If I go to my doctor and complain of a sore knoee, the doctor will send me to a joint specialist.
If my doctor hears a heart murmur, she will send me to see a cardiologist.
If I describe symptoms of synesthesia, she will send me to a neurologist.
If I complain about abdominal discomfort, she will send me to a gastrointernologist.
If I describe symptoms of depression and anxiety, she will prescribe me SSRIs and mood stabilizers.
Idon’t hate doctors. If you’ve read this blog so far, you should know that. However, I do have issue with the relative ease many patients have in getting psychopharmaceuticals. I also think therapy is often ignored. These are not grounds to tear down the entire medical establishment. But it is some food for thought, especially considering that psychiatry is a perfectly respectable specialty. (I know, some doctors have issues with psychiatrists, but some doctors also have issues with dentists, and I’ve never had a GP try to clean my teeth.)
When I lived in Parkersburg, WV, I worked in a mental health short-term crisis stabilization unit while I was finishing my RBA. One of our doctors was Dr. Mike Dickerson. Dr. Dickerson was great. He told lots of stories about being a medic in the military, and was a no-nonsense doctor overall. He and I would get into heated discussions, then go off and do it all again a few days later. I learned a hell of a lot from him, but one day I think I really got the point across as it related to medicine and diagnosis.
I had heard a story from a professor that I was passing around the office. This professor used to work as a child psychologist, and she had a client come in who had been seen at another behavioral health clinic. The doctor spent 5 minutes with the child, wrote a prescription for Ritalin, and said “Give him this. If it doesn’t work, he doesn’t have ADHD.”
I had stated that this was sloppy, that the doctor should have spent more time in the diagnosis stage, and that drugs working/drugs not working” should not be the test for ADHD. I still believe this, especially since, according to Skeptical Inquirer, there are at least 8 million kids diagnosed with mental disorders today. Dr. Dickerson stated that this was acceptable, and that it had happened to him. He took his son to the head of the neurology department at Duke University while he lived in North Carolina, and the events transpired the same way. I responded with “Do you know any former heads of the Duke Neurology Department who are working down the steet at the local mental health clinic?”
I know, it’s an argument ffrom authority, but it is a valid point. I think neurologists are better equipped at making these kind of decisions than family doctors who work in mental health clinics because Medicaid doesn’t pay enough to attract a psychiatrist. Dickerson got that point, too, and relented.
Again, we don’t need to dismantle the entire system, we just need to put a little more thought into how we treat mental illness.