Diagnostic procedure for psychs (off-topic)

[manofoneway]

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Deleted.

 

[michaelrack]

If he actually opened up the dsm 5, that's a problem

 

[manofoneway]

Deleted

 

[Fan_of_Meehl]

Greetings,

This is kind of off-topic, but I'd appreciate it if psych residents can chime in (as they're likely to have developed an understanding of how the diagnostic process works in general).

I recently made a visit to see a psychiatrist. At the beginning of the session, he/she spent nearly 30-40 minutes of the session going through a list of symptoms from the DSM-5 manual.

This, to me, was a red flag. In my world, an experienced psychiatrist should be able to hone in on the problem (or at least the main symptoms) without systematically checking-off symptoms while flipping through pages from a reference manual. I have never had this happen in any other medical specialty, where the MD had to follow a routine questionnaire in a robotic way without even eliminating redundant/irrelevant questions (based on the patient's responses).

My question is: Is this standard practice? Does this seem like a sign of an inexperienced or close-minded "by-the-book" psychiatrist?

I understand that this act, in itself, might not be something to draw conclusions of of. However, I wanted to see if this generally seen/considered standard practice (based on your experience as a psych resident/student).

Feel free to remove if off-topic, but I'd certainly appreciate if people can chime in. 😀

Cheers,
Andrew

You could always ask him the next time you see him. He may even have carefully thought through why he practices the way he does and may even be able to explain it to you. Then, you can decide if his explanation makes sense.

 

[manofoneway]

Deleted.

 

[Shikima]

Can you explain why this is a problem for you as a consumer?

 

[FlowRate]

The issue is that I don't have sufficient time/money to change psychiatrists after already committing to several visits with one.

As such, I wanted to see if what he/she did is considered standard practice. To me, it seems completely unjustified for a psych to use a manual while seeing a patient. I'm also very skeptical because he/she have asked me questions regarding whether I committed any serious crimes or had any history of violence. Note that I already informed the Psych that I'm an introverted PhD student, and the initial set of symptoms that I gave were simply panic attacks, brain fog, and social anxiety, so it's bizarre to be asked these questions (seems quite off-tangent). Again, I'd love someone to correct me on this.

It's not atypical for people to take a forensic (legal) history as part of an intake.

 

[manofoneway]

Can you explain why this is a problem for you as a consumer?

I'm trying to see if what I just described can be indicative of lack of experience/common sense from my psychiatrist. It's not a problem per se, just my way of trying to evaluate their competency (however trivial these indicators might be).

 

[Shikima]

I'm trying to see if what I just described can be indicative of lack of experience/common sense from my psychiatrist. It's not a problem per se, just my way of trying to evaluate their competency (however trivial these indicators might be).

Can you define competency more clearly?

 

[manofoneway]

Can you define competency more clearly?

I don't have a strict definition for what makes a psychiatrist competent or effective. But I suppose it includes (but is not limited to): Diagnostic knowledge, ability to recognize patterns, critical thinking, etc.

Going through a checklist of symptoms page-by-page from a manual was a red flag for me and I'm trying to see if this is standard practice.

 

[Fan_of_Meehl]

The issue is that I don't have sufficient time/money to change psychiatrists after already committing to several visits with one.

As such, I wanted to see if what he/she did is considered standard practice. To me, it seems completely unjustified for a psych to use a manual while seeing a patient. I'm also very skeptical because he/she have asked me questions regarding whether I committed any serious crimes or had any history of violence. Note that I already informed the Psych that I'm an introverted PhD student, and the initial set of symptoms that I gave were simply panic attacks, brain fog, and social anxiety, so it's bizarre to be asked these questions (seems quite off-tangent). Again, I'd love someone to correct me on this.

As a clinical psychologist, I can tell you this. The clinical case formulation (that will drive the specifics of your treatment) is critically dependent on what particular anxiety disorder (social anxiety, panic disorder per se, generalized anxiety, OCD, etc.) you may be suffering from and this is best determined (that is, most reliably and validly determined) via structured interview (or semi-structured interview) utilizing DSM criteria.

I would imagine that differential diagnostic specificity is also important to the practice of psychiatry/psychopharmacology.

I've seen plenty of crap treatment being implemented (and failing) due to poor differential diagnostic work and treatment planning.
Now THAT's a waste of time/money.

 

[manofoneway]

As a clinical psychologist, I can tell you this. The clinical case formulation (that will drive the specifics of your treatment) is critically dependent on what particular anxiety disorder (social anxiety, panic disorder per se, generalized anxiety, OCD, etc.) you may be suffering from and this is best determined (that is, most reliably and validly determined) via structured interview (or semi-structured interview) utilizing DSM criteria.

I would imagine that differential diagnostic specificity is also important to the practice of psychiatry/psychopharmacology.

I've seen plenty of crap treatment being implemented (and failing) due to poor differential diagnostic work and treatment planning.
Now THAT's a waste of time/money.

Thanks for the detailed response. I'm glad to see that these structured interviews are considered standard practice, and that my psych wasn't simply following a checklist systematically due to lack of common sense.

 

[Fan_of_Meehl]

I'm trying to see if what I just described can be indicative of lack of experience/common sense from my psychiatrist. It's not a problem per se, just my way of trying to evaluate their competency (however trivial these indicators might be).

No. It's not. If he was taking the time to use a structured interview to ensure accurate diagnostics upfront (sounds like he was probably using the SCID-5)...then I would take it as a sign of competence.

 

[deleted343839]

I'm glad to see that these structured interviews are considered standard practice, and that my psych wasn't simply following a checklist systematically due to lack of common sense.

Airline pilots and surgeons use checklists too. It doesn't mean they lack "common sense"; it means they don't put all their faith into heuristics and what they remember to ask themselves that day.

Standardized interviews aren't that common in clinical practice, but I wouldn't necessarily take their use as a sign of incompetence.

 

[Shikima]

Thanks for the detailed response. I'm glad to see that these structured interviews are considered standard practice, and that my psych wasn't simply following a checklist systematically due to lack of common sense.

How are you equating check list with a lack of common sense? How is this a red flag for you?

Sure, I get that you were uncomfortable with this style of questioning however it would be better if you can explain your concerns in better detail. So far you've gotten some very good responses and you return back to vague statements.

 

[hamstergang]

Thanks for the detailed response. I'm glad to see that these structured interviews are considered standard practice, and that my psych wasn't simply following a checklist systematically due to lack of common sense.

We don't know if your psychiatrist was using a validated structured interview, his own checklist that he found useful, or the DSM itself in a way it wasnt intended to be used. Be careful about assuming anything we say actually applies to your personal situation.

For instance, it is completely standard to ask about arrests or violence. You don't want to assume the answer, and it can become relevant even in cases where it doesn't seem obvious that that would be the case at first. But it's certainly possible that your psychiatrist asked more than what was needed or wasn't listening. How could we know?

 

[manofoneway]

How are you equating check list with a lack of common sense? How is this a red flag for you?

Sure, I get that you were uncomfortable with this style of questioning however it would be better if you can explain your concerns in better detail. So far you've gotten some very good responses and you return back to vague statements.

I was equating checklist to lack of common sense since the psych was asking questions that were (from my perspective) over and above what's necessary to reach an understanding of the condition. To reiterate, the symptoms that I presented were those of anxiety and, during the session, I was getting asked about past incidents of violence, criminal activities, drug abuse, etc. Also, part of the checklist covered whether I had experienced psychotic episodes or hallucinations, etc.

The red flag was raised when I found that the new questions weren't being formulated based on the answers of the previous ones. From my perspective, a script was being followed come hell or high water, which led me to believe that the psych is inexperienced, lacks common sense, and/or is simply not listening to the answers. However, many of the posters here have reassured me that some psychs opt to follow a structured interview for reliability purposes and that this shouldn't raise concerns. If anything, the psych was just being thorough in his evaluation.

For the most part, I believe my question has been addressed (unless you want to add anything else).

We don't know if your psychiatrist was using a validated structured interview, his own checklist that he found useful, or the DSM itself in a way it wasnt intended to be used. Be careful about assuming anything we say actually applies to your personal situation.

For instance, it is completely standard to ask about arrests or violence. You don't want to assume the answer, and it can become relevant even in cases where it doesn't seem obvious that that would be the case at first. But it's certainly possible that your psychiatrist asked more than what was needed or wasn't listening. How could we know?

I don't think I'm in a position to differentiate between these techniques. However, it's still reassuring to know that having some form of "structure" isn't necessarily a hallmark of an inexperienced psych.

 

[FlowRate]

I was equating checklist to lack of common sense since the psych was asking questions that were (from my perspective) over and above what's necessary to reach an understanding of the condition. To reiterate, the symptoms that I presented were those of anxiety and, during the session, I was getting asked about past incidents of violence, criminal activities, drug abuse, etc. Also, part of the checklist covered whether I had experienced psychotic episodes or hallucinations, etc.

The red flag was raised when I found that the new questions weren't being formulated based on the answers of the previous ones. From my perspective, a script was being followed come hell or high water, which led me to believe that the psych is inexperienced, lacks common sense, and/or is simply not listening to the answers. However, many of the posters here have reassured me that some psychs opt to follow a structured interview for reliability purposes and that this shouldn't raise concerns. If anything, the psych was just being thorough in his evaluation.

For the most part, I believe my question has been addressed (unless you want to add anything else).



I don't think I'm in a position to differentiate between these techniques. However, it's still reassuring to know that having some form of "structure" isn't necessarily a hallmark of an inexperienced psych.

One should always cover major symptoms of major diagnostic categories in the initial interview, even if the patient only complains of anxiety. That means hallucinations, paranoia, impulsiveness, unusually good mood, low energy, thoughts of suicide, etc.

Patients (and doctors when they're patients) don't have the perspective necessary to accurately diagnose themselves.

 

[PikminOC]

I was equating checklist to lack of common sense since the psych was asking questions that were (from my perspective) over and above what's necessary to reach an understanding of the condition. To reiterate, the symptoms that I presented were those of anxiety and, during the session, I was getting asked about past incidents of violence, criminal activities, drug abuse, etc. Also, part of the checklist covered whether I had experienced psychotic episodes or hallucinations, etc.

The red flag was raised when I found that the new questions weren't being formulated based on the answers of the previous ones. From my perspective, a script was being followed come hell or high water, which led me to believe that the psych is inexperienced, lacks common sense, and/or is simply not listening to the answers. However, many of the posters here have reassured me that some psychs opt to follow a structured interview for reliability purposes and that this shouldn't raise concerns. If anything, the psych was just being thorough in his evaluation.

For the most part, I believe my question has been addressed (unless you want to add anything else).



I don't think I'm in a position to differentiate between these techniques. However, it's still reassuring to know that having some form of "structure" isn't necessarily a hallmark of an inexperienced psych.

So did you walk out with the adderall prescription you wanted?

 

[manofoneway]

So did you walk out with the adderall prescription you wanted?

I don't think I was trying to bias him/her into diagnosing a certain condition. Surely there are easier/cheaper ways to acquire prescription meds. However, I think it doesn't hurt to see if their diagnostic methods are a cause for concern, especially since I don't have the time to get second/third opinions.

 

[PikminOC]

I don't think I was trying to bias him/her into diagnosing a certain condition. Surely there are easier/cheaper ways to acquire prescription meds. However, I think it doesn't hurt to see if their diagnostic methods are a cause for concern, especially since I don't have the time to get second/third opinions.

You had time to write this post.

 

[thoffen]

In my opinion this thread needs to be locked and the OP needs to address his/her concerns with their psychiatrist.