# How can a medical center diagnose conditions that they then do not treat (as a policy matter)? **URL:** \ **Category:** Factual Questions\ **Created:** [February 15, 2018, 11:58pm UTC](https://boards.straightdope.com/t/how-can-a-medical-center-diagnose-conditions-that-they-then-do-not-treat-as-a-policy-matter/808904 "2018-02-15T23:58:40Z")\ **Posts on this page:** 10\ **Page:** 2
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [February 17, 2018, 7:36am UTC](https://boards.straightdope.com/t/how-can-a-medical-center-diagnose-conditions-that-they-then-do-not-treat-as-a-policy-matter/808904/21 "2018-02-17T07:36:55Z")
> [@TriPolar](#): > > 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. You honestly see no issue with a psychiatrist with a specialty in schizophrenia diagnosing a patient with paranoid schizophrenia and turning around and saying “But Im sorry, I don’t treat schizophrenia.” And on top of that, offering no professional guidance as to where that patient could find adequate treatment. ETA: schizophrenia was only used as an example to make my point. I beat those demons years ago. ������ ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [February 17, 2018, 1:42pm UTC](https://boards.straightdope.com/t/how-can-a-medical-center-diagnose-conditions-that-they-then-do-not-treat-as-a-policy-matter/808904/22 "2018-02-17T13:42:08Z")
> [@Ambivalid](#): > > You honestly see no issue with a psychiatrist with a specialty in schizophrenia diagnosing a patient with paranoid schizophrenia and turning around and saying “But Im sorry, I don’t treat schizophrenia.” And on top of that, offering no professional guidance as to where that patient could find adequate treatment. But that’s not the case here. You said the clinic specializes in psychiatry and related issues , not that they specialize in treating ADHD. You don’t seem to be allowing for the possibility that the psychiatrist has a specialty in schizophrenia , diagnoses a patient with ADHD, and turns around and says " I’m sorry, I don’t treat ADHD" And there are psychiatrists and clinics that do specialize in treating certain diagnoses but not others. I think the most common specializations I’ve seen are in eating disorders and dual diagnosis (co-occurring substance use and psychiatric disorders) but I’m sure there are others. ---
**Author:** ![Smeghead](https://avatars.discourse-cdn.com/v4/letter/s/f1d935/32.png) [@Smeghead](https://boards.straightdope.com/u/Smeghead)\ **Post date:** [February 17, 2018, 3:46pm UTC](https://boards.straightdope.com/t/how-can-a-medical-center-diagnose-conditions-that-they-then-do-not-treat-as-a-policy-matter/808904/23 "2018-02-17T15:46:09Z")
I agree that your situation here is odd and somewhat infuriating; your generalization, however, goes way beyond what is reasonable. ---
**Author:** ![PastTense](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pasttense/32/14550_2.png) [@PastTense](https://boards.straightdope.com/u/PastTense)\ **Post date:** [February 17, 2018, 4:02pm UTC](https://boards.straightdope.com/t/how-can-a-medical-center-diagnose-conditions-that-they-then-do-not-treat-as-a-policy-matter/808904/24 "2018-02-17T16:02:57Z")
It might be because of the Medicaid coverage: > [@](#): > > ADHD Medication Prior-Authorization Policies in State Medicaid Programs. > Prescription prior-authorization policies require review of a physician’s prescription request by a state program or health plan before coverage for a medication is granted. In response to concerns about the growing number of children prescribed ADHD medications, many state Medicaid programs have implemented prior-authorization policies. A policy coding study was conducted with collaborators from Temple University’s Policy Surveillance Program and ChangeLab Solutions to catalogue and characterize the criteria of prior-authorization policies used in state Medicaid programs across the United States. [https://www.cdc.gov/ncbddd/adhd/documents/fact-sheet-adhd-medicaid-policies.pdf](https://www.cdc.gov/ncbddd/adhd/documents/fact-sheet-adhd-medicaid-policies.pdf) While these policies seem directed toward those not adults, perhaps it is in your state or perhaps the medical practice generalized their reaction. ---
**Author:** ![Arcite](https://avatars.discourse-cdn.com/v4/letter/a/67e7ee/32.png) [@Arcite](https://boards.straightdope.com/u/Arcite)\ **Post date:** [February 17, 2018, 5:07pm UTC](https://boards.straightdope.com/t/how-can-a-medical-center-diagnose-conditions-that-they-then-do-not-treat-as-a-policy-matter/808904/25 "2018-02-17T17:07:47Z")
> [@Chronos](#): > > It’s a little surprising that they diagnosed her, though: The definitive test for ADHD is to see how the patient reacts to stimulants. > [@Tom\_Tildrum](#): > > I’m wondering where this is from? Discussions of the DSM-V diagnostic criteria are [here](http://adhd-institute.com/assessment-diagnosis/diagnosis/dsm-5/) and [here](http://www.helpforadd.com/2013/june.htm), 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. Yes. God, **Chronos** , _please_ do not perpetuate that huge and harmful misconception! Every day across America, people are presenting to their doctors’ offices saying “I tried my nephew’s Adderall and it ‘worked,’ so I realized I must have ADHD!” _Everyone_ finds it easier to concentrate, be motivated, and get their work done with a stimulant in their system. In fact, at one point I developed in my mind a little spiel about controlled substances–about how the reason some drugs are subject to abuse is that unlike other drugs, say, antibiotics or antihypertensives, everyone, even people who don’t have a disease or disorder, feels better when they take them. I quickly gave up on giving this spiel to patients I thought were exhibiting drug-seeking behavior, because it totally goes in one ear and out the other. They can smell a denial coming from a mile away. They weren’t processing the words coming out of my mouth. All they hear is “I refuse to give you the one thing that relieves your suffering.” The definitive test for ADHD is, as **Tom Tildrum** posted, whether a person satisfies the DSM criteria for ADHD. Which is to say, there is no definitive test, because it’s up to a clinician’s subjective judgment. The issue of adults, who have no childhood history (despite that DSM criterion of having symptoms before the age of 12,) becoming convinced they have ADHD and going to psychiatrists in search of a stimulant is huge right now, because these drugs have become so widespread. The makers of Vyvanse have a direct-to-consumer ad campaign saying “ADHD is often underdiagnosed in adults. Ask your doctor about Vyvanse!” Most of these people do not satisfy the DSM criteria, but can be extremely persistent and make doctors extremely uncomfortable, because they often claim a severely impairing and completely debilitating inability to concentrate (i.e., to the point of getting fired from their jobs, or failing out of grad school) despite no other symptoms. The best means of assessing adults is a long, detailed, structured clinical interview (of which several have been published) but the sticking point is that criterion of having symptoms before the age of 12. Confirming that really requires talking to a parent, reviewing report cards with teacher comments, parent-teacher conference reports, etc., but there’s no way to bill insurance (including Medicaid or Medicare) for that work. I completely don’t blame a mental health clinic for saying they don’t treat ADHD (although if I were them I would also say I don’t treat it either.) ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [February 17, 2018, 5:37pm UTC](https://boards.straightdope.com/t/how-can-a-medical-center-diagnose-conditions-that-they-then-do-not-treat-as-a-policy-matter/808904/26 "2018-02-17T17:37:58Z")
> [@](#): > > Yes. God, Chronos, please do not perpetuate that huge and harmful misconception! Every day across America, people are presenting to their doctors’ offices saying “I tried my nephew’s Adderall and it ‘worked,’ so I realized I must have ADHD!” Everyone finds it easier to concentrate, be motivated, and get their work done with a stimulant in their system. I guess I’m a nobody, then, because caffeine kills my attention span. ---
**Author:** ![Pantastic](https://avatars.discourse-cdn.com/v4/letter/p/3bc359/32.png) [@Pantastic](https://boards.straightdope.com/u/Pantastic)\ **Post date:** [February 18, 2018, 12:44am UTC](https://boards.straightdope.com/t/how-can-a-medical-center-diagnose-conditions-that-they-then-do-not-treat-as-a-policy-matter/808904/27 "2018-02-18T00:44:05Z")
> [@Arcite](#): > > Yes. God, **Chronos** , _please_ do not perpetuate that huge and harmful misconception! Every day across America, people are presenting to their doctors’ offices saying “I tried my nephew’s Adderall and it ‘worked,’ so I realized I must have ADHD!” _Everyone_ finds it easier to concentrate, be motivated, and get their work done with a stimulant in their system. In fact, at one point I developed in my mind a little spiel about controlled substances–about how the reason some drugs are subject to abuse is that unlike other drugs, say, antibiotics or antihypertensives, everyone, even people who don’t have a disease or disorder, feels better when they take them. While it may be true that ‘do stimulants help someone concentrate’ is not a valid test for ADHD, your claim that _everyone_ finds it easier to work with a stimulant in their system is not true - I tried Ritalin years ago (on script from a doc) and it had no significant effect on me that I could tell. I didn’t feel more awake, motivated, or more able to concentrate or get things done, I’ve seen plenty of examples of people having non-high response to things that get most people high, and I’ve seen published articles on the topic. If you’re telling people that everyone gets high on Ritalin, or pot, or Vicodin, you’re spreading misinformation. ---
**Author:** ![Living\_Well\_Is\_Best\_Revenge](https://avatars.discourse-cdn.com/v4/letter/l/6bbea6/32.png) [@Living\_Well\_Is\_Best\_Revenge](https://boards.straightdope.com/u/Living_Well_Is_Best_Revenge)\ **Post date:** [February 18, 2018, 1:44am UTC](https://boards.straightdope.com/t/how-can-a-medical-center-diagnose-conditions-that-they-then-do-not-treat-as-a-policy-matter/808904/28 "2018-02-18T01:44:02Z")
If I take adderal I could never work. It’s like it gives me ADHD. I’m a spastic mess. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [February 19, 2018, 12:56am UTC](https://boards.straightdope.com/t/how-can-a-medical-center-diagnose-conditions-that-they-then-do-not-treat-as-a-policy-matter/808904/29 "2018-02-19T00:56:28Z")
> [@Ambivalid](#): > > Benzos are only Schedule IV controlled substances. > Most prescription pain meds are Schedule II and Schedule III. So benzos are much less tightly regulated. Most ADHD meds are as well. My daughter takes Vyvanse (a prodrug in the amphetamine category, meaning it metabolizes into the active drug in the body) and she has to have a new paper scrip every month for the stuff. When I get my Ritalin every couple of years, they have to give me a paper scrip as well. One time, I requested it between visits (I see them every 6 months) and they had to mail it to me. For an established patient, the guidelines _do_ allow a prescriber to write 3 months’ worth of prescriptions of these at a time, but on 3 separate prescriptions and each has to be labeled “do not fill before xxx date” (which played merry hell the time we tried this with the mail-order pharmacy!). I’m surprised benzos are schedule IV; I’d have thought them higher, but whadda I know. So are Ambien and Sonata (sleep medications), and Nuvigil / Provigil (non-amphetamine wakefulness-promoting drugs). I know those prescriptions are only good for 6 months. ---
**Author:** ![Francis\_Vaughan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/francis_vaughan/32/3093_2.png) [@Francis\_Vaughan](https://boards.straightdope.com/u/Francis_Vaughan)\ **Post date:** [February 19, 2018, 3:11am UTC](https://boards.straightdope.com/t/how-can-a-medical-center-diagnose-conditions-that-they-then-do-not-treat-as-a-policy-matter/808904/30 "2018-02-19T03:11:04Z")
> [@Mama\_Zappa](#): > > 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. I think this is the core problem. ADHD is something that clearly comes under the banner of stuff they are working with. A blanket “we don’t treat that” fails a whole range of duty of care issues. They need to go some distance further. Either the ADHD is not enough of an issue to warrant treatment - in which case say so. If they have a blanket policy that it should not be treated - ie a professional judgement that would be at least slightly controversial. If the ADHD is something they don’t wish to be involved in treating, but it is a serious issue, they should provide referral to someone who will treat it, and further they should coordinate with them about the treatment regime to ensure appropriate overall therapy. Simply announcing a diagnosis and flatly saying they don’t treat it invites a situation where a patient seeks out treatment elsewhere with no oversight or coordination occurring, with potential for bad outcomes. [Previous page](https://boards.straightdope.com/t/how-can-a-medical-center-diagnose-conditions-that-they-then-do-not-treat-as-a-policy-matter/808904.md?page=1)