[lenjan]

Not sure this belongs here, but it seemed most logical -- move if needed.

Wednesday I got copies of the reports from the hospitals I was in for my aplastic anemia over the winter. I was lucid enough, just barely, when I got to the first one to tell the dr. my mental health dx's, recurrent major depression and PTSD.

Well! Turns out he also listed me as "anxiety disorder NOS" (I've never been told anything except that anxiety comes with depression -- never had an official dx of it) and borderline.

The borderline -- and nobody who knows me, including every mental health professional I've ever seen, thinks I have a personality disorder -- comes along with the self-injury, I'm told. But how fair is that?! SI is the only symptom of borderline I have, and yet I'm lumped in there.

I know labels don't mean much, but it just kind of annoyed me that this guy (a blood disease dr.!) took it upon himself to change my dx! And now every time my records get sent somewhere, it's going to be in there. ARGH.

Candy

[JustBen]

That sucks. If you're treated by someone who's either lazy or just trying to cover his butt, you'll almost always end up with either a BPD or Adjustment Disorder dx.

yeah adjustment disorder as in the doctor couldnt be bothered to adjust himself to properly examine you :P

[kimmydawn]

((((((((((((((Candy))))))))))))))))

I would raise cane! Can you not contact their office and as why an MD treating a blood disorder would want to dx you with additional dx's when you were seeing professionals for that? I don't know much about that stuff, but can it be removed by the dx'ing dr?

I'm sorry, sweetie.

KD

[Rapunzel]

Candy, I don't think it was a blood doctor's place to add to your mental health dxs either. I wonder if he even thought of the stigma that a bpd dx can carry and how that can come back to bite people. You don't seem like someone who has BPD from what I know of you. I can kind-of see what his purposes might have been - maybe noticing the scars he could have been concerned about the possibility of sabotaging your treatment or something like that (hmm, sounds like something I would do, but not something you would do), and wanted to make a note. But he could have just noted scars from SI, and that would have covered it. I believe that I have BPD, and no therapist has argued with me much when I ask them about it straight out, but I've never officially received that dx. I think they are avoiding stigma and considering the effect that the dx could have on my career.

As for anxiety, while I don't know what business that doctor had giving you the dx, anxiety can easily be invisible to us in some forms. I never recognized that I had an anxiety disorder until my T was very blunt about that, and then dxed me with GAD. I think she had to put something other than personality disorders as a primary dx so that insurance would pay (since my insurance doesn't cover personality disorders), but my anxiety is really only being addressed as a side topic. I can see it though once she started pointing it out to me. I do see anxiety in you, such as when you worry about what your test results are going to be. That's basically what anxiety is - a range of feelings from worry up through more intense fear. If you worry more than an average person would or about more things than average, that could be anxiety.

I'm sorry that your doctor took it upon himself to change your dx in an area where you were being treated by more qualified professionals. That really is annoying! And I hope that I haven't just gone off on unrelated tangeants, and that some of this actually helps you.

[jennie]

I'd talk this over with the mental healthcare provider treating me. If he/she disagrees with diagnosis, ask him/her to remove the misdiagnosis out of the record. Maybe a letter could be placed in record that corrects the issue?

Sounds like its a violation of JCAHO standards. You have the right to report that doc and hospital. http://www.jointcommission.org/

[lenjan]

Wow,thanks you guys. I didn't know anything could be done about this, I was just irritated with the guy. Now I'm good and mad at him! LOL

Thanks for the tips. Rap, if intense fear = anxiety, then I am the most anxious person I know! So I guess it fits. Maybe I *shouldn't* have taken myself off the Xanax?

Candy

[Lexicon78]

That's just wrong! Although I fit every characteristic of borderline I do know that not everyone who self injures should be classified as that just because they do it!

And I repeat...that's just wrong!

[radio_flyer]

Off topic... i know.. but i had to comment.... your post made me smile... because adjustment disorder was my first dx by the same t that told me to run around the car should i have a panic attack while driving... lol........ smilen at the comment lazy or covering his butt... i believe he was covering his butt big time... lol .... ya made my day on that comment

[radio_flyer]

I agree.. it sounds very wrong..... a blood doctor giving a mental health dx just doesn't sound right.. maybe you can have your old t straighten him out.............

[January]

(((((((((( Candy ))))))))))))

Protest it! How dare he!!! Grrr on your behalf.

Hugs,

Jan

Basically what happens if the professional doesnot have other records and doesn't do psyychological testing they go on the symptoms that they witness you experiencing. They probably saw you're self injury scars and some anxiety and so they knew you were saying you have this disorder and that one but no records to back it up at that moment so they lopped all the symptoms into the general Borderline personality disorder catagory. anyone that does a comprehensive psychological evaluation comes up with at the least Borderline because the tests don't test for normal behavior patterns they test for the abnormal. Then NOS was put on aniety probably because they could not tell which your present at that moment anxiety was coming from your PTSD and other mental problems or from being so physically ill. so they again loppped it all together.

Your best defence against this happening again is to fill out a form. Here its called Declaration for Mental Health Treatment. On the form is my diagnosis- both physical and mental, contact information to my therapy agency, my primary physician, my designated representative should I be unable due to physical or mental illness to make my own decisions, my medication allergies, and any treatment plans that I have for each of my physical and mental health diagnosises. I carry this with me at ALL times, my primary physican. therapist and therapy agency and my representative all have copies.

Now no matter what the problem is if I land in the hospital the hospital has to treeat me according to this paper for it is legal and binding and if they have other treatment options then what I have consented to in the paper and unable to give my consent they have no choice but to contact my representative.

Anyway long story short with this paper they will have all they need for knowing and verifying my diagnosises and wont be pitching blind in treating me and writing down diagnosises and so on that are not me.

[(JD)]

lol no, probably not a good idea to self medicate (removing meds included ) I think I would also request that the record be amended. Anxiety is part of PTSD too! sheesh.

[jennie]

Patient medical records serve as legal documents. They are the property of the healthcare facility, "not yours." Medical records serve as a financial reimbursement for the facility treating you.
Also . . .
</font><blockquote><div id="quote"><font class="small">Quote:</font>
It serves to correlate, for all involved, important patient information regarding the treatment rendered and the patient's treatment plan, and is the means by which a level of communication is achieved among all health care providers involved in the patient's care. (source: link

</div></font></blockquote><font class="post">
I do not know the reasoning why that doc added psych diagnoses to your medical record. Will the hospital receive more money for their claim on you with more diagnoses being coded? I don't know. Is the doc trying to feel more knowledgeable in medicine by documenting psych diagnoses but probably isn't board certified in psychiatry? I don't know.

I do know that there is stigma involved with a label of a personality disorder. Docs are supposed to "do no harm."

Please get an addendum to your medical record correcting this unfair dx. I think that doc should apologize to you, too.

Hopefully this misdiagnosis (if it is one) is not charted electronically. Electronic medical records are very vulnerable to privacy breaches.

JCAHO requires medical record documentation to be accurate. They also monitor the quality of care of accredited institutions. You can check to see if you hospital is accredited and file a report (linked in my earlier post) stating your concerns (if the hospital does not resolve the issue first). JCAHO search link

[JustBen]

I've encountered mental health professionals who have flat-out told me: I diagnose every single patient as either adjustment or borderline. They're serious enough that the insurance will pay, and vague enough that I can fit just about any kind of symptom I want in there.

And it's not just a matter of getting a reimbursement check, either. It's the legal stuff, too. Someone comes to see a physician with self-injury and he/she doesn't provide a diagnosis right away, there might be real problems down the line. Let's say that patient goes home and does something even more serious a few days later. The family hires a lawyer and goes after the MD for malpractice. The lawyers say, "He wasn't providing sufficient care...he didn't even provide a diagnosis!" (Result: Bye-bye career, bye-bye license; hello trying to pay back massive medical school student loan debt with a low-paying job.)

I'm not trying to defend the doc here. Just pointing out that the system encourages this kind of crap.

[radio_flyer]

I don't think you can blame it all on the system..... That is a poor excuse for giving folks wrong dx's... I can say if I go to the hospital for surgery for ingrown toe nails and I wake up with my left leg amputated, I am not going be a happy camper....

I don't know how long a therapist has to give a correct dx so as to "cover his @ss" or "get get insurance 'payments", but I can say if after three months he/she is still shaking their head and not know, they should tell the person they aren't sure, or seek advice from other therapists.... NOT just give out a dx of borderline or adjustment disorders. That really sucks big time.... That is one thing that is wrong with this world and that is folks doing "wrong things". Knowing they are doing wrong, just to cover their @ss.......... Whatever happened to integrity???????????? grrrrrrrrrr

[Rapunzel]

It's just not an exact science, assigning diagnoses. Some mental health professionals avoid diagnosing at all because they just don't believe in it, but when they have to provide a dx for insurance they will be as vague as possible. I don't think that I would do that, normally, because sometimes having an accurate dx can help with finding treatments that work, relevant literature and resources, etc.. But on the other hand, a lot of treatments are more general and effective for lots of diagnoses, and someone like me can easily look through the DSM and find tons of diagnoses that all seem to fit (I tend to collect them).

Yeah, and my next class starting now is assessment and diagnosis. It's going to be a blast! Yup, I dx myself constantly. And T has accused me of treating myself like my own client.
Rap

[JustBen]

I didn't blame it all on the system, I just pointed out that it contributes. (Also, the "system" is really just shorthand for a bunch of people not doing the right thing.)

I take mental health statistics with the same huge grain of salt I take crime statistics. Why? Because almost no one is in jail for the crime they actually committed--most people take a plea and a conviction of a lesser crime in exchange for leniency.

It's a similar deal in mental health, unfortunately, though for different reasons. A lot of therapists "upcode" or "downcode". They "upcode"--provide a more severe diagnosis than is actually warranted--in order to get paid by insurance companies or government programs or whoever happens to be signing the check for a particular client. They "downcode"--provide a less severe diagnosis than is actually warranted--if they think the real diagnosis would create problems for the client (i.e. problems at work, social stigma, etc.) So a lot of folks are never given their real diagnosis at all. (Or they are given one diagnosis, and the govt/agency/HMO is given another.)

Here's another example:
Jane Doe is seeking treatment for a phobia--specifically, a fear of heights. This is a huge deal for Jane because her job is now requiring her to fly on a semi-regular basis. She's a single mom without a lot of money, and she needs her job to make ends meet. She's seeing a therapist for this phobia and planning to use her HMO to pay for services since she can't afford treatment out-of-pocket.

Here's the catch: Her HMO doesn't pay for the treatment of specific phobia. What can the therapist do in this situation? He can "upcode" Jane to something like Generalized Axiety Disorder on the paperwork and actually treat her for the phobia. Or he can be honest with the insurance company and not treat Jane at all. (Which could very well result in Jane getting no treatment and losing her job.) Either way, someone is going to question his integrity or accuse him of not putting the client's welfare first.

(PS - I realize there are other options here. The therapist could take the work pro bono, but many therapist are not in a financial position to do that. Also, he could refer Jane to a low/no-cost clinic--but those clinics tend to have long waiting lists and it's probable that Jane would lose her job before she actually got any treatment.)

It's not always as simple as it might seem at first.

[gardenergirl]

It is possible to put down a provisional diagnosis and to include hypotheses about other diagnoses that might fit as "Rule out" (R/O) diagnoses. With ongoing assessment and treatment, a mental health provider can and should update the diagnosis as more information becomes available.

Medical doctors treating medical disorders, however, well....unless they had a great deal of supportive evidence, I don't think they should be diagnosing a mental disorder. Particularly if it's not relavent to the medical treatment. And if it were me, I'd make it a provisional diagnosis or an NOS versus specific. And I'd definitely avoid putting down any Axis II disorders unless it's been confirmed by someone who knows the client much much better. It's impossible, imo, to determine whether someone has a relatively rigid pattern of behavior in one visit.

gg

[radio_flyer]

I can understand your point that assigning a dx is not an exact science....... You may know this, but the "client" doesn't.. They are believing the T knows what he/she is doing and not just guessing.........But I believe the point here is "unfair dxs" and/or just giving a dx for the sake of giving one, more or less for the T to justify his job..............

In my case, I was a "CASH" paying client......And given unfair dxs too......I was a basket case when I ventured to seek help... One T telling me to run around a car when having a panic attack and another T looking me right in the eye and asking "who am I talking to".....(my jaws dropped and I was thinking, now who has the problem here, if she doesn't know who she is talking to) rolls eyess and grumbles a few bad words........ grrrrrrr All this garbage and I wasn't really helped, but they did get their payments.... it would of been easier if problems were worked on instead of all this other crap of playing the dx game......

[radio_flyer]

an example....... My mother was given a dx of alzheimers so she could get in a better, private nursing home....... so what do they do in the nursing home..... Dope her up with meds that made her more or less a zombie..... Written on paper in black and white mother has alzheimers, She now is in a lock-up unit prob by now fitting in well with the other patients........ this sucks. It was the doc's and my sister and brother agreed to the dx.....

My mother was 83 when put in the nursing home... She has always been a "feisty" woman...... But now she is quiet as a mouse and less of a problem to anyone, including my brother and sister..... sooooooooooooooooo

I might mention again, the topic is unfair dx's...... I still think it is wrong to just write a dx for the sake of treatment or payment........ I like what gg said...... it is honest, and still gives room for future assessments and dx.....

[radio_flyer]

Since dxs are not an exact science... Maybe therapists should put a sign on their door saying,............"Since you prob fit the criteria of 20 out of l00 dxs, we are going to just guess along the way", ........................instead of showing bright shiny plaques and degrees stating they are experts in the mental health field.......

[Rapunzel]

((((radio flyer)))) I'm so sorry that you had such unhelpful experiences with therapy. I did too. My first therapist told me I was just homesick and all I needed was to get married. He decided I was better, and my 10 sessions were up, so he dismissed me. A year later I was suicidal. I did get married, and never learned to take care of myself and live my own life. Seventeen years later, I'm trying to figure out how to start living, something I've never done before despite years of therapy. I think I'm on my 8th therapist now. I lose track. That probably doesn't inspire confidence either, does it?

But I think maybe I didn't say that right. Therapy is more like an art, and it does take skill and intuition, etc. It's the art of helping people to become who they could be.

Diagnoses are part of the medical model, which says that there is something wrong with you that needs to be cured/treated or even eradicated. That's a harsh way of looking at it. Some therapists choose a more positive model or philosophy that says we are all in the process of developing, and sometimes we might need help and guidance and support in order to get through some obstacles that get in our way, but that's just part of the process, and you have what it takes inside of you to find your way. In the latter philosophy the emphasis is on being well (it's called the wellness model), and those therapists try as much as possible to stay away from anything that labels people as sick or defective somehow. They emphasize growth, and dx just doesn't matter so much. In the wellness model therapist still have to be licensed, but there is much less tendency to hold themselves up as experts. The client is the best expert on his or her own development.

I hope that's clearer and more helpful than what I wrote before.

Rap

[radio_flyer]

Yes........... Thank you ((((((( Rapunzel)))))))))..... I was atleast "heard" and understood and not debated .. ty again... No comment on your 8th therapist... grins.........Good luck in your studies.....

Thank you again for taking the time to respond... your post put out the fire under a very hot kettle.. lol.......

[Rapunzel]

Thanks. & You're welcome.