I Was In, Out and Diagnosed in 20 Minutes

Where has common sense gone in this world? Why has almost everyone in power or a position of stature lost the ability to see outside of their small circle of reality? We spend hundreds of millions on war, and space exploration; we have politicians committing hundreds of thousands of dollars in fraud with no repercussions, yet our healthcare system is falling apart. Cancer patients waiting months for treatment, seniors waiting up to two years for surgeries, and as for mental healthcare, you would be lucky to see a therapist that is not private, within six to nine months. However, as with everything, the same problems do not apply to the upper echelon, and sadly those are the ones in power, and hence, nothing changes, or if it does, it’s a long time coming. Canada’s healthcare system is not what many may think.

My experiences in terms of the mental health aspect of healthcare system have been less than favorable, especially in the last year. I have been left on hold for over an hour, on numerous occasions, on several different crisis lines, as they are primarily unfunded and run by volunteers. I was turned away from a hospital before even seeing a doctor, but after waiting 4 hours, for “not being suicidal enough” and was then sent home with two valium and a list of crisis line numbers. I have had to carefully manipulate my way through the hospital system in order to gain short term access to a psychiatrist just to prescribe the medications I am taking, and of the psychiatrists I have seen, I have been diagnosed and prescribed medication each time in less than 20 minutes, and with the exception of one, left traumatized each time.

I have no issues with therapy, I go to therapy, and have done on and off for years, and I believe everyone should look for whatever type of practitioner works best for them. I personally have tried multiple therapeutic approaches, with social workers, psychologists and psychiatrists, and I encourage everyone to search for what works best for them. I try not to use my blogs as a forum for a personal rant, but this time I am going to make an exception due to the level of frustration I am at with the upper echelon of the mental health society. Again, this is not against any one individual, nor is it a generalization of all psychiatrists, just my personal experiences.

                To: The Psychiatrists I have seen,

I understand that you consider yourselves at the top of your field, above psychologists and social workers, and your hourly rates certainly confirm that. I understand that you had to work hard to become an MD and then further that with another four years and I understand you believe you have earned instant respect because you are better educated than the average person. I also understand that you have trained to learn multiple types of mental illnesses and their corresponding medications, I wonder if there was a class on how to deal with actual people, and not just look at them as an illness. I understand and that you do indeed have the ability to diagnose what condition you perceive I have based on set guidelines that I can easily find online.  What I question is how you possibly come to any thoroughly conclusive diagnosis in under 18 minutes, which would be considerably less time than it took me to write this blog.

Your general demeanor does not emanate compassion or empathy but rather that of a judgmental human textbook. Your handshakes upon greeting are cold and businesslike. You started to judge me the minute I entered your perfectly appropriate office and sat down. You have noticed if I am competent in personal grooming and if I am dressed “appropriately” for the situation. You have taken mental note of whether I am fidgety or talking too quickly as you pull out you IMac to start taking notes. The questionnaire is basically the same regardless of where you are: Have I felt depressed for more than 2 weeks consecutively? Yes, 40 years. Have I experienced some sort of trauma? Well if we had spoken first before diving into the Q & A you may have your answer. Have I heard voices or am I paranoid? Have I been hospitalized? Have I had suicidal thoughts or behaviors and/or thoughts of self-harm? Have I thought of harming others?  Do I drink or use drugs? Do I have attachment issues? Am I reckless and impulsive? The questions roll on, yet not once have you asked how I am, or even what brings me to your office. You glanced briefly at the brief history of me you have been given, and still, not a question that is not on your form.

12 minutes have passed.

You finally peel your eyes away from your screen, close your laptop halfway and lean forward with a feeble attempt to make eye contact. You reach into a drawer to grab a notepad and pen, and proceed to diagnose me with multiple illnesses, which you jot down on the paper. You grab a small pink pamphlet that has basic information on Borderline Personality Disorder (one so basic I could have written it after my first diagnosis) and proceed to explain how I fit into eight of the nine criteria so that is what I have. Again, not once have I had a chance to explain anything about my past or how I am presently feeling.

16 minutes have passed.

You briefly explain and write down the types of therapies that are beneficial, and then proceed to tell me which pills will work best for my depression, or anxiety, or whatever the diagnosis of the day is. You finally make eye contact, and ask if I have any further questions…funny, as I don’t recall having been given the option to speak, never mind ask questions, and tears the sheet off the pad of paper to hand to me. By the time I can fold the paper in half, you are standing up with a hand extended towards me, thanking me for coming in and walking me towards the door…I barely remember standing up. You say thanks again, give my file to your receptionist, go back in your office and close the door.

20 minutes have passed; I have been diagnosed with four separate mental illnesses, and have been prescribed medication accordingly. In 20 minutes!! I feel like I have been sucked in and spit out of the eye of a hurricane. My mind is spinning, my heart racing and to be quite honest I am extremely pissed off. I don’t care what books you studied 20 years ago, or how much practicum you may have, you have forgotten the most important aspect. People are individuals, all of whom do not fit into your selected, in the box, criteria.

Allow me to diagnose you in a paragraph. You are neither, better or necessarily smarter than I am, you simply are better educated. You had a life that allowed you to follow your goals and you look down on people like me who have not had that same luxury in life. The pretentiousness of your office, with your degrees displayed front and center, with the appropriate text books on the shelf speak volumes about your sense of self.  Your lack of eye contact makes it uncomfortable for your patient and shows an apparent lack of sympathy.  You diagnose not based on the individual client in your office but by the textbook, or by the small criteria boxes you tick off as you ask your questions, without truly ever listening for an answer. You prescribe whatever the latest medication on the market is, without a true knowledge of what is best for that individual, and regardless of side effects. If I come back and say the side effects are too much, or it’s not working, your first comment is that I have not given it enough time to work, and if I continue to complain you prescribe the next thing on your list, having no idea what a medicinal rollercoaster you have put your patient on. Years of experience gives you hands on knowledge, but it would seem most of you missed the class on dealing with people. It is possible to keep a level of respect and professionalism and also have a sense of empathy. It is possible to actually listen, and to ask questions that are not listed for you. I don’t care how many degrees you have, or how long you have been in practice, you cannot properly diagnose anyone in 20 minutes, and certainly not without speaking with them, and actually listening. Not everyone fits into the preconceived boxes you want to place them in….and perhaps that includes you.

I am not a 20 minute diagnosis, and you are not a paragraph.20-min

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3 thoughts on “I Was In, Out and Diagnosed in 20 Minutes

  1. There is a similar problem here in the U.S.– and yet, our healthcare systems are very, very different. Comparing notes also with various Twitter friends in the UK– it seems that this mess of bureaucracy is much the same, whether the healthcare system is single payer, other socialized, or for-profit.

    Which then leads me to wonder what the solution might be. You may remember Athena Moberg spoke of the problems of the “medical model”– sequential checklists of symptoms, instead of an integrated, holistic approach.

    I get 20 minutes with my general practitioner/internal medicine physician, as well as my psychiatrist. About the only thing I can think of that seems to help me somewhat is when I do my “homework” beforehand: their various paperwork forms, medicine lists, etc. That doesn’t stop the bureaucracy, of course; please note that I am a bit dismayed to find that many doctor’s offices pretty much ask me to do their legwork for them; that includes pain management, orthopedic surgeons, and so on. And speaking of offices- sometimes, I just LOVE the doctor, but I really do detest the attitudes of the receptionists, office managers, and so on. Some aren’t just rude– but they’re woefully inept at doing their actual jobs.

    Like

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