Two Things: Med Eval? & Disability

Ok, so my GP has been doing my bipolar meds ever since, well, ever. And it's been a string of GPs in a string of states. Now that I'm home and in the system and things are (slowly) chugging along, things are, well, chugging along. A few things maybe you guys can add input on...?

1. Today I had the first of THREE evals for my disability application since they said there was inadequate medical history on me. (Well, duh.) But still, three seems like a lot. Today's was with a psychologist. The next is with an MD. The last is with a pdoc (which will be the first time I've ever spoken to one in my life). So anyway, the one I saw today...I hear these are supposed to be fast appointments. He kept me there talking (and I was nervous and obviously having a hard time and very frustrated with myself and trying to answer things) for an hour and fifteen minutes. He asked me TONS of questions even though the paper he had to fill out seemed simple and yes/no. he'd ask a million questions and I mean REALLY personal in-depth stuff (I almost broke down in tears a few times although I was obviously trying really hard not to and never quite broke down, but I was struggling) and would every now and then circle something or make a short note. And he asked some WEIRD questions, too. On the memory and verbal subtraction stuff I was like a deer in headlights and at one point he asked me to subtract seven from 71 and I just blanked and started to freak; I could not figured out why I couldn't do it (caught off guard?)...so I had to work it out aloud starting from 70 minus seven and then adding one. I was so embarrassed. But anyway, my question is: is this normal? An hour and fifteen minutes? For a disability psych eval? (I was told these are basically a joke, a token 5-10 minute novelty thing where they try to figure out if you are trying to defraud the government...)

Ok, so next topic:

2. So I've been on a wait list to get in to see a pdoc. Until then, to stay in the system my insurance has approved, I have had to regularly see a social worker, which I have done. The wait list was said to be 6 months to a year. I got a call today saying they had an appt for me for a med eval!! I asked if this was with a pdoc and she said yes, and then, "Well, he's a psychiatric Nurse Practitioner." Um, is this pretty much the same deal? Should I consider this my spot off the wait list? I'm a little confused. I guess I should have asked the person that called, but I'm phone phobic and I was a bit flustered. It's August 10. But this is a mental health place in a hospital approved by m,y insurance and will be taking over all mental health meds management from my GP so I guess this is it? So maybe I can finally maybe try Lithium? And they can prescribe me anti-anxiety meds? (The last psychiatric NP would not, since it was an emergency services place and my GP doesn't like to because she's a GP.) I'm so new to actually getting treatment. Argh. I really should have asked these things. Maybe this means I'm finally about to get proper treatment for this?

Well, I'kk try to help and answer what i know. 1. My eval's for disability have been l;ong and also short. I met with a psychologist who tested me on all kinds of cognitive skills like memory, math, patterns, that sort of thing. I also saw a psychiatrist for about 15 minutes who asked me a few questions and that was it. He ended the session after I told him about my self harming behaviors. He seemed a little taken aback. But I digress..

2. From what I can gather, a psychiatric nurse practitioner can prescribe psych meds, but is NOT a psychiatrist. A psychiatrist is a MD with a specialization in psychiatry. A psychiatric nurse practitioner has usually a master's degree in nursing with a specialization in psychiatry. So one is a medical doctor and the other is a nurse. Quite different in my mind. Here is a link to a website on psychiatric nursing
http://www.apna.org/i4a/pages/index.cfm?pageid=3292

Hope this helps.

I knew the difference between the two (NP versus Pdoc) but I was told I was on the wait list for a pdoc...but I guess maybe the psychiatric NP is what I'm gonna get.... Well, better than nothing, I guess. Maybe better than a pdoc even? My best friend (also bipolar) says her pdoc spends about 3 minutes with her, shoves meds at her, and sends her on her ways...but the NP that works for him who sometimes does his med evals actually talks to her, listens to her, and prescribes meds more appropriately. I just feel like I am constantly getting the runaround. I've needed help for so long and I have yet to see a shrink. Ever. To be honest, while I am grateful to at least finally be in a mental health system that will be taking over all my mental health care, I wish I could at least just see a damn pdoc, even once. I mean, even all of my diagnoses have come from GPs and disability (and even my eval guy yesterday) has mentioned this disdainfully several times, as if they doubt the validity because its not from a pdoc, but I can't get to see one! Argh!! Frustrating. When I mention that I've seen psychiatric NPs they say, "Um, that's not a doctor and they cannot diagnose." Yet, aside from my GP, that's the only bone the system will throw me. Sheesh.

Yeah, the disability eval was really weird. I just didn't know what to think. I wish I knew what he was going to report to disability! I'm so curious. I know I won't get to know, but I sure wish I did. Thank you so much for sharing your experience. I appreciate it. I was kicking it around in my head yesterday in circles all day long. I don't know why I over think everything like that, although it's probably a combo of my OCD kicking in and my desperation to have my application for disability approved (although I do have realistic, meaning low, hopes). Thanks again, Lauru.

Glad I could help, even a little. I think it's ridiculous no one has gotten you into a psychiatrist yet. That's just stupid of them. Good luck and best wishes

I'm ridiculously excited to finally get appropriate treatment. August 10th cannot come soon enough.

You helped a lot.

My experience with the "psychodiagnostic" evaluation, as they called it, was similar to yours for disability. It went on for an hour and a half. I was nervous and anxious and depressed at the time. I stared at the floor mostly. He asked weird stuff like what does the phrase "He who lives in a glass house should not throw stones" mean? I totally blanked out. I finally decided that it meant if you were in public life you shouldn't do certain things because people will find out. I'm not even sure if that is right and it took me a couple of minutes to even say that. He also asked me to hold out my arm with my palm down. Said something about Wernike-Korsakalf syndrome, whatever that is. He also asked me to repeat numbers he said out loud only in reverse order. I think I got as high as 5 I could do. Then on the sixth and seventh strings I blanked completely. It is so hard to focus under pressure. They were supposed to send a copy of his report to my therapist, but they never did. After the eval, they denied my claim a couple of weeks later. I appealed immediately and my T and my pdoc wrote letters explaining why I am seriously disabled. In June they reversed their decision, now I'm on disability. I think they automatically deny everyone on the first try, so the professional evaluators of their choice don't even really matter. The guy told me that in his opinion I had a good case before I left his office. Still they denied me that first time. And my docs had written letters too before that. It was the appeal and the second letters using the "four areas of functioning" as a guideline that got the decision reversed. That's how I think it works, but it may just be my case.

I wish you the best of luck in trying to get disability. I just wouldn't hold my breath about all of the evaluations on the first try. Someone sent me a link to the four areas of functioning. I wish I had it. You need to give that to your docs for the appeal if you don't get through on this one. Sorry it sucks right now. The process is grueling. I think they put us through all this stuff hoping that we'll give up. The sad thing is, the people who need disability the most (depressives) often give up because they are so depressed and hopeless. I hope you get it on the first try, but don't give up if you don't.

I had to keep trying it took me 3 times to get my disability

Sorry to edit so heavily, but just had to say, hoo boy, can I relate to these, Shakti. The only difference is that my dx *is* from a p-doc (and, it's probably important to note *had* insurance at that time). But now I am in a different state, uninsured, basically unemployed (about 5 hours a week) and having the most ridiculous time getting help. Including from the so-called safety net providers. And I have persevered far beyond any reasonable threshold, which I'm proud of in a strange way. Still there are many days I can't deal with the relentless rejection. Boy, do I feel your pain. Know that you are not alone. I even found myself being insanely jealous of others for even having help(!) Which is ridiculous, since of course I wouldn't want it any other way for them! WTH, brain?! I've read all your posts right along, and wanted to respond more on this, but wasn't able to even know how to describe how desperately alienating the experience has been. Maybe bits here and there, but I honestly can't remember what I've written sometimes, especially as I've kept this pain close to the vest, but little bits may have leaked out so to speak. It's just hurt soooo badly. It's incredibly frustrating, but know that in this frustration, I'm right there with you, and very much thinking of you.

Again, yes!!! The one glimmer that finally broke was a psychiatric nurse practitioner for me too. They're more than a half hour drive away, so I'm going to keep trying for something closer, but in the meanwhile...
And guess what?! They've got me pencilled in for August 10th too!!!

Wooohooo, Innerzone! We'll have to let each other know how it goes. I'm going to cross my fingers for you.

Thinker22, I saw the four area of functioning link somewhere on here and I tried to used that very very heavily in my initial application, so I hope maybe (just maybe maybe maybe) that will help. I'm pretty confident I'll get shot down the first time, in which case I'll either give up (yep, we depressives, it's how we roll) or just go the attorney route. I am hoping beyond hope (and I'm surprised I can drum much up, to be honest) that somehow it will just work out. But I'm trying to be realistic.

Thank you all so so much for your input.

At least you can do the first appeal online. They then send out new forms to your doctors and let you add in any new information since you first applied, such as hospitalizations or seeing new doctors or nurses for the same problem. Don't give up! I got it after that single online appeal and my doc's new letters.

You can do the first appeal online!! I had no idea. That is wonderful! I think even I can drum up enough energy to do that. That might actually work out well because all of my evals end on July 26th, but there are total hospital/med/doctor and probably (official) diagnosis changes happening in August. Maybe that will work in my favor if I get denied. Which I'm sure I will.

They definitely make you jump through hoops. And for just enough money to be barely over the poverty line (which is done on purpose). Enough to keep you poor and on the fringes of society. But I'll just get started on a rant about the treatment of the mentally ill in the U.S., so I'm gonna zipper my lips before I get started.

Just wanted to give all of you a little hope. I did my own research online 5 1/2 years ago regarding disability application and used websites that really explained well exactly what the SSA looks at when they decide if someone is disabled or not. I got the statements from my docs (admittedly I had both physical and mental disabilities) and had a history of having to take jobs with less and less responsibility and stress until I just couldn't do it anymore. Bottom line, I was interviewed by the SSA people only and did get approved on the first try. So, it can be done. Gotta dot your i's and cross those t's, though. It's a painstaking process but very worth it. And, yes, some 70% are denied first time. But an appeal helps tremendously.

Best of luck to you all.