This has really irritated me. My girlfriend, after a lot of false starts, had finally gotten the proper diagnosis of ADHD, and it was from two different medical professionals from this same establishment. After a lot of useless red tape and bureaucratic bullshit, she finally was able to set up her appt to find out what medicines were going to be prescribed for her.
Well she has a couple co-mordid conditions that were also being treated, so when the medications were revealed to her, they were for all of her conditions-except for the ADHD. When she brought this up, she was informed that they “do not treat ADHD”.
Now this is something I just do not understand. This medical center, which specializes in psychiatry and related issues and was more than capable of handing down credible diagnoses related to their expertise, should be obligated to treat patients that they have diagnosed with conditions in their field of expertise. And my girlfriend had two separate diagnoses for the ADHD, from two different practicioners who were both in this medical group. It strikes me as a form of patient neglect to diagnose them with a serious condition and to not offer treatment for that condition.
My question is, how is this possible? I’m leaving out zero details. Well, other than my girlfriend is on medicaid (if that relevant, I don’t know). She’s requested that all of her medical information, included all of her diagnoses and medical history be mailed to her (or let her come pick it up herself). But she shouldnt have to take this kind of thing into her own hands and search for a doctor or network that treats legitimate medical diagnoses. How\and what point is there to a diagnosis if the person with the diagnosis is seen as a drug seeker when trying to improve her life? And she never even asked or specified any sort of drug or medicine at all. She simply asked the doctor what sort of treatment he would recommend for her ADHD. There isn’t even a hint of drug-seeking behavior in any of that.
So now, my girlfriend is all on her own, searching for a reputable doctor (probably a psychiatrist) who treats ADHD and also accepts Medicaid. I think it not acceptable. But I admit to being ignorant of the inner goings-on of the medical/doctor community and how they operate and why they operate the way they do. So I am humbly asking the more medically knowledgeable posters at the dope to fight some of my ignorance.
ETA: this doctors office also did not offer any other resources which she could use to obtain the treatment that they diagnosed but wouldnt’ treat.
Now keep in mind, Im a fairly radical cynic of the medical system in our country, but I can’t help but think some pretty dark beliefs and motivations that come from those beliefs are what fueled this experience. In my admittedly cynical-bordering on paranoid view, I have been thinking that the overreach of the “war on opiates” has made doctors (often legitimately) scared that the law will come for them if they (the law) determines that this doctor was prescribing too much of these opiods (so basically law enforcement overrides medical doctors as to which drugs at which amounts are appropriate. But these two groups (medical, law enforcement) have very conflicting goals in re to what the best plans are to tackle this problem smartly. And while adhd medications are not opiates, I can’t blame a patient who is successfully treated for adhd being scared that the war on opiods could take a soft left turn and wage war against those successfully treated in our as with adhd drugs (btw, those consist of much more than the stronger stimulant meds like adderall or ritalin).
You’re leaving out one important detail; any account of why the medical centre doesn’t treat ADHD, or why they say they don’t. Did your girlfriend not ask them that question?
I agree, on the face of it refusing treating for a diagnosed conditions seems to raise obvious ethical issues. So it’s impossible that this question hasn’t already been asked, and that there isn’t an answer offered.
I don’t see any ethical issue at all. Clinicians can diagnose all sorts of problems that they are not going to treat. They may not be qualified to treat those problems, or they can simply choose to stick to specific specialties for any reason they choose. This is not like denying life saving treatment to a patient, your girlfriend just needs to find a doctor who will treat ADHD.
So they gave her a bunch of psychiatric drugs, but not anything for the ADHD? They came out and stated firmly that they didn’t treat that disorder but were fine treating a whole bunch of other ones? I don’t have an answer, I’m just rather curious why they would take this stance, especially since they don’t seem to have a problem with its existence as a disorder. I could understand if they said they wanted to treat the co-morbid problems first and see if the ADHD is still a problem after that, but just straight up not treating it is absolutely mind-boggling.
I doubt that Medicaid is the reason for not prescribing. Not taking Medicaid would be a reason for not *seeing *your friend in the first place, but IME if they would accept her as a patient, they would prescribe.
Were the “medical professionals” who diagnosed her, able to prescribe?
Were they an MD, NP or PA? I don’t believe that a psychologist, for example, can prescribe.
The standard treatments for ADHD are also highly controlled, and highly valued on the street. It’s hard to blame a doctor for not wanting to prescribe something very much like meth.
It’s a little surprising that they diagnosed her, though: The definitive test for ADHD is to see how the patient reacts to stimulants.
Is it possible that the doctors simply meant that the medications they had prescribed for her don’t treat ADHD, as opposed to the doctors not doing so? In other words, maybe they put her on meds for her co-morbid conditions to see first how she responds, and then once those conditions are under control, they can reassess whether to add ADHD meds or some other therapy?
On the general topic, an urgent-care place once turned away my wife’s nosebleed (and sent us to the ER) because “they didn’t do noses.” It turned out that the treatment was to shove a comically horrifying apparatus up into my wife’s nostril, and the clinic was not set up for it.
I’m wondering where this is from? Discussions of the DSM-V diagnostic criteria are here and here, and that’s not part of the assessment (nor my personal experience via family members). Also, ADHD can be treated in some people by a non-stimulant (Strattera) or by behavioral therapy.
What is this legal obligation based on? A doctor generally has a duty to provide a reasonable level of care, but he is not required to treat every condition that his patient has.
The details are probably important here, especially if the examining clinician felt there was drug-seeking behavior here (your post is somewhat ambiguous about whether or not THEY, not you or your girlfriend, believed there was such behavior).
It does sound odd, given that the medical center specifically does deal with psychiatric issues (and ADHD is surely comorbid with a lot of them). Are they the ones that diagnosed the ADHD? If not, do they have her records from the practice which did?
What baffles me about your girfriend’s scenario is “this medical center, which specializes in psychiatry and related issues”. ADHD is certainly something that should be covered by that description. If they’re handling other psychiatric meds, you’d think they’d WANT to have oversight into everything she takes.
Not relevant to your situation, but it’s been my experience that some doctors are reluctant to prescribe medications outside their main area, especially if it’s a new diagnosis and you’re trying to figure out the right medication regimen. But for established conditions, where the treatment has been in place and working well for some time, they can be overcautious. I met with a potential new primary care doctor some years back, and she freaked out at two meds I take. One is a slightly outdated asthma medication (she said I’d have to have that prescribed by a pulmonologist), and the other is a common sleep aid (Sonata), which she said would have to be prescribed by the sleep specialists.
Those were a big part of why I didn’t go with her: I can actually understand the asthma medication (which I happen to have stopped using since then) as most doctors aren’t that familiar with it any more, but the sleep aid is not unusual, and I could show my insurance history to prove it was something I took only occasionally. Part of that may have been that I was a new patient (though Sonata is hardly Vicodin), but her reaction was a bit over the top.
I’ve since asked my primary care doctor (NOT the one mentioned above) to prescribe some slightly unusual medications, e.g. a small amount of Ritalin which the sleep clinic has given me in the past to use for driving. I wouldn’t have expected the primary care doc to be willing to write that scrip on a first visit or even introduce it as a new medication later on. The time I did that, I was already an established patient, had established (I hope) some credibility with her, and she had records from the sleep specialist.
Like dofe mentioned, did the Doctor explicitly say ‘no evidence of drug seeking behavior’ or is that just your conclusion? If they’re not treating the condition that typically gets treated with something that’s commonly used as a recreational drug, it’s likely that it’s either a general policy against writing scripts for that kind of drug, or they saw something in her behavior that looked like drug-seeking to them. I’m sure you think your GF isn’t exhibiting any behavior like that, but sometimes people overlook faults in people close to them, and sometimes the doctor may be looking for signs that you don’t recognize. I’m reminded of the thread where Stoid, known writing about distributing Valium prescribed for her dogs to friends, was furious that a vet wouldn’t prescribe her dog more Valium and insisted that there’s no way the vet could have noticed any warning signs from her.
Anecdote to add to the pile: my PCP office instituted a blanket ban on prescribing any pain meds or ADD/ADHD meds as of Jan 2018. If you’ve got a standing prescription, you have to find a pain specialist or a psychiatrist to re-affirm the script and continue prescribing. Oddly enough, no issues with prescribing benzos.
They don’t want to be accused of farming pills or contributing to dealers.
It is an entirely different situation but when I broke my ankle a dozen years ago, I limped over (didn’t know it was broken) to the nearest hospital emergency room. They X-rayed it, told me it was broken, sold me a pair of crutches and sent me to the nearest hospital that actually did orthopedic surgery. It never occurred to me that there was anything wrong about this. The various hospitals around town specialize in different things.
The OP seems to think that a policy of “if you diagnose it, you are obligated to treat it” would be a good idea.
In practice, I suspect that the result of such a policy in practice would be “Never diagnose anything that your facility is not equipped to treat” even if the doctor would otherwise be confident in that diagnosis. Would you really prefer that? I don’t understand why you would think that’s better than knowing a diagnosis without local treatment.
A psychiatrist is in the business of treating mental disorders. Sure, he wouldn’t treat an ear infection or a broken leg but ADHD is certainly a condition psychiatrists are experts in treating.
And there was ZERO drug seeking behavior, from any perspective. She had all her diagnosis, which included 2 separate diagnoses of ADHD, and she only inquired as to what her best options may be (stimulant based or otherwise). She didn’t mention a single drug by name (plus she’s beautiful and healthy, not a poster child for drug seekers.) Altho I know that doesn’t mean very much, they come in all shapes and sizes.
This was a psychiatric clinic. It wasn’t like being diagnosed with a broken leg at an urgent care center and then having them tell you to go to the hospital for treatment. Psychiatrics diagnose psychiatric conditions, where else but to a psychiatrist would you go, both for diagnosis and treatment?
Benzos are only Schedule IV controlled substances.
Most prescription pain meds are Schedule II and Schedule III. So benzos are much less tightly regulated.