DISQUS

Dr. Deb · 3 years ago

There is a larger issue here. A psychiatric or psychological concern in a young child should *always* result in a referral to a specialist. The problem with healthcare in the US is that there no longer is a community minded approach in treating patients. A thorough evaluation would take the guess work out of this case. Medication is a wonderful treament option, and one that I endorse wholeheartedly. For anyone to prescribe "despite being unsure of his diagnosis" is reckless. Doesn't the saying go "First Do No Harm?"

drumsnwhistles · 3 years ago

Dr. Deb --

I agree with you in principle, but reality is entirely different. As I said in my entry, that would be the one thing I as a parent would want to do. However, I speak from personal experience when I say that it works better in theory than it does in practice.

For starters, it's difficult to find pediatric psychiatrists. If you are a single parent with no money, you might as well get in line and hope for the year 2021. I was fortunate - I had the money to pay out of pocket for the psychiatrist, because my insurance company wasn't going to honor my primary provider's referral.

Dr. Parker's bio indicates that he is the director of behavioral and developmental pediatrics, so that would indicate that he must have a pretty solid background in psychiatry as well as medicine.

The psychiatrist that evaluated Sticks came right out of the box with the statement that diagnosing ADHD and/or bipolar disorder was, at best, guesswork, based on input from a number of sources. Unfortunately, there's not a blood test that will tell us for sure...

As for the lack of community-mindedness with regard to treating patients, lay that one right at the feet of the insurance companies, who much prefer to underpay primary physicians at the expense of specialties and encourage their insureds NOT to seek specialists.

Donna · 3 years ago

Beautifully written post, DnW.

Dr. Deb · 3 years ago

If you visited my blog, I think you'd see that I take meds myself, and a very pro medication. Dr. P being a chief of "developmental pediatrics" is in no way the same as being a psychiatrist. I agree that healthcare in the US is terrible in many respects - but local universities, local clinics and even specialists like myself will see individuals and families at no cost (pro bono) or at low cost. It is important for health care professionals to work together in a community. I endore that seriously and I practice in that way too. What my concern was that by Dr. P's own admission, he was unsure of a diagnosis. A specialist should have been called in - that would have been in the patient's best interest, it would have been ethically and morally correct. As a parent of an ADHD child as well, I know that meds work. As a professional who treats ADHD and Bipolar issues, I know how life changing meds can be. But never, ever should meds prescribed without a diagnosis.

Thanks for the opportunity to express my thoughts here.

~Deb

Dr. Deb · 3 years ago

Oh, one more thing.....diagnosis of ADHD or Bipolar disorder in children is not guesswork. There are psychological tests and scales that are used to secure the diagnosis.

Thanks again for letting me express this info.

drumsnwhistles · 3 years ago

Dr. Deb --

I appreciate your comments and they're welcome any time. I hadn't read your blog till you posted last night, then I went and read through your entries for the last couple of months, so I am now more familiar with you than I was when I responded to your first comment.

I agree with everything you said with regard to community. Perhaps Dr. Parker did consult with someone, though it is not clear in his post. It seems to me that his primary point in blogging this topic at all was to highlight the dilemmas faced by doctors when working with a very young child with serious behavioral problems. Yet instead of really looking at those issues, many simply smacked at him for prescribing without a consultation by a pediatric psychiatrist (or psychologist, for that matter).

Should the practice of medicine be more communal? As a patient, I heartily answer with a resounding "YES". I can't speak for the medical profession, but there are areas of specialty within my own field where I would much prefer to refer clients out to the specialists than try to handle it myself, and I do refer as a matter of routine.

Why isn't community more routine within the practice of medicine? That's probably a topic for another blog post by someone more qualified than I to answer. From my vantage point, practices are so tightly controlled by what insurance will and will not pay, what specialists are and are not approved, and what conditions will be covered, that it's almost a science unto itself.

Sticks and I were referred by our primary care doctor to one of the best area specialists in childhood ADHD. As I mentioned, the referral was not honored by the insurance company despite the fact that this doctor was on their approved list. Ultimately, they DID approve it, but only after the suspected diagnosis was changed from ADHD to depression. Why the bias?

I write this to share some of the problems we have in the diagnostic process. What if I were a parent who had no discretionary funds to pay out of pocket for such an evaluation, yet had too much to qualify for free services (the wonderful middle class...)? There are times where our pediatrician is a lifeline and parents would simply be hung out on a line without any help if it weren't for them.

I guess what I'm trying to say in an awkward way is that this is an imperfect system inside of an imperfect world, and as parents, we're doing our best to do our best for our kids. Sometimes we need help, and we take what's available. I'm grateful for pediatricians who listen and take me seriously.

liz · 3 years ago

Here I'm wondering about differences in differing areas. Example: I have a dear friend who lives in a western state. Her child has neurological challenges (don't want to go into details) very similar to those of a friend's child who lives in my town. The children have faced *very very* different treatment options. The Western State friend has had virtually zero support for her child's education and behavior management. As a result, the child, although quite bright, has had nearly no education. The Neighbor friend's child is enrolled in community college.

Dr. Flea is in the Northeast -- in Mass, I suspect. He is resisting the "medication will solve all problems" mindset. There are school districts with huge numbers of kids referred for medication, when the real issue is weak parenting skills and weak classroom management.

David Harmon · 3 years ago

My own experience shows both sides of the issue. I got Ritalin for what's now called ADHD through elementary and middle school, and it did indeed help a lot. But when it stopped working around 12-13, then they put me on Thorazine, -- telling both Mom and me that it was an "anti-emetic"! I then spent much of my adolescence in a tranquilized haze....

drumsnwhistles · 3 years ago

Hi David,

Thanks for coming and commenting! Your story is awful...I cannot imagine what possessed any doctor to move from Ritalin to Thorazine. I did a brief stint while in college at the local VA hospital with vets medicated on Thorazine, and it's powerful stuff.

I'm glad you stopped by -- your story deserves to be heard!