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Adult Diagnosis & Treatment This forum is for the discussion of issues related to the diagnosis of AD/HD

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Old 05-19-18, 10:25 PM
Silverware23 Silverware23 is offline
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I'm worried I'm not seeing the right kind of doctor?

I'm in my 30s. For years I've assumed my "weirdness" and some of my mental challenges and hangups would probably be described by something like mild autism, although I was never convinced that was a perfect fit. Even if so, I figured it wasn't worth getting a diagnosis.

A friend just got an ADHD diagnosis a few months ago, which made me look it up, and I never realized just how much it could describe me too. The "inattentive type" literally sounds exactly like me, and I am completely convinced that I must be ADHD. I feel like a lot of my bad habits and day to day struggles have been getting worse in the past few years, and I'm desperate for some kind of change. While I'm happy with who I am and extremely comfortable with my "weirdness," I'm becoming increasingly aware of just how much my brain is in the way of doing the things I want to do, and I'm ready for help.

I asked my doctor for a referral for ADHD, and he promptly got me in with the psychiatric associates of the same healthcare system. I got a call from them and scheduled an appointment. I checked my online information, and the person I am scheduled for has an MSW degree - I looked this up and it is Master's of Social Work. I'm not at all an expert in what social workers do, but it seemed rather strange to me that I wouldn't be seeing a psychiatrist.

I feel fairly convinced that what I need is medication. I already know myself very well and I know what my mental struggles are. I've got coping mechanisms, even if they're falling apart lately. I'm just concerned that if I'm not seeing an actual doctor, then I'm not getting closer to real solutions that I need.

The appointment is in two months, I'm struggling badly with my job right now, and I don't want the day of the appointment to arrive, all to find out it was all a waste of time and I'd need to wait months and months longer to get real help. I want to get this done while my health insurance situation is stable, because I honestly can't see myself staying at this job for a whole more year (although if medication could really help me, maybe it would change my perspective on the job).

I'm also somewhat concerned what kinds of medications I'll be able to take. I've recently been put on blood pressure medicine because my family has a genetic history of high blood pressure, and my own blood pressure has been high for a long time. I understand that stimulant type ADHD medications can raise blood pressure, so I'm not sure if my regular doctor would approve of it (or if a higher dose of blood pressure medication can offset that).

At any rate, I'm very new to this whole psychiatry thing, and I'd just like some advice as to whether this looks like a normal pathway to a happy diagnosis! I'd just like to know what to expect from a social worker, or if I should look into pursuing this from a different angle!
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Old 05-20-18, 06:57 AM
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Re: I'm worried I'm not seeing the right kind of doctor?

I am surprised that you wouldnt be seeing a psychiatrist as well because a social worker cant prescribe medication and usually can only do therapy.
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Old 05-22-18, 01:36 PM
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Re: I'm worried I'm not seeing the right kind of doctor?

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Originally Posted by Silverware23 View Post
I asked my doctor for a referral for ADHD, and he promptly got me in with the psychiatric associates of the same healthcare system. I got a call from them and scheduled an appointment. I checked my online information, and the person I am scheduled for has an MSW degree - I looked this up and it is Master's of Social Work. I'm not at all an expert in what social workers do, but it seemed rather strange to me that I wouldn't be seeing a psychiatrist.
I also asked my primary care doctor for a referral 6 years ago and he referred me to the behavioral health department in the same healthcare organization.

The first person I met was a clinical psychologist. After an appointment or two, she then referred me to a psychiatrist who was part of the same department and for the next few months, I saw both of them, one for therapy, the other for medication management. And oddly enough, I was diagnosed separately by both of them.

But I suspect that the psychologist I saw initially was probably a kind of gatekeeper, talking to me first to decide if I really had ADHD, and then referring me to the psychiatrist after this was confirmed.

There's another thread here in ADD Forums called "My quest for ADHD treatment through Kaiser Permanente". In the case of the person who made this post, even the gatekeepers had gatekeepers. He says that after calling the Psychiatric department at Kaiser, they set him up with his first appointment three weeks later. Here's a condenses version:

Quote:
Three weeks later I go to my appointment only to find that it’s not really an appointment for treatment, it’s a group meeting to introduce people to the fact that Kaiser has a Psychology department. Rather pointless. At that meeting they set me up for a 2nd appointment 3 WEEKS from then...

Three weeks later I go to my ADHD appointment only to find it’s not really an appointment for treatment, it’s a group meeting to introduce people to the fact that they have ADHD and Kaiser has a Psychology department that treats it. The only apparent reason for this appointment is to test your blood pressure and give you a drug test....

Three weeks later I go to my private appointment, hoping finally to receive some relief. The appointment was with a nurse who asked my history and I gave her as honest and thorough a rundown as I could given the fact that they are churning patients in and out every 5 minutes....

She said she would only give me Strattera and she would schedule an appointment with a Psychiatrist in 3 ½ weeks.
So, maybe the MSW you're scheduled to see is just a gatekeeper on the way to getting an appointment with a psychiatrist.

Also, there are a lot of other people besides psychiatrists who can diagnose ADHD and prescribe medication for it. Psychologists can do the diagnosis and some of the leading experts in ADHD such as Thomas Brown and Ari Tuckman are psychologists. In cases such as this, they will refer a patient to someone else for medication, perhaps a psychiatrist they know.

Also, regular doctors, Nurse Practitioners and Physician Assistants can prescribe psychotropic medications (although 12 states don't allow PAs to prescribe Schedule II medications), and some of them are quite good. The primary care clinician that I'm seeing now is a Physician Assistant and he prescribes all of my medications including the Vyvanse I take for ADHD. He's also much more knowledgeable about ADHD than what the psychiatrist was that I saw initially.
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Old 05-22-18, 06:26 PM
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Re: I'm worried I'm not seeing the right kind of doctor?

Psychiatrists who take insurance in many parts of the country are simply overwhelmed with patients.

So what various practices do is send you to meet a psychologist or social worker first ... and then that person screens you and makes the referral to the psychiatrist.

Some places may require you to be in treatment with a therapist in order to also see the psychiatrist.

Your two month wait seems to back up my thinking ... that practice is incredibly busy! .... So many psychiatrists don't take insurance these days ... so the ones who take insurance are really backed up ... with long long lines to their offices.

As for blood pressure, you tell that to the psychiatrist when you get to him ... and you go from there ... The psychiatrist will know which meds interact with which particular stimulants. They will have some history of how to treat patients with high bp.

Between your regular doctor and the psychiatrist and you ... you will all try to find a med combo that is ok for your heart and helps your ADHD. I say assume you can find a combo as you start the process.
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Old 05-24-18, 03:29 PM
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Re: I'm worried I'm not seeing the right kind of doctor?

Thanks! The "gatekeeper" logic does seem reasonable, and makes me feel a lot better. I was hopeful that it wouldn't be a prolonged process, but I just have to be prepared to be patient.
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Old 05-26-18, 03:44 AM
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Angry Re: I'm worried I'm not seeing the right kind of doctor?

Quote:
Originally Posted by PoppnNSailinMan View Post

Also, regular doctors, Nurse Practitioners and Physician Assistants can prescribe psychotropic medications (although 12 states don't allow PAs to prescribe Schedule II medications), and some of them are quite good.
You're lucky if you can get a regular doctor to prescribe ADHD medications. Mine would not. I had a really bad experience with a psychiatrist and refused to see one for years. For a few months she let me slide and would write me a prescription but she always said she was not supposed to. My new doctor will absolutely not. My insurance only had 2 doctors. One was booked full and wasn't taking patients. The other doctor was only doing group studies so I ended up waiting about 6 months until the 1st doctor had an opening.

The first one that turned me against psych doctors basically never heard a darn thing I said for the first several sessions. Then she overreacted and things escalated.
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