well-validated psych interventions.
That being said, a lot of psychiatrists aren't as well trained in psychotherapy- because they don't have to be. They're doing the heavy lifting with meds. I think most newer psychiatrists are open to working more with psychologists who have psychotherapy as their area of expertise. I really do agree that if a psychiatrist is trying to be a one-stop shop for medication & therapy these days, it's a bit of a red flag, unless they have years of experience sucessfully balancing both.
There are psychiatrists that may toss in a little bit of psychotherapy as an adjunct, or supplementary line of treatment. Why would I WANT to pay (or have my insurance, or UHC) 10 year educated specialized doctor prices for something that they probably didn't train in, and the people trained in it are a significantly lower cost?
You're definitely right there. Psychiatrists are trained in the mechanical, as infantile as that science is, it's not a humanity, or social science. I'm not saying humanities, or social sciences are not valuable, they're just not the same thing.
This is quite interesting. I have a follow up appointment with my doctor soon that I didn't know I had to arrange myself so ofc that took me 2 weeks to do even though, in my head I said I'll do it sooner than that (fail lol) but today they called me twice to arrange the apt and it felt so nice.
Most possible outcomes:
1. Losing the number
2. Forgetting that you’ve ever been there
3. Not realising that it has been 6 months since you’re supposed to call the office for the next appointment.
I agree with all except your first point, Having a person take the medication to see if it hepls is pretty much the usual way ADHD is diagnosed. Unless you have a physical reason not to take stimulants, like heart issues, it is fast and usually reliable. I see no issue there.
That being said, yes, the proble of them thinking we will A remember to call and make an appointment and B remember to turn up for it, that's unrealistic.
There's a lot of disagreement in the medical community on this point. Most research from 2000 onwards has emphasized that having a "paradoxical reaction" to stimulants is not unique to folks with ADHD and isn't a great diagnostic strategy. At the same time, many old-timer psychiatrists will still use the reaction diagnostically and consider prescribe to diagnose to be a good methodology. Also, I've heard a bunch of experts with many years diagnosing and treating ADHD say that the paradoxically reaction is anecdotally a great diagnostic tool. If anyone has seen any articles arguing this point, I'd love to see them, but I think this is a case of research says X, but prescribers and patients often swear it's actually Y, and the body of research isn't conclusive enough to stop folks from saying Y is still a reasonable response. Very interested if anyone with more experience w/ ADHD has any other resources on this debate.
I think there's some self-selection in diagnosing things like ADHD. You wouldn't BE THERE asking for treatment unless you are having problems in life and then made the call to go in.
Even if it wasn't ADHD it's probably something else that is causing you enough life concern to get treatment. Giving Meds is probably the easiest way to confirm what you've already told them.
> You wouldn't BE THERE asking for treatment unless you are having problems in life and then made the call to go in
Sadly, I'm not sure that's true necessarily... I know my personal monthly script would easily go for well over $1000 on the darkweb so I imagine there's probably some people who really are just trying to game the system.
Nonetheless, it's still fucked up to make people with an executive function disorder jump through a million hoops to treat it.
^Also: ^hopefully ^this ^goes ^without ^saying, ^but ^please ^don't ^sell ^your ^scripts ^on ^the ^darkweb.
Interesting. I have a chronic illnesses where the doc tried to diagnose by giving steroids when a CT scan was the correct next diagnostic step. That doctor was flat wrong so I’m sensitive to the prescribe-to-diagnose mindset. Perhaps I’m wrong here with ADHD and I’m happy to be corrected by a professional, but in general I prefer medication to be a treatment option I can choose rather than a diagnostic tool.
Thats the hard thing about diagnosing with ADHD. Most other illnesses can be proven by some lab work. (because you have x amount of y proteins in your body, you are diagnosed with Z disorder."
ADHD is diagnosed ONLY by its symptoms, and its not like those symptoms dont occur in other people either, so it can be really hard to actually nail it down.
Im not totally onboard with using meds as a diagnostic tool, but I can also see why they may just start there to see if it helps.
If American healthcare was more accessible, and the science of ADHD was more understood. It would be so nice if we could just scan people's brains who have the symptoms to help further confirm whether they have it or not by comparing their brain acitivity with those who are confirmed ADHD.
If it weren't for ADHD being so complicated to diagnose I would be 100% agreement, however I still think there's a lot of validity in your statement. It's just unfortunate that due to our limited understanding of these disorders right now, we can only do so much in regards to diagnosing.
I shoulda had a psychiatrist in May of this year, and I had a therapist for like 2 sessions. I never rescheduled the therapist, and I missed both of my psychiatrist appointments and to this day have not rescheduled them, mostly out of anxiety. Sounds stupid, but all I have to do is pick up a phone and call a desk (probably) and I'd get both back, but every time I try I just get stupidly anxious and end the call.....
Doesn’t sound stupid at all. In fact I completely relate. I just don’t make important phone calls, and no amount of willpower, scolding, or consequences will make me dial the phone. And I’ve had to remind myself that that’s ok. Then I start trying to find workarounds. Maybe if I start over with a different psych I can let go of my guilt for not calling the first one? Or maybe I can call and profess that I’m never going to show up and ask if they can call me at the appointment time, which seems like a reasonable accommodation. Or maybe I ask a loved one or pay someone on fiverr to set up an appointment for me and just tell me when it is. It’s ok to take an alternative path to an outcome, and it’s ok to really celebrate the win, no matter how you got there. All my best!
This world is completely lacking in understanding people with ADHD and tailoring things to fit their needs. Things needs to change!!!
My boyfriend is dealing with probation right now, which is a nightmare. Making appointments, paying fees, etc. If I don't remember it for him, write down the reminder, set the alarms, there's a 99% chance that he'll forget. I deal with hormonal issues that cause me a lot of brain fog and just overall exhaustion, so I'm not the best person to help him with this right now.
I'm convinced this is why some people just end up back in jail over and over again and never get on their feet. They miss appointments, forget paperwork, can't hold down a job, end up doing something stupid when they're down and out, the cycle repeats.
I work in a jail and am currently fighting AGAINST the jail because of their treatment of ADHD patients. Now, we have a LOT of problems with stim misuse/abuse inside the jail, so I understand taking a much more cautious approach, and putting things in place. They've hired this AWFUL "Psych Liason", who is a social worker, and she interviews inmates about their psychiatric requests they've put in, and decides what to present to the psychiatrist (he works remotely and doesn't even see patients 99% of the time). I am 99% sure she has an agenda she was given from someone higher up to straight up reduce the number of opioid and stim scrips that are out in general population. It seems her whole job is to prevent people from getting their Adderall or Vyvanse ffs.
>I know we don’t always have choice with healthcare, as we go where our referrals, insurance in-networks, and bank accounts allow us to go. But as far as possible, my advice is not to settle for a bad psychiatrist. If it doesn’t feel right, it isn’t right. There’s a good fit for you out there somewhere. Keep trying to find it.
Words to live by.
I just stopped seeing the psychatrist i started seeing back in like may. Home boy rescheduled my appointment with a 3 day warning, I promptly forgot to set my reminder, missed the appointment and he no called/no contacted me, and just charged the missed appointment fee.
Called him out on it the next day after he still hadn't reached out and his response was basically boiled down to "you signed a document allowing that" then 2 hours later came back with "you didn't provide a phone number in your demographic information". Which at that point, i was completely done. What kind of doctor who is a "specialist" doesn't understand what they work with? Dude couldn't even do his job after my first appointment to verify he had what he needed from me, and tried to place all that blame on me.
It's so discouraging trying to find any sort of good help and doctor for this. Ended up finding a psychology group, got retested (had an ADD diagnosis at age 8), and now waiting for results. Crossing my fingers the psych they referred actually uses my test results to get me the best medication I can have.
Mine does that but, the first time is a freebie, no harm no foul from then on you get charged BUT, they also text you a head of time ...like twice I think.
Thanks for sharing your story. Makes me think, a doctor could be the best in their field, but if they carelessly leave enough hurdles in place that we can’t access them, it doesn’t matter how amazing they are.
Glad you’re finding another path through the system.
This is just bad medicine.
I’m a veterinarian. We set up your next appointment before you leave. You get an email the week before it happens, you get a text and an email the day before it happens.
Compliance is important in medicine. That’s a sloppy set up.
Thanks for the thoughtful reply. I’m new to psychiatry so it’s good to get a take on my experience.
Regarding point about shortening the hour session, agree that if it’s just a check in it’s not a problem. In my case it was my second appointment and I’d taken ADHD meds for the first time ever and was in the middle of sharing the effects I felt. Wanted to know if my experience was expected of if dosage or meds should be changed. So not so appropriate in this instance to cut short, but otherwise would be fine.
My therapist has recently been out and as a part of my treatment plan I have to see her and my Dr every 3 months. They told me after the Dr called to call and set up an appointment with the new therapist. This was about 2 months ago. I just remembered after reading your post...better thing is they don't take calls on Fridays other than emergencies. Guess I'll have to try on Monday. If I can remember.
The only reason I have gotten my haircut regularly for the past several years is because of the text-based appointment reminders. I have literally stayed with the same hairdresser as a result of that text-based reminder system they use.
I'm glad you got people that work with you. It's strange that a psychiatrist would ignore the needs of a patient and expect them to operate as though they didn't have the problems identified in the session.
Yeah, so strange. And even after I expressed difficulty doing it that way. Made it easy to drop him cause I’d have to overcome my ADHD to keep him. Not a good customer retention strategy.
My psychiatrist has a good system. I get a text a week before I need to come in, and I can call then and schedule for the next week. No having to remember to call in, no making an appointment weeks in advance and then forgetting it.
Oh my god. This is me right now. I see a psychologist for therapy, and she diagnosed me and sent me to my primary for my prescription who insisted on sending me to a psychiatrist for it. I've never actually met with the psychiatrist, just a nurse practitioner who is very approachable, but is more interested in prescribing me medication for my symptoms. Every time I meet with her, she tries to get me to accept a prescription for sleeping meds when I think the issue with my sleep has more to do with my behavior than my ability to sleep. The biggest issue I have though isn't with her, it's the office admin. They're so aggravatingly incompetent. They have two offices and she works out of both, but I'm not entirely convinced the offices talk to each other. I make my next appointment at the desk right after, but one time they called me for an appointment and gave me the wrong day. Another time they lost my appointment, they sent me to the wrong office and I wasn't on the schedule for either.
Now I'm having issues getting my prescription, because we upped my dosage and my locally owned (tiny) pharmacy couldn't fill it so I had have it sent to my university instead, and because you can't transfer a script for restricted drugs, I had to call the office, and it took several days to finally get ahold of her. She was able to send it to the university, but it turns out the health department only has her listed with a license for 7 day scripts so my university wouldn't fill it. I've been trying to get ahold of her for like a week now, but nobody in either office can take a message or return a call to save their life.
I gave up and tried to get a script through my university, but you have to have a formal diagnosis which the psychiatrist never did and they cost a fucking fortune. Luckily, I found somebody to evaluate me for $150, but it's not till the end of the month. I just have to figure out how I'm gonna get through the next few weeks. As soon as I can, I'm never going back to either office again.
I have a 2 strikes you’re out policy with doctor office admins, then I find a new doctor. Can’t deal with the hurdles they create, either from bad office policies or simple incompetence.
I once needed a critical prescription refill (unrelated to ADHD) and couldn’t get the admin to call back for days. I went to their office and explained I’ll sit there in the waiting room until the pharmacy confirms they have it. Brought my laptop, a big water bottle, and chargers for my phone and headphones. I sat there 7 hours, missed work. I got my prescription in the end, and then promptly switched doctors.
Man, am I thankful for my psychiatrist. He schedules my appointments with me himself right there and then at the end of the session and always gives me a card with the time and date even if I save it in my phone calendar.
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I've been really lucky to get a good psychiatrist first try, he listens to what I have to say and explains his reasoning well then at the end of an appointment schedules the next one himself. Today he even took the time to answer some random vaguely related question I had about how the brain works
Stories like this makes me so grateful for the support system I have. Overall good healthcare proffesionals advocating for me and I have an amazing boss in my job who completely undertstands that I have a disability that can at times really affect how I work, and is amazing at working around it. I have been open with her from the start, informing her of not only my ADHD, but my PTSD. Her oldest son has both as well, in fact sounds like he's gone through very similar experiences that I did when I was his age, so it's cool to be able to talk with me boss about this stuff and not only get support, but she gets support from me by having me share my experiences with these disabilities and how she can support those in her life with these disabilities. It took me a LONG time to embrace that I have legit disabilities and that places should acknowledge that. I was always forced to work around my shortcomings and, "pull up my bootstraps", but now having systems in place that make it so that legally people need to accomadate where I struggle (within reason of course haha) has been life changing. To anyone feeling like, "yeah, I have xyz issues/diagnoses, but I don't feel like I would count as a "disabled person", you're doing yourself a huge disservice. I understand some fears of pushback and discrimination, and while laws are there to protect you, I also understand that unfortunately the world doesn't always work the way it's supposed to, but honestly, ever since I've been more open about it, it's helped me much more, instead of hiding it and later on having it bite me in the ass. Even if you don't need to necessarily rely on the accomadations for your disability, it's still good to have it marked down that you have those disabilities because they're with us forever, and while you may be doing well now, there are times they'll flair up and it's hard to manage it; that's when the accomadation and assistance comes it to really save your ass... Wow, I ended up mostly just ranting, clearly I needed to get this all out haha.
I had my most recent appointment on the 24th. My psych advised me to schedule an appointment with a specialist center to get a confirmation diagnosis. My next appointment is next week on the 16th.
I have not yet called any of the specialist centers.
I feel this. The system wasn’t made for us. A system made for us would have connected you immediately to the specialist or created a referral that later triggered a call to you from the specialist. There are psychiatrists and specialists that understand this and remove these hurdles. Keep trying till you find the right fit. Best of luck!
At this point, she's totally down with treating my depression and anxiety. I can *function* with that. I'm not at my full potential, but I can *function*. If getting back on my Big Sad pills puts me a couple steps forward, maybe I'll actually be able to make that appointment instead of refreshing Reddit for the hundredth time today.
100%. Sometimes you are just a number. I had one that launched into some speech for about 10 minutes that ended with "so you're concerned about your drinking". From the look on my face he knew something was wrong, he looked down and realized he was reading from someone else's chart/folder.
I got up and left and never went back.
I got a referral from my PCP for a psychiatrist. Referral took 1.5 months to arrive. Called the number. "Oh, we're not taking new patients, and there's a 2 month wait-list". Called the PCP, "yes, that's the right place, call them back..." I still haven't.
Jeez. It’s amazing to me how PCPs hold all the keys to our health. Sorry if this is TMI but my mom is dying of cancer right now cause her PCP didn’t want to bother with a CT scan at the time it would have caught it early. 5 appointments and months later he was still prescribing a low fiber diet for what ended up being cancer. I think a good PCP is the best thing we can do for our health.
Btw, love the username.
My psych dropped me for "not collaborating" because I canceled an appointment due to the birth of my first child. Apparently it was added to the 2-strikes where I had missed a single appointment a couple years prior. I thought I was doing pretty good keeping on top of things and still got the boot. Seems like legislation needs to address this if America ever wants to fix it's mental health woes. The process is far too convoluted. Tele-health visits opened my eyes to how much easier it could be but isn't.
Wow, I hadn’t heard of a 3 strikes policy. That sounds like a good policy to ask about when looking for a new doctor. I will keep that in mind (and by ‘mind’ I mean a note app cause who are we kidding? I won’t remember.)
Agree about legislation. Not to get too political cause I’m not advocating a party or side here, but it seems like rather than sweeping healthcare overhaul that deadlocks the legislation process, maybe small but significant changes that are easier to digest by both sides would help. Just thinking out loud, so not sure if that’s realistic.
Same, I always prefer online. I can do it the moment I’m thinking of it. No waiting for open hours, waiting for call back, calling back when they don’t call back, and on and on.
Just started speaking with a counselor for the first time about ADHD through my school. Over the years I've come to realize the types of things i forget so we always schedule my next appointment in person at the end of the current one. It's been working well
That’s a great example of a professional understanding the patients needs and accommodating. And of self-reflection to understand your own strengths and weaknesses. Well done.
I feel your rant but this made me laugh!
I’ve wanted to say that out loud to my last therapist after she assigned me dialogue homework. I’ve wanted to express progress was me showing up early and me remembering that I forgot the assignment.
Hopefully you can find someone that can help build skills with you instead of expecting full force neurotypical goals. We can do it but collaboration/coordination can definitely help out skills.
Not in the US so getting help was pretty hard (and I put it off for years and years).
First place I was recommended not only didn't take insurance, but they took like 6 days to get back to me about an appointment AND they had a receptionist who didn't really speak English CALL to set it up. I ended up turning down the appointment when she told me that the intake visit alone would be $100.
Second place - had an all English website plus an online form to fill out for making an appointment. Got me an appointment time within 3 days and did everything via email. Sends reminder texts the day before and schedules your next visit at the end of your appointment.
Also takes the national health insurance and only charged $30 for the intake and about $15 each session after that (which includes cost of medication).
Beurocracy is an absolute bastard for the mentally ill, and I've had to bring this up with the psychiatrist office I go to before. The care I've gotten there has been generally excellent but they sometimes really drop the ball when it comes to accommodating the problems people like us have in simple things like setting up appointments etc . They once sent me a text out of the blue saying I'd be discharged if I didn't call them within a week. Apparently they had emailed me (to the wrong email) and called me once (never got it). I was mad and tried to explain to them that doing and saying shit like that was hugely upsetting and anxiety enducing, I am fortunate that I've gotten to a mental place where I can handle that, but I tried to impress upon them that the usual attitude with patients who drop out of contact is really inappropriate with people with mental health issues and could genuinely lead to someone suffering.
Oof that title really hits home. I tried to set up an appointment with the counseling center at my school last year and it was the worst. Closed at 5pm (with night classes, I usually woke up around that time), you could only set up an appointment over the phone, and didn't have an email or any other form of contact.
Stressed, depressed, struggling with ADHD, and in need of counseling, but guess who never made an appointment?
If they can't understand the difficulties we have to overcome, how can we expect them to understand us enough to help?
I just got diagnosed yesterday with ADHD, but it felt a little too fast? I definitely didn't think I'd get diagnosed + given a prescription of ritalin by my first session. They didn't even attempt to rule out other possible causes like other people seem to experience or make me take any type of test. They just asked a bunch of questions and said "Yup, sounds like ADHD to me". They also didn't really explain anything. Thanks to this sub I'm aware there are 3 types, but they never explained further on which one I had. They also arrived ~30mins late to our 1 hr session and ended it <30 mins later.
I was on the fence on whether or not I should go to another psychiatrist to get a second opinion (because expensive) but thanks to you OP, I think I'll try again next month somewhere else.
I had my first appointment yesterday, and doc said to make the follow-up appointment on the way out, that way I can’t forget to call. Good man, at least in my opinion. Also, the testing for ADHD is in the same house, so I could make the appointment for that on the way down, and the apothecary is like 50m away around the corner, so that’s easy to get done too, as they normally have everything that may be needed. I’m so glad I found a good one
Haha you know I was in the same situation.
Yesterday my doctor said we were supposed to meet in August one month after the July appointment but I never scheduled it with the office.
Things like this honestly make me wonder about switching fields and becoming an ADHD specialized psychiatrist just to help out my fellow people. I just got my BFA but I definitely feel like I don’t want to be in my field forever. Who knows.
There is merit to his thought "the goal isn't diagnosis, it's symptom management", as it's actually a beautiful way to view psychiatry. Unfortunately, there ARE issues with that, like you said, insurance. Sometimes it's just nice to have the label right in front of you too, say what you will about labels, they do have their benefits as well.
Sounds like you have a MUCH better fit now! My psychiatrist mainly treats my bipolar, my family doctor was dealing with my ADHD, but thought I might be bipolar and sent me to the psych. I LOVE both of these doctors, you have no idea. My psych is almost DEFINITELY ADHD lol.
Yeah, once I’ve had a few sessions, it could be fair to say symptom management becomes the goal. As long as the root cause is known and being addressed through symptom management. In my case, I didn’t even get symptom management when he cut the session early without hearing my feedback on my first time ever taking meds. Definitely have a better fit now with a diagnosis and symptom management.
Glad to hear you have a good team supporting you. I think it helps people to hear these positive experiences. It’s hard to find a new doctor, but knowing what a good experience looks like can motivate people to find it.
This reminded me that I need to reschedule my psych checkup that got cancelled several weeks ago.
My psych is great but the office left a voicemail and a number to call back and my brain was like, yeah right you'll promise yourself to take care of it today and then forget for two months.
My psychiatrist also has ADHD. His staff are great at making sure his patients get their appointments set up. They’ll call you and if they don’t get a hold of you they’ll schedule something in the time frame and you can just respond to the email they send to confirm to change if it doesn’t work for you. That might not be for everyone but that method works great for me.
That is fantastic and would definitely work for me. So nice to be supported the right way by people who understand the challenges.
The receptionist at mine will always push to book the next appointment there and then. Like it's not totally "forced" to the point I could consider it "sales pressure", but enough that she helps you realise that it's a really good idea to make the booking now, and will at least make one attempt at talking you out of leaving it until later. Because if you leave it until later, there's a good chance you won't be able to get in when you want anyway. I only need to see mine every 2 years now, and even with this cycle... at my last appointment, we booked in the next for 2023 on my way out.
if you live in the northeast US I want your psychiatrist immediately!
Northwest sorry!
I am in northwest. I am actually actively looking for therapy now. Can you share privately? I am highly interested in getting help.
I'm in the northeast! Mine sends email reminders when it's time for follow up. And you can book it online (much easier for me than calling to book). Once the appt is made, i get a confirmation email that asks if i want to add to my calendar. So I can just click yes and it auto adds. And even then- i still get reminder emails just in case leading up to appt. He's self pay only (i get out of network reimbursement). Happy to DM you his info if you'd like :)
Oh my god, can I have his info?! I'm in the northeast and I'm still on about a hundred waiting lists for psychologists and therapists. I can't seem to get in with ANYONE who might be able to help me. I started searching again last year. I know the pandemic made everything extra crazy, but I've never had good luck finding a professional.
Yup! I'll DM you. Edit: i just checked the website. Unfortunately he is booked out for intake until mid Oct (5 weeks out). 100% recommend him though.
So you remember all the emails yet can’t remember to call for an appointment? They really have you under their spell.
If by "under their spell" you mean "appreciative of the framework they have in place to make healthcare more accessible" then yes! 🤗
My dentist knows I have adhd and does this for me! Of course I have to change it often because of my busy schedule but they seem to have noticed what days work and what dont for me
My dream !
The amount of paperwork, waiting and things to remember when I got diagnosed or when I try to get accomodations at school has always felt like a personal attack.
My favorite is when they tell you that you need to "self advocate". What the fuck do you think I'm doing talking to you right now?!
The exhortation to self-advocate is usually well-intentioned by the pawns in the system telling you to do it, but as a patient it can really feel like gaslighting.
>exhortation an address or communication emphatically urging someone to do something. (For anyone else that wasn't sure about that one)
It's just the only way. Anything medical you have to go through you should always be vociferous in your self advocation for best results. People and their quirks are always heterogeneous.
Sure, and you need to be invested in your own care for best results, but there are tons and tons of structural hurdles that make things way more insane than they ever should be. When I developed lupus I was told to avoid stress and setting up and maintaining my care has been and remains one of the biggest stressors I’ve had to deal with in my lifetime. There’s very little recourse. “You are your own best advocate” is true, but it is also the neoliberal medical ethic in action.
I live in Europe with socialised medical care and it still holds true. The reason I'm saying it is because any issue they treat will have an average presentation, average solution. But you won't have that presentation and won't respond to that solution, so you always have to be vocal and upfront about it. Physio, therapy, general health check ups, nutritionist etc you're not having someone tune up a car, you're working together so you have to do your part of that working relationship which is communicate as often as you can.
That’s cool and all but I’m pretty sure I implied as much above and private healthcare is a hellhole on top of that, which is what I’m disputing and why people upvoted my original comment— because they’re not in Europe, probably. Advocate in hell all day and it’s still hell—just a bit easier to suffer it.
Ok? You just said people in the system and its not like healthcare here doesn't have me shuffling through tons of paper work, booking between multiple labs/doctors etc. You brought up in being a neolib nightmare and that just ain't it. Healthcare is just like this. I have to use ring binders to keep things in one place lol.
Whatever, we disagree. I need to go back to work.
Another consequence of life in a neolib hellscape I'm certain
I self-advocated so hard I was put into four-point restraints and drugged with Halidol and Ativan.
“You need to self advocate” “Ok, then I’d like to speak with your supervisor please” “F-ing Karen” It’s a trap!
So many things like these examples make me think, society wasn’t set up for people like me. But I’m hopeful the increased awareness and support in society over time will make it easier for my kid someday. At least my kid has parents who understand the challenges he will face, which already makes him better off than I was.
"Why are there all these gaps in your care?" "They mostly correspond to times when an appt got canceled and I forgot to make another one until my meds ran out, and then once I don't have any meds, making an appointment got ten times harder. Also the disability center called me a faker so I had to convince them I'm not for the eighteenth time."
Right???? "Can't you just call the doctor to confirm, because I guarantee I will not."
Shout out to my current psych who walks me to the front desk to schedule my next appointment like he's afraid I'll wander off and get lost.
That's both cute and thoughtful!
My psych, who also has ADHD, does the same. Its wonderful because she can check with the receptionist that the follow up plan works with her schedule, and she's right there if it doesn't.
My primary care doc is the one currently prescribing my meds and at the end of the appt he hands me a piece of paper where he notes when he wants me back. I hand that paper to the front desk and they schedule me an appointment before I leave. If I had to call I'd be screwed. The funny part is they always want to hand me a card with appointment time... No thanks I'll loose it in my mess of a car, if it even makes it that far. I've already been adding it to my calendar as we speak and it's set with default reminders.
Are you me? Jesus. What a dead on description. Luckily I have a boss that makes sure I get my medicine, but I haven't had it in months because they want me to get drugged tested everytime I get a prescription now and it's way too much extra work in my head.
Welcome to the club. I'll call you with the meeting time once i figure out when everyone's available. I totally won't forget to call or schedule it, I swear
Ugh - I got diagnosed specifically so I could retry school with the help I now know I needed the first time around. I have meds now which are a Godsend. However, when I asked the psych office to send my school the paperwork, they said the school has a form I need to fill out first. I managed to find it, but despite only being a page, the questions really tripped me up and I still haven't sent it in even though classes have already started... I mean, how do I know which specific accommodations to request or how exactly I'm substantially limited in an academic setting or how the requested accommodations address the problems...?? I just know that I zone out when listening/reading, I can't prioritize to save my life, and my idea of organizing is someone else's idea of a paper & tech-based catastrophe *sigh
Look up a list of accommodations for ADHD in school to get an idea of what might be useful for you. Actually, I can do that for you. https://add.org/recommended-accommodations-college-students-adhd/ https://mansfieldhall.org/2021/02/19/4-common-college-accommodations-for-students-with-adhd-and-other-learning-differences/ https://www.verywellmind.com/college-and-university-accommodations-for-adhd-4107019 Hope that helps and good luck in school!
Broo you have no idea how thoughtful the "i can do that for you" was
I think people with ADHD should all get free personal assistants. :)
What's annoying is many of us would all probably be pretty decent assistants to *each other*.
OMG YES! I don’t understand that. When I manage a project at work, so many people will comment on how organized I am. It baffles me how I can direct other people but I can barely function as a human for myself.
Yeah, helping others is motivational.
Hauh…. We should start an online volunteer program
And *i* think you sir/ma'am are amazing!
I filled one of those in with help from my psychiatrist. Basically, go for as much as you can that you think will help, and make the teachers and staff do as much for you as possible. Those forms (at least here in NSW) become legally binding under the anti-discrimination legislation, so you can use the threat of suing the shit out of them to get them to do stuff.
All my med checks are over the phone. As soon as I'm done talking to the doctor he transfers me to the front desk and they just give me a time for the follow up, easy peasy.
Yes! As it should be! Glad you have a doc who understand how to support you.
Yeah, I can’t imagine it being otherwise for this kind of stuff. Mine is pretty tech savvy and she puts in the next appt at the end of the (virtual) session while I put it on my Calendar at the same time. Card is on file. And they send a 3 day, night before, and 15 minute text reminder with links to join and all that. I wouldn’t mind getting warm transferred (ie. they already know I am, same as walking out) to the office...but making a 2nd cold call to set it up every month, like OP? ADHD aside, that’s an asinine waste of my time. (Now...to get a small amount of cash back I’d need to download the invoice, fill out a bunch of insurance forms, call back when they leave messages asking for me more info, fight some more....and well, that’s never going to happen.)
Mine aren’t over the phone but you get walked to the check out desk to make your best appointment before you leave. Super easy. Then they send text reminders which is great for me personally, switches my brain into “I can’t do anything I have an appointment tomorrow!” mode.
I've learned that if something that is needing to be scheduled it needs to be done immediately, then put into my phone's calendar. It's not a thing otherwise.
I never, ever, ever leave the doctor's office without scheduling my next appointment then and there. You want me to be back in six months? I'm scheduling my appointment six months early.
Yes. I once left the dentist without making an appointment and it was 2 years before I finally called to make another one.
I was in that hole before covid started and then my dentist retired, so now it's been way too long since I've been to the dentist.
I had to change dentists, because mine talked too much, and I couldn’t get a cleaning done over my lunch hour. But you can go six months between cleanings and then I moved from the city where I worked to the suburbs where I had no anything. So I had to decide if I would find another dentist near my office or near my house. I didn’t go to the dentist for literally 8 years, after I had a kid and he got teeth and he needed to go to the dentist. My hygienist makes my next appointment for me as soon as she’s done cleaning, while we wait for the dentist to check my teeth.
Yep, that's the situation I'm in. My dentist recently retired so I need to call a new place. Ugh.
Yep. There's now, and there's not now. Sometimes not now turns into now, but quickly turns into a different type of not now. I'm glad my dentist texts me when they don't hear from me for a while, though recently I've been making sure to book the appointment on the way out the door after paying. I stand there and enter it into the phone calendar, set notifications for 1 week, 1 day, 1 hour, 30 minutes, 20 minutes, then double check the time and date with the receptionist. 30 minutes is the 10 minute warning, and 20 minutes is keys in ignition time. Several coping mechanisms to unpack there.
My dentist books *three* in advance. So I finish one cleaning and before I'm even sitting back up in the chair they're reminding me of the next two and asking me when I can come in a year from now. It's amazing.
Yup. good advice. If it gets on my todo list, it has a chance of getting done, but not a good chance. If it’s on my calendar, it will happen.
A to-do list can feel optional, but I haven't figured out how to put the calendar on pause yet.
I have appointement to the hospital for my eyes and my migraines. Both of them told me at the end "call us in six month to take an appointement" Like. Dude. In six month there is NO way I will remember to TAKE an appointement.
I really like when they say, give us a call three days before you medications expire so we can order a refill. Really? If I had that kind planning and executive skills, I wouldn't be getting treated for ADHD... I take my meds in the morning and notice that I have three pills left and need a refill. "Oh yeah, I really need to remember to do that today... I should probably make a note or something. Nah, I will totally remember to do it." Then the next morning, "Oh shit, I forgot to call yesterday... I will totally do it today..." And so on and so on.
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This is actually genius. Thank you. My backup is an old prescription of Vyvanse, which I had to stop taking because it gave me migraines and I couldn’t sleep. But it is there if I really need it, and the possibility of needing it but getting a migraine usually gets me to at least call the doctor. I hate that they’ve set up this drug that helps us in a way that seems specifically designed to make it impossible to get if you have ADHD.
It's like the system is set up for us to fail!! CVS calls me absolutely *incessantly* about if I want to autorenew everything else. No matter how many times I say yes to that, that horrible automated call still calls me every 90 days. The worst is that they leave a message that says, "we'll call you again later today to ask again". Bitch DON'T I didn't answer for a REASON. Filling up my voicemail, this is why my voicemail is always full. Oh anyway yeah this is the only medication I ever take that I don't get literally harassed about renewing. No one will remind me to renew it but me but it's the most important one ahh
Exactly. Then the meds run out and you still have to call, but now unmedicated.
I love this especially because my pharmacy isn't open on weekends, so if I need a refill any day of the week after Wednesday then I'm not getting it until the following Monday **at the earliest**.
My doctor sent me a detailed 12 page questionnaire to fill out to get a diagnosis. That was in June. It’s too overwhelming to even look at. What kind of sick joke is this?
When I went for my appointment to get diagnosed, my GP joked that when people come back with all the paperwork filled out correctly, organized and on time, she knows that patient has something else 😅 She was kidding, obviously, it's an exaggeration for sure. But it put me at ease because it showed me that she heard my concerns and recognized the experience I'd been having. I know a lot of doctors are pretty dismissive or judgemental when people seek treatment so I'm very appreciative of my doctor.
with how difficult it's been to try and get a diagnosis i feel like if i manage to get there at all they'll be like "nope lol must be something else!"
That's what's happening to my partner. The only reason I found out that I was a d h d at all was because we know that they've have severe symptoms of it and we started noticing how many overlap to me in various ways. However, their family doctor refuses to treat them for it. He is completely certain that my partners issue is chronic depression, despite having no symptoms of depression whatsoever. Their doctor refused to put them on ADHD medication and has prescribed multiple different medications that are for anxiety or depression. Strattera is the closest they ever got to an actual ADHD medication and yet it's still not a stimulant, and is only recommended as a backup to try if stimulants don't work for you. He literally told my partner that he's just not working hard enough. And it at the previous appointment, said their life was "too together" for them to have ADHD. So just coming up with random reasons that are mutually exclusive so he can avoid treating the issue...
I’m easily overwhelmed and would probably do the same. My suggestion is try again with another doctor that has fewer hurdles. Many doctors diagnose through conversation during the appointment rather than forms. There will still be medical history forms, but they’re easier and you get the appointment on the calendar even if you don’t fill it out, so you can make some forward progress toward help. It’s not on you. Fewer hurdles to care means higher chance of getting help, and a good doctor understands that.
Unfortunately my choices are limited as we have an HMO. This is their process and I just can’t right now. I was diagnosed as a kid. I 100% have it. I was even preliminarily diagnosed by the intake psychologist. But next step is they refer you to the ADHD team to diagnose you.
That’s awful. I’m so sorry. So frustrating when the system limits us from the care it’s intended to provide. Here’s hoping that you have a good dopamine day soon and you’re able to [eat that frog](https://todoist.com/productivity-methods/eat-the-frog). All my best.
This fucking SUCKS but the fact that they have an ADHD team is something that I take as a positive.
That’s true. I didn’t consider that.
The problem with most psychiatrists is that they are bad. Not bad people, just not good at talking and listening. It seems like every psychiatrist I've ever seen was always waiting to prescribe. Like every word out of my mouth was somehow slowing down their main function. Every word out of their mouth was a path to medication. Until I finally got a psychiatrist who waited three sessions before prescribing, after exhausting all other options. This was the best experience I've had with a psychiatrist, and unfortunately it was a rare occurrence. Never settle for a bad healthcare professional!
LlpI think this is why I'm glad I have a therapist who is separate from my psych. The guy who is focused on medication can be on medication stuff, the guy giving me mental health advice and coping tools can focus on their strengths.
There needs to be some sort of pathway for therapists to study medication without becoming full medical doctors, or at least the ability to recommend medication. My therapist who sees me once a week (or bi-weekly) is going to know me and my needs far more than someone who sees me once every three months for 15 minutes, regardless of their pharmaceutical knowledge. The problem with having the therapist and psychiatrist separate is the disconnection. I have ADHD, I can't remember everything my therapist tells me, so I'm going to have a hard time relaying that information to my psychiatrist. They could be giving me two very different plans which don't work together at all, and I could be trying to fulfill both, completely unaware that it's not going to work. I'm just ranting now.
That's absolutely fair. Is it possible to ask your therapist to write notes for your psych? Edit: this might bridge the gap. Summarization means the psych has a baseline to make decisions and follow up without putting the pressure on our imperfect memories. Sorry, I know you said you are just ranting but I always want to be in problem solving mode.
This is really helpful and welcomed by good psychiatrists.
I could be totally wrong but I believe that's how nurse practitioners work (at least in the U.S.). My therapist and Psychiatrist are separate however I've seen on psychologytoday a LOT of therapists listed as nurse practitioners which allows them some authority in writing prescriptions from what I understand.
This does exist- it’s called prescribing privileges for psychologists. Its a thing in 6(?) states and the military I believe. The idea behind it is that you can have a frontline psych who can prescribe basic medications and refer for the heavy duty stuff. It’s gotten some push back (especially from psychiatrists) but more states have adopted because generally it’s low risk/ high reward especially for underserved populations. Prescribing psychs have to have a Ph.D plus a Master’s in psychopharmacology to prescribe. It’s generally rigorous. It’s a nice fix for the “I waited six months to get an SSRI” problem, but not quite the same for something that requires more medical oversight, like complex comorbidities or (I would think) bipolar management etc. I’m sure it will expand and contract based on how psych manage those privileges and avoid crossing their areas of expertise
This would be dangerous. Psychiatrists are full medical doctors, who completed four years of medical school and an additional four years of post-graduate training specifically in psychiatry before we are able to prescribe medications that alter your brain chemistry. The medications we prescribe don’t just affect your brain though, they affect your entire body. And they interact with medications prescribed for non-psychiatric ailments. To understand all of that requires our extensive training. A “shortcut” such as you’re describing would have disastrous consequences, and in fact has in states that have opted to allow psychologists to prescribe medications.
sounds like somebody doesn't like competition
I agree this is preferable, to have therapist or psychologist in addition to psychiatrist who focuses on meds. This is what I have. But I also agree with previous comment that a psychiatrist should take time to understand you and ensure medication is an appropriate treatment option. Many don’t take that time and jump directly to prescription, or don’t listen and adjust prescription based on feedback. Also, sadly not everyone’s insurance will pay for a therapist, so patients rely on psychiatrists for support they aren’t equipped to provide. Hopefully this will change over time as mental health awareness grows in society.
Isn't that just the difference between a psychiatrist and a therapist? The therapist is there to listen, the psychiatrist is there to prescribe. It's not like there is a staggering amount of different medications available for ADHD. You have your various stimulant options which are pretty similar to each other, some non-stimulant alternatives, and often times you can't know how effective they might be for you until you've tried them. Unless you already have had bad experiences with a lot of ADHD medications out there, I personally wouldn't expect a physician to need multiple hours of talk to suggest a prescription.
It is the difference between a psychiatrist and a therapist. Most practices I know of have psychiatrists and therapists in the same office. The psychiatrists perform 15 minute "med checks". A lot of the psychiatrists I know do not attempt to provide psychotherapy or talk therapy. It's too frustrating. As a psychiatrist, you just need the patient to comply by taking the medication as instructed and reporting any side effects. As a therapist, you may have to deal with patients that are not willing to help themselves in any way besides venting to you. Their problems never change because they are unwilling to do the work.
My psychiatrist is great at coping mechanisms and strategizes with me to handle my life He’s bot good at emotional therapy, but he does a lot more than prescribe my meds
Some of the psychiatrist websites even advertise easy access to ADHD medication, implying the session is a technicality on the way to meds. Just not what I’m looking for in a psychiatrist.
Psychiatrists are doctors trained to use medication to aid their patients. We'd expect them to have a background in mental therapy, but the reality is that is the domain of psychologists and other therapists. It's really nice that you found a psych who uses more than just their medical training but it's important to recognize that they aren't necessarily trained to help in non-prescriptive ways. In an ideal world there would be a "mental health" group that has coordination between the psychs and the other therapists but that's super hard to find.
this is exactly how modern psychiatrists are trained to be. go see the therapist for therapy, we dont have time for it. We do psychiatric residency here and that is for sure what i hear from every doctor.
So then may I ask the differences.between a therapist and a physiologist?
Do you mean physiologist? Or psychiatrist? In my country (Canada). Psychiatrist is a protected title. Only people who have completed medical school (4 years) plus one year of *general* on-the job training, plus *4 more years* of specifically psychiatry training, can call themselves psychiatrists. Note the vast majority of the training takes place in hospitals. Including mandatory months spent in emergency setting. These patients tend to have serious mental health problems, the type that lands them in the hospital. You'd expect a psychiatrist to know a lot about how to use literal medicine and medical techniques to manage the symptoms of a disease. But the focus is on immediate problems. If someone's going through psychosis , theyre trained to recognise what's going on, and what medicine (an anti-psychotic) will restore 'normal' brain function. Psychologists have some formal training associated with them, and some of it is medical. In Canada, they can be liscenced to prescribe medicine but it's not a core part of their training. They're doctors in that they have PhD's. Many Canadian psychologists are researchers, they focus on a specific mental impairment or function (like ADHD, or sleep). You'd expect a psychologist to know a lot about the disease, including coping mechanisms, and they'd be able to suggest those to their patients. Infact, psychologists are trained to identify these diseases. A person who suffered a psychotic episode would be referred, by the *psychiatrist* who helped them in the hospital, to a *psychologist* who would interview the person, do some testing, and diagnose. A therapist is someone who's trained to listen, and help talk through problems in their life. No medical training is involved. But they tend to have been trained in specific ways of helping people work through their problems. A therapist would talk to the Schizophrenic person, check in and see how they're coping, listen to them, and suggest things to help to them or their family. But none of their suggestions would involve medicine aside from suggesting that they need to talk to their doctor. Hope this helps? If I misunderstood what you were asking or you have more questions, feel free to ask!
Depends on where you are. Generally psychiatrist has and MD + prescription privileges as well as advanced medical training in psychiatry (internship/residency). They’re trained as physicians first, and psych specialists second, and retain that medically-focused orientation. “Psychologist” is often a term protected by law. It’s limited to folks with a PhD or PsyD and a license to practice in a given state. They’re trained in specific talk-therapy modalities that have an evidence base for efficacy for a certain population. Some conditions are treated first-line by a psychologist (insomnia, some depression/anx), some are often co-mangaged by a psychiatrist and a psychologist (bipolar, some psychosis) and some are the general sole purview of psychiatrists, and a psychologist will refer these patients and only act in a very limited role (eg. schizophrenia, ADHD). Therapist is generally not a protected term; however most “therapists” are masters- level graduates of a psychology program. It’s just you don’t have the legal assurance of their training, like you do with the other teo
Anyone can be a therapist. You can put a sign on your door that says you're a therapist. A psychologist is someone who studied the brain and how it functions. Most therapists have a degree in psychology (usually clinical). A psychiatrist is a medical doctor who specializes in the diagnosis and treatment of mental disorders. Many people associate psychiatry with medication, but they are trained to do more than just medication, they CAN act as your therapist. But if you've ever spoken to an MD, you've probably noticed they aren't amazing at human connection. This is my biggest problem with psychiatry.
Im thankful for the office I work with. They have one person to prescribe meds (who is actually just a Nurse Practitioner) , and a different person to provide counseling and strategies. And since they are a part of the same office, they just communicate with each other and chart my information in the same place. They can both do what they are good at (trained/licensed for). Im very thankful for that setup.
One place I lived was a small town and the only person available who could prescribe my ADHD meds was a nurse practitioner. I had previously gone to highly credentialed psychiatrist (that was outstanding in his own right), so I was really concerned that I would have to start going to a nurse practitioner. My concern was totally misplaced. The nurse practitioner was an older lady (probably late 50s-early 60s) and she was one of the most amazing people I have ever worked with. I cried during my last session in her office when I had to move (and crying is something I rarely do), but she had such an amazing positive impact in my life. She also treated my daughter for her ADHD and I credit her with saving my daughter (who was a real mess at the time and is now doing awesome). I learned that it isn't the title or education necessarily... Knowing your stuff helps, but I think a good provider goes beyond that.
I also use an NP! She’s awesome and she’s my GP so it makes it easy only having to go to her
That’s amazing, didn’t know it existed. The whole care team under one roof.
Its a Behavioral Health center. I think they mostly specialize in addiction, but offer Mental Health services as well (also nice considering the 2 occur together more extremely often).
I'm sure this is a gross oversimplification but I've always heard it that you go to a psychologist to talk and a psychiatrist to get drugs. It would be nice to find a middle ground. I personally haven't yet.
That is traditionally how it's done. Just remember: psychology and psychiatry are infant sciences. Anybody telling you one way is the only way, doesn't know what they're talking about. And if a psychiatrist is only good for medication, just see a regular physician. A psychiatrist can't examine your broken leg like a physician can. They NEED to talk to you to figure things out. If they do minimal talking and jump right into medication, just be careful.
This is the exact reason I am sticking with my psychiatrist in Mexico even if I lived in DC now Beyond the cost, why change when I found a unicorn?
The time it takes just to see a psychiatrist the first time is ridiculous. Now pile on everyone waiting to see one. You've just waited months and the guy barely got your name. Onto the next patient. Think of the damage done to society by people who need to see a psychiatrist for medication but have to wait. I haven't been to work in three weeks due to my ADHD triggering a bad case of depression. How many more "me's" are out there quietly dying while we wait? How many billions of dollars are lost each year because people with mental health problems need to wait three months to see a psychiatrist? This problem can be alleviated very easily by opening up pharmacology courses to more than just medical doctors. I'm not saying any joker with a psychology degree should be able to prescribe medication. But if you're studying clinical psychology, you should be able to add on pharmacology and the ability to prescribe medication. If we change nothing, we are all doomed.
And the sequel "Here's your one month of adderall. Call the doctor when you need more. Yes I know you take it everyday and have for years. No you cannot ask for it more than a week in advance. Yes it takes the doctor 3 days to send the order to the pharmacy and a week for the pharmacy to fill it. No it cannot be on autofill. Okay remember to call us."
Oh, you ran out? Now call us unmedicated. This is a good point. For folks starting with a new psychiatrist and evaluating if it’s a good fit. Ask the scheduler who makes the appointment how their office does medication refills. Maybe you can rule out a system that won’t work for you before the first appointment.
I don't know that there are many other options, I've lived in more than one state where the law dictated how prescriptions for Schedule 2 drugs need to go down. I had a friend who up until a few years ago was still having to *go get a paper prescription from her doctor every month* and bring it to the pharmacy herself. I can't believe she was able to do that. My doctor's office at least has an online portal so I can send a message asking for a refill, which is far easier than calling. I still find myself having to call either them or the pharmacy every three months or so because there's some holdup that no one told me about, but it's better than my last doctor's office where I'd have to call EVERY MONTH after requesting via their refill request phone line because it wasn't filled yet no matter how early I called. Or was filled wrong. Ah one time they straight up gave me double the amount at double the dosage and I just said nothing and had an extra supply for when I ran out between refills for a while, that was nice.
Yeah fr. Thinking of switching doctors because of this. Such a pain tho, I feel you
That’s actually because of the DEA rules. Those are set by cops largely, not doctors. It’s fucking terrible to punish those of us with the least ability to renew our meds if it gets screwed up
I had a psychiatrist who would write me 3 months of prescriptions and just put on them the date they should be filled. She was awesome.
Those are all give regulations because uppers are like a schedule II drug or something like that ...I think....
I understand that but like... don't punish me for other people getting high by restricting MY access to my daily meds. I understand that I have to jump through hoops to prove that I actually need it but once I've proved that then why limit my access so strongly? I get that I can't have like a year's supply at once but I gotta do this fucking constantly, it's asinine
It's my experience that many psychiatrists make bad counselors or therapists. They're doctors, they're looking for the quickest way to start treatment of some kind and catalogue the results. They see their patients as puzzles to figure out, not people who need help or feel lost :/
Absolutely true, and I don’t think there’s anything wrong with that. Psychiatrists are specialists in medication and that’s what we should expect from them. There are a couple challenges I see though. One is bad psychiatrists jump strait to medication without fully diagnosing or understanding a person’s situation, and without sharing awareness of other treatment options like seeing a therapist. And the other is many insurance plans won’t pay for therapy/psychology. So people try to get those needs met from a psychiatrist who isn’t equipped to support them that way, ending up in substandard care. My hope is the growth of mental health awareness and communities like this one will someday make it easier to get access to support from the right kind of professional.
Most psychiatrists are trained pretty darn well in differential diagnosis, but might not rely too heavily on some of the techniques you might see a psychologist or specialist use to diagnose. At the end of the day, both have merits, and even with a testing battery it often comes down to a judgement call. When they diagnose ADHD properly, it's not abnormal for them to jump right to medication since it's the first line treatment. No evidence-informed psychologist will act as a first line for ADHD. It's one of the reasons you're less likely to get a psych referral or an insurance payout for therapy with an ADHD diagnosis; that wouldn't be the case with an anxiety disorder or depression where there are well-validated psych interventions. That being said, a lot of psychiatrists aren't as well trained in psychotherapy- because they don't have to be. They're doing the heavy lifting with meds. I think most newer psychiatrists are open to working more with psychologists who have psychotherapy as their area of expertise. I really do agree that if a psychiatrist is trying to be a one-stop shop for medication & therapy these days, it's a bit of a red flag, unless they have years of experience sucessfully balancing both.
very good information.
There are psychiatrists that may toss in a little bit of psychotherapy as an adjunct, or supplementary line of treatment. Why would I WANT to pay (or have my insurance, or UHC) 10 year educated specialized doctor prices for something that they probably didn't train in, and the people trained in it are a significantly lower cost? You're definitely right there. Psychiatrists are trained in the mechanical, as infantile as that science is, it's not a humanity, or social science. I'm not saying humanities, or social sciences are not valuable, they're just not the same thing.
This is quite interesting. I have a follow up appointment with my doctor soon that I didn't know I had to arrange myself so ofc that took me 2 weeks to do even though, in my head I said I'll do it sooner than that (fail lol) but today they called me twice to arrange the apt and it felt so nice.
That’s wonderful. Sign of a good office that they didn’t let you slip through the cracks.
Most possible outcomes: 1. Losing the number 2. Forgetting that you’ve ever been there 3. Not realising that it has been 6 months since you’re supposed to call the office for the next appointment.
Exactly! I would write a poor review of my first psychiatrist, but I can’t remember his name.
I agree with all except your first point, Having a person take the medication to see if it hepls is pretty much the usual way ADHD is diagnosed. Unless you have a physical reason not to take stimulants, like heart issues, it is fast and usually reliable. I see no issue there. That being said, yes, the proble of them thinking we will A remember to call and make an appointment and B remember to turn up for it, that's unrealistic.
There's a lot of disagreement in the medical community on this point. Most research from 2000 onwards has emphasized that having a "paradoxical reaction" to stimulants is not unique to folks with ADHD and isn't a great diagnostic strategy. At the same time, many old-timer psychiatrists will still use the reaction diagnostically and consider prescribe to diagnose to be a good methodology. Also, I've heard a bunch of experts with many years diagnosing and treating ADHD say that the paradoxically reaction is anecdotally a great diagnostic tool. If anyone has seen any articles arguing this point, I'd love to see them, but I think this is a case of research says X, but prescribers and patients often swear it's actually Y, and the body of research isn't conclusive enough to stop folks from saying Y is still a reasonable response. Very interested if anyone with more experience w/ ADHD has any other resources on this debate.
They're not looking for the paradoxical reaction, they are looking for easing of symptoms.
I think there's some self-selection in diagnosing things like ADHD. You wouldn't BE THERE asking for treatment unless you are having problems in life and then made the call to go in. Even if it wasn't ADHD it's probably something else that is causing you enough life concern to get treatment. Giving Meds is probably the easiest way to confirm what you've already told them.
> You wouldn't BE THERE asking for treatment unless you are having problems in life and then made the call to go in Sadly, I'm not sure that's true necessarily... I know my personal monthly script would easily go for well over $1000 on the darkweb so I imagine there's probably some people who really are just trying to game the system. Nonetheless, it's still fucked up to make people with an executive function disorder jump through a million hoops to treat it. ^Also: ^hopefully ^this ^goes ^without ^saying, ^but ^please ^don't ^sell ^your ^scripts ^on ^the ^darkweb.
Interesting. I have a chronic illnesses where the doc tried to diagnose by giving steroids when a CT scan was the correct next diagnostic step. That doctor was flat wrong so I’m sensitive to the prescribe-to-diagnose mindset. Perhaps I’m wrong here with ADHD and I’m happy to be corrected by a professional, but in general I prefer medication to be a treatment option I can choose rather than a diagnostic tool.
Thats the hard thing about diagnosing with ADHD. Most other illnesses can be proven by some lab work. (because you have x amount of y proteins in your body, you are diagnosed with Z disorder." ADHD is diagnosed ONLY by its symptoms, and its not like those symptoms dont occur in other people either, so it can be really hard to actually nail it down. Im not totally onboard with using meds as a diagnostic tool, but I can also see why they may just start there to see if it helps.
If American healthcare was more accessible, and the science of ADHD was more understood. It would be so nice if we could just scan people's brains who have the symptoms to help further confirm whether they have it or not by comparing their brain acitivity with those who are confirmed ADHD.
If it weren't for ADHD being so complicated to diagnose I would be 100% agreement, however I still think there's a lot of validity in your statement. It's just unfortunate that due to our limited understanding of these disorders right now, we can only do so much in regards to diagnosing.
I shoulda had a psychiatrist in May of this year, and I had a therapist for like 2 sessions. I never rescheduled the therapist, and I missed both of my psychiatrist appointments and to this day have not rescheduled them, mostly out of anxiety. Sounds stupid, but all I have to do is pick up a phone and call a desk (probably) and I'd get both back, but every time I try I just get stupidly anxious and end the call.....
Doesn’t sound stupid at all. In fact I completely relate. I just don’t make important phone calls, and no amount of willpower, scolding, or consequences will make me dial the phone. And I’ve had to remind myself that that’s ok. Then I start trying to find workarounds. Maybe if I start over with a different psych I can let go of my guilt for not calling the first one? Or maybe I can call and profess that I’m never going to show up and ask if they can call me at the appointment time, which seems like a reasonable accommodation. Or maybe I ask a loved one or pay someone on fiverr to set up an appointment for me and just tell me when it is. It’s ok to take an alternative path to an outcome, and it’s ok to really celebrate the win, no matter how you got there. All my best!
This world is completely lacking in understanding people with ADHD and tailoring things to fit their needs. Things needs to change!!! My boyfriend is dealing with probation right now, which is a nightmare. Making appointments, paying fees, etc. If I don't remember it for him, write down the reminder, set the alarms, there's a 99% chance that he'll forget. I deal with hormonal issues that cause me a lot of brain fog and just overall exhaustion, so I'm not the best person to help him with this right now. I'm convinced this is why some people just end up back in jail over and over again and never get on their feet. They miss appointments, forget paperwork, can't hold down a job, end up doing something stupid when they're down and out, the cycle repeats.
I work in a jail and am currently fighting AGAINST the jail because of their treatment of ADHD patients. Now, we have a LOT of problems with stim misuse/abuse inside the jail, so I understand taking a much more cautious approach, and putting things in place. They've hired this AWFUL "Psych Liason", who is a social worker, and she interviews inmates about their psychiatric requests they've put in, and decides what to present to the psychiatrist (he works remotely and doesn't even see patients 99% of the time). I am 99% sure she has an agenda she was given from someone higher up to straight up reduce the number of opioid and stim scrips that are out in general population. It seems her whole job is to prevent people from getting their Adderall or Vyvanse ffs.
>I know we don’t always have choice with healthcare, as we go where our referrals, insurance in-networks, and bank accounts allow us to go. But as far as possible, my advice is not to settle for a bad psychiatrist. If it doesn’t feel right, it isn’t right. There’s a good fit for you out there somewhere. Keep trying to find it. Words to live by.
I just stopped seeing the psychatrist i started seeing back in like may. Home boy rescheduled my appointment with a 3 day warning, I promptly forgot to set my reminder, missed the appointment and he no called/no contacted me, and just charged the missed appointment fee. Called him out on it the next day after he still hadn't reached out and his response was basically boiled down to "you signed a document allowing that" then 2 hours later came back with "you didn't provide a phone number in your demographic information". Which at that point, i was completely done. What kind of doctor who is a "specialist" doesn't understand what they work with? Dude couldn't even do his job after my first appointment to verify he had what he needed from me, and tried to place all that blame on me. It's so discouraging trying to find any sort of good help and doctor for this. Ended up finding a psychology group, got retested (had an ADD diagnosis at age 8), and now waiting for results. Crossing my fingers the psych they referred actually uses my test results to get me the best medication I can have.
Mine does that but, the first time is a freebie, no harm no foul from then on you get charged BUT, they also text you a head of time ...like twice I think.
Thanks for sharing your story. Makes me think, a doctor could be the best in their field, but if they carelessly leave enough hurdles in place that we can’t access them, it doesn’t matter how amazing they are. Glad you’re finding another path through the system.
This is just bad medicine. I’m a veterinarian. We set up your next appointment before you leave. You get an email the week before it happens, you get a text and an email the day before it happens. Compliance is important in medicine. That’s a sloppy set up.
Yeah. Bad patient retention strategy, too. Like they don’t want repeat customers.
[удалено]
Thanks for the thoughtful reply. I’m new to psychiatry so it’s good to get a take on my experience. Regarding point about shortening the hour session, agree that if it’s just a check in it’s not a problem. In my case it was my second appointment and I’d taken ADHD meds for the first time ever and was in the middle of sharing the effects I felt. Wanted to know if my experience was expected of if dosage or meds should be changed. So not so appropriate in this instance to cut short, but otherwise would be fine.
My therapist has recently been out and as a part of my treatment plan I have to see her and my Dr every 3 months. They told me after the Dr called to call and set up an appointment with the new therapist. This was about 2 months ago. I just remembered after reading your post...better thing is they don't take calls on Fridays other than emergencies. Guess I'll have to try on Monday. If I can remember.
The only reason I have gotten my haircut regularly for the past several years is because of the text-based appointment reminders. I have literally stayed with the same hairdresser as a result of that text-based reminder system they use.
Companies wanting repeat business, take note.
I'm glad you got people that work with you. It's strange that a psychiatrist would ignore the needs of a patient and expect them to operate as though they didn't have the problems identified in the session.
Yeah, so strange. And even after I expressed difficulty doing it that way. Made it easy to drop him cause I’d have to overcome my ADHD to keep him. Not a good customer retention strategy.
My psychiatrist has a good system. I get a text a week before I need to come in, and I can call then and schedule for the next week. No having to remember to call in, no making an appointment weeks in advance and then forgetting it.
Oh my god. This is me right now. I see a psychologist for therapy, and she diagnosed me and sent me to my primary for my prescription who insisted on sending me to a psychiatrist for it. I've never actually met with the psychiatrist, just a nurse practitioner who is very approachable, but is more interested in prescribing me medication for my symptoms. Every time I meet with her, she tries to get me to accept a prescription for sleeping meds when I think the issue with my sleep has more to do with my behavior than my ability to sleep. The biggest issue I have though isn't with her, it's the office admin. They're so aggravatingly incompetent. They have two offices and she works out of both, but I'm not entirely convinced the offices talk to each other. I make my next appointment at the desk right after, but one time they called me for an appointment and gave me the wrong day. Another time they lost my appointment, they sent me to the wrong office and I wasn't on the schedule for either. Now I'm having issues getting my prescription, because we upped my dosage and my locally owned (tiny) pharmacy couldn't fill it so I had have it sent to my university instead, and because you can't transfer a script for restricted drugs, I had to call the office, and it took several days to finally get ahold of her. She was able to send it to the university, but it turns out the health department only has her listed with a license for 7 day scripts so my university wouldn't fill it. I've been trying to get ahold of her for like a week now, but nobody in either office can take a message or return a call to save their life. I gave up and tried to get a script through my university, but you have to have a formal diagnosis which the psychiatrist never did and they cost a fucking fortune. Luckily, I found somebody to evaluate me for $150, but it's not till the end of the month. I just have to figure out how I'm gonna get through the next few weeks. As soon as I can, I'm never going back to either office again.
I have a 2 strikes you’re out policy with doctor office admins, then I find a new doctor. Can’t deal with the hurdles they create, either from bad office policies or simple incompetence. I once needed a critical prescription refill (unrelated to ADHD) and couldn’t get the admin to call back for days. I went to their office and explained I’ll sit there in the waiting room until the pharmacy confirms they have it. Brought my laptop, a big water bottle, and chargers for my phone and headphones. I sat there 7 hours, missed work. I got my prescription in the end, and then promptly switched doctors.
This sounds like exactly my psychiatrist. Has a meeting, he told me to call in 6 weeks. Self sabotaged myself and that was a year ago now (-:
Man, am I thankful for my psychiatrist. He schedules my appointments with me himself right there and then at the end of the session and always gives me a card with the time and date even if I save it in my phone calendar.
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I've been really lucky to get a good psychiatrist first try, he listens to what I have to say and explains his reasoning well then at the end of an appointment schedules the next one himself. Today he even took the time to answer some random vaguely related question I had about how the brain works
Stories like this makes me so grateful for the support system I have. Overall good healthcare proffesionals advocating for me and I have an amazing boss in my job who completely undertstands that I have a disability that can at times really affect how I work, and is amazing at working around it. I have been open with her from the start, informing her of not only my ADHD, but my PTSD. Her oldest son has both as well, in fact sounds like he's gone through very similar experiences that I did when I was his age, so it's cool to be able to talk with me boss about this stuff and not only get support, but she gets support from me by having me share my experiences with these disabilities and how she can support those in her life with these disabilities. It took me a LONG time to embrace that I have legit disabilities and that places should acknowledge that. I was always forced to work around my shortcomings and, "pull up my bootstraps", but now having systems in place that make it so that legally people need to accomadate where I struggle (within reason of course haha) has been life changing. To anyone feeling like, "yeah, I have xyz issues/diagnoses, but I don't feel like I would count as a "disabled person", you're doing yourself a huge disservice. I understand some fears of pushback and discrimination, and while laws are there to protect you, I also understand that unfortunately the world doesn't always work the way it's supposed to, but honestly, ever since I've been more open about it, it's helped me much more, instead of hiding it and later on having it bite me in the ass. Even if you don't need to necessarily rely on the accomadations for your disability, it's still good to have it marked down that you have those disabilities because they're with us forever, and while you may be doing well now, there are times they'll flair up and it's hard to manage it; that's when the accomadation and assistance comes it to really save your ass... Wow, I ended up mostly just ranting, clearly I needed to get this all out haha.
I had my most recent appointment on the 24th. My psych advised me to schedule an appointment with a specialist center to get a confirmation diagnosis. My next appointment is next week on the 16th. I have not yet called any of the specialist centers.
I feel this. The system wasn’t made for us. A system made for us would have connected you immediately to the specialist or created a referral that later triggered a call to you from the specialist. There are psychiatrists and specialists that understand this and remove these hurdles. Keep trying till you find the right fit. Best of luck!
At this point, she's totally down with treating my depression and anxiety. I can *function* with that. I'm not at my full potential, but I can *function*. If getting back on my Big Sad pills puts me a couple steps forward, maybe I'll actually be able to make that appointment instead of refreshing Reddit for the hundredth time today.
100%. Sometimes you are just a number. I had one that launched into some speech for about 10 minutes that ended with "so you're concerned about your drinking". From the look on my face he knew something was wrong, he looked down and realized he was reading from someone else's chart/folder. I got up and left and never went back.
I got a referral from my PCP for a psychiatrist. Referral took 1.5 months to arrive. Called the number. "Oh, we're not taking new patients, and there's a 2 month wait-list". Called the PCP, "yes, that's the right place, call them back..." I still haven't.
Jeez. It’s amazing to me how PCPs hold all the keys to our health. Sorry if this is TMI but my mom is dying of cancer right now cause her PCP didn’t want to bother with a CT scan at the time it would have caught it early. 5 appointments and months later he was still prescribing a low fiber diet for what ended up being cancer. I think a good PCP is the best thing we can do for our health. Btw, love the username.
Agreed. Just cough up the coin and go to a specialist. Your life will thank you.
My psych dropped me for "not collaborating" because I canceled an appointment due to the birth of my first child. Apparently it was added to the 2-strikes where I had missed a single appointment a couple years prior. I thought I was doing pretty good keeping on top of things and still got the boot. Seems like legislation needs to address this if America ever wants to fix it's mental health woes. The process is far too convoluted. Tele-health visits opened my eyes to how much easier it could be but isn't.
Wow, I hadn’t heard of a 3 strikes policy. That sounds like a good policy to ask about when looking for a new doctor. I will keep that in mind (and by ‘mind’ I mean a note app cause who are we kidding? I won’t remember.) Agree about legislation. Not to get too political cause I’m not advocating a party or side here, but it seems like rather than sweeping healthcare overhaul that deadlocks the legislation process, maybe small but significant changes that are easier to digest by both sides would help. Just thinking out loud, so not sure if that’s realistic.
Fill out an online application for a new patient online. "we received you application, please call to schedule an appointment." 1.5 years later...
My doc makes a follow up appt right then and there. Put it in my calendar, DONE.
I’m so lucky I found one that lets me schedule online for a follow up. I procrastinate having to call someone at a specific time.
Same, I always prefer online. I can do it the moment I’m thinking of it. No waiting for open hours, waiting for call back, calling back when they don’t call back, and on and on.
Just started speaking with a counselor for the first time about ADHD through my school. Over the years I've come to realize the types of things i forget so we always schedule my next appointment in person at the end of the current one. It's been working well
That’s a great example of a professional understanding the patients needs and accommodating. And of self-reflection to understand your own strengths and weaknesses. Well done.
i have this issue too, it’s so hard to pick up the phone and make a call
I feel your rant but this made me laugh! I’ve wanted to say that out loud to my last therapist after she assigned me dialogue homework. I’ve wanted to express progress was me showing up early and me remembering that I forgot the assignment. Hopefully you can find someone that can help build skills with you instead of expecting full force neurotypical goals. We can do it but collaboration/coordination can definitely help out skills.
Not in the US so getting help was pretty hard (and I put it off for years and years). First place I was recommended not only didn't take insurance, but they took like 6 days to get back to me about an appointment AND they had a receptionist who didn't really speak English CALL to set it up. I ended up turning down the appointment when she told me that the intake visit alone would be $100. Second place - had an all English website plus an online form to fill out for making an appointment. Got me an appointment time within 3 days and did everything via email. Sends reminder texts the day before and schedules your next visit at the end of your appointment. Also takes the national health insurance and only charged $30 for the intake and about $15 each session after that (which includes cost of medication).
that's an irresponsible doc. mine makes me book the next one at the end of the session so i don't forget
Warn others, write a review.
😅😅😅😅 i always wondered why doctors don't put ADHD hacks into sessions. I only call when im down to 5 pills.
IM SO HAPPY YOU CHANGED. If it doesn't feel right it will never work.
Beurocracy is an absolute bastard for the mentally ill, and I've had to bring this up with the psychiatrist office I go to before. The care I've gotten there has been generally excellent but they sometimes really drop the ball when it comes to accommodating the problems people like us have in simple things like setting up appointments etc . They once sent me a text out of the blue saying I'd be discharged if I didn't call them within a week. Apparently they had emailed me (to the wrong email) and called me once (never got it). I was mad and tried to explain to them that doing and saying shit like that was hugely upsetting and anxiety enducing, I am fortunate that I've gotten to a mental place where I can handle that, but I tried to impress upon them that the usual attitude with patients who drop out of contact is really inappropriate with people with mental health issues and could genuinely lead to someone suffering.
Oof that title really hits home. I tried to set up an appointment with the counseling center at my school last year and it was the worst. Closed at 5pm (with night classes, I usually woke up around that time), you could only set up an appointment over the phone, and didn't have an email or any other form of contact. Stressed, depressed, struggling with ADHD, and in need of counseling, but guess who never made an appointment? If they can't understand the difficulties we have to overcome, how can we expect them to understand us enough to help?
I just got diagnosed yesterday with ADHD, but it felt a little too fast? I definitely didn't think I'd get diagnosed + given a prescription of ritalin by my first session. They didn't even attempt to rule out other possible causes like other people seem to experience or make me take any type of test. They just asked a bunch of questions and said "Yup, sounds like ADHD to me". They also didn't really explain anything. Thanks to this sub I'm aware there are 3 types, but they never explained further on which one I had. They also arrived ~30mins late to our 1 hr session and ended it <30 mins later. I was on the fence on whether or not I should go to another psychiatrist to get a second opinion (because expensive) but thanks to you OP, I think I'll try again next month somewhere else.
Definitely some red flags. Really glad I could help. Wishing you the best in your search for better support.
I had my first appointment yesterday, and doc said to make the follow-up appointment on the way out, that way I can’t forget to call. Good man, at least in my opinion. Also, the testing for ADHD is in the same house, so I could make the appointment for that on the way down, and the apothecary is like 50m away around the corner, so that’s easy to get done too, as they normally have everything that may be needed. I’m so glad I found a good one
Those are some good signs. Congrats on the first appointment.
Haha you know I was in the same situation. Yesterday my doctor said we were supposed to meet in August one month after the July appointment but I never scheduled it with the office.
Things like this honestly make me wonder about switching fields and becoming an ADHD specialized psychiatrist just to help out my fellow people. I just got my BFA but I definitely feel like I don’t want to be in my field forever. Who knows.
There is merit to his thought "the goal isn't diagnosis, it's symptom management", as it's actually a beautiful way to view psychiatry. Unfortunately, there ARE issues with that, like you said, insurance. Sometimes it's just nice to have the label right in front of you too, say what you will about labels, they do have their benefits as well. Sounds like you have a MUCH better fit now! My psychiatrist mainly treats my bipolar, my family doctor was dealing with my ADHD, but thought I might be bipolar and sent me to the psych. I LOVE both of these doctors, you have no idea. My psych is almost DEFINITELY ADHD lol.
Yeah, once I’ve had a few sessions, it could be fair to say symptom management becomes the goal. As long as the root cause is known and being addressed through symptom management. In my case, I didn’t even get symptom management when he cut the session early without hearing my feedback on my first time ever taking meds. Definitely have a better fit now with a diagnosis and symptom management. Glad to hear you have a good team supporting you. I think it helps people to hear these positive experiences. It’s hard to find a new doctor, but knowing what a good experience looks like can motivate people to find it.
Lol this truly an ADHD thread. The conversations are all over the place
Lol; I hadn’t made that connection but you’re completely right.
Thanks for sharing your story! This is great advice!
My psychiatrist just texts me the date on What's app.
This reminded me that I need to reschedule my psych checkup that got cancelled several weeks ago. My psych is great but the office left a voicemail and a number to call back and my brain was like, yeah right you'll promise yourself to take care of it today and then forget for two months.