How bad of an idea is it to see a psychiatrist at your own hospital?

[ohiopsych]

Long story short, I'm about 99% sure I have ADHD and would like to be evaluated by a psychiatrist. I was planning on finding a psychiatrist outside of my hospital but turns out our insurance is garbage. There's only one group outside my institution that accepts our insurance and they're not seeing new patients. I could go out of network if I have to but our out of network reimbursement is also garbage so I'd be looking at paying 80-90%. Calling around, all the private practice psychiatrists would require psychological testing for ADHD so I'd be paying for that out of pocket too. All in, looking at probably $1500. Which is doable if I have to but.....a psychiatrist at my hospital would cost me a grand total of $15. If they require psychological testing, that would be an additional $15.

So is this a bad idea? I called to see about availability and there's an attending who does all outpatient in the suburbs and I've had no contact with during residency who could see me. Her only possible future interaction with me would be during things like grand rounds (which are all virtual this year anyway).

Am I playing with fire but seeing someone in my institution?

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[whopper]

This is something not clearly defined. While there are boundary issues clearly with sexual relationships, hiring patients, etc. there's softer boundaries such as treating someone in the same facility you work in.

Add to the problem that choices in psychiatrists are not plentiful in many areas. E.g. a psychiatrist might be the only one in the town, and if you happen to know this person and you need a psychiatrist then what are you supposed to do? Go to one in a different town over an hour away? Holy geez. I currently have patients that traveled over 5 hours to see me although with COVID-19 they now telemedicine me.

I used to not take patient's family members as other patients to maintain boundaries. After about 1 year of doing this and the family member telling me their other family member hasn't gotten any better and the other psychiatrist was doing something very questionable (e.g. keep the patient on Citalopram 5 mg daily for 2 years and the person is severely depressed and the psychiatrist won't change meds) I finally reneged and said I'd take family members, and often times got those family members much better within weeks, and seeing with disappointment that had I not taken them the person likely wouldn't have gotten better. In that specific situation there were only 2 psychiatrists in that town and the other literally had his office on top of a strip club. His partner psychiatrist who used to work in that same town had his license taken away for sexually assaulting patients. Yes that's how bad they were and this really happened. The guy who didn't lose his license defended the partner in court who was giving his psych patients rectal exams saying it was part of psych treatment.

So my policy now is I'll take family members but there's rules. E.g. they are not allowed to ask about the other person's treatment unless they're together both with me at the same time, and if I detect any problems such as one trying to poison my opinion of the other I'm going to have to ask one of them if not both to get a new doctor etc.

The bottom line is it's up to you and that psychiatrist. This is not a clear yes or no. You have limited options and some apparently are cost-prohibitive. The ideal situation is the treating psychiatrist have no connections with you outside of treatment but life is hardly ideal. I find it troubling how sometimes people give a very flat answer of "don't see that psychiatrist" when there might not be other options available, as if psychiatrists are plentiful and everywhere which is hardly the case.

 

[Sushirolls]

Pay the money and go outside your institution.

This is your brain, not a Cholecystectomy.

I wouldn't be suprised if the neuropsych testing isn't legit Neuorpsych testing, more basic forms. Wender Utah, or Adult ADHD rating scale etc.

You can always take the consults/treatment plan outlined by the Psychiatrist and then go back to your PCP, hand them the records yourself, and they can hit refill for the long haul.

 

[TexasPhysician]

I would not see a psychiatrist, neurologist, and probably a few other specialties at my institution. While it may end up ok, the risk of admin retaliation exists.

 

[clausewitz2]

If you trust anyone in your training program's leadership, you might ask if there are any therapists or psychiatrists they refer people who have close connections to the institution to. You can frame this as asking for a friend or for a close relative. I would not be surprised if there is a point person or persons for this.

Also, no ADHD neuropsych testing is legitimate neuropsych testing unless you are suspicious of learning disabilities or something along those lines.

 

[Hematochezia666]

The fact you’re asking this question hints at how bad of an idea it is.

 

[NickNaylor]

If the extent of your concern is limited to ADHD symptoms and you have no interest/desire in engaging in more potentially fraught work (e.g., long-term psychotherapeutic treatment, addressing more "personal" and sensitive issues in your life, etc.), then I think the risks mentioned above, while potentially real, are highly limited. Paying what you describe as 100x more for assessment of ADHD symptoms seems a little absurd to me, privacy concerns notwithstanding.

 

[clausewitz2]

If the extent of your concern is limited to ADHD symptoms and you have no interest/desire in engaging in more potentially fraught work (e.g., long-term psychotherapeutic treatment, addressing more "personal" and sensitive issues in your life, etc.), then I think the risks mentioned above, while potentially real, are highly limited. Paying what you describe as 100x more for assessment of ADHD symptoms seems a little absurd to me, privacy concerns notwithstanding.

This is a really good point. I promise you will not bethe first resident at your institution to be prescribed stimulants on a regular basis. ADHD just does not have stigma in the way, say, bipolar I or a PD might.

 

[Candidate2017]

Cash pay NP telepsych. They specialize in discreet and definitive 1st line treatment for self-diagnosed ADHD.

 

[psychacad]

If the extent of your concern is limited to ADHD symptoms and you have no interest/desire in engaging in more potentially fraught work (e.g., long-term psychotherapeutic treatment, addressing more "personal" and sensitive issues in your life, etc.), then I think the risks mentioned above, while potentially real, are highly limited. Paying what you describe as 100x more for assessment of ADHD symptoms seems a little absurd to me, privacy concerns notwithstanding.

But going to a psychiatrist with the attitude of "I'm just going to talk about my ADHD sx" frankly isn't the best way to approach care. It could certainly start there and end up somewhere entirely different.

Personally I'd just go for another facility and save myself a lot of headache.

 

[whopper]

Psychiatrists don't get the training to do the more in-depth and objective cognitive testing. I've found it frustrating that the academic training for diagnosing and treating ADHD only went so far as merely asking the patient about their symptoms.

Take for example the ASRS (Adult Self Report Scale). If one simply looks at it for about 10 seconds one could figure out how to simply pick the symptoms that show you have ADHD and say you suffer from them worse than others. The ASRS is a great tool if the person is being completely honest. The problem with ADHD is there's plenty of opportunities where patients have incentives to fake having it, the the least being that treatment often involves a controlled substance with a street-value.

Unfortunately the typical tools we psychiatrists are trained for with ADHD are self-report scales.

While neuropsychological testing isn't perfect there are psychological tests that are objective and designed to weed out people exaggerating and faking their presentation.

Another problem is some clinicians don't know that their ASRS is easily faked, giving it to patients taking the results with full-faith that it's accurate. Some call it "neuropsychological testing" although I wouldn't nor would many psychologists or psychiatrists.

 

[Monocles]

Terrible idea. Go see someone outside your system.

 

[singasongofjoy]

are you... sure you don't want psych testing? Maybe there's someone outside the hospital that would be covered by your insurance (psychologists probably aren't quite as hard to find as psychiatrists). It's super rare IME that there's not some other potential rule-out for ADHD which might warrant additional testing/time beyond what would be available in a psychiatry visit and at any rate having testing (beyond self-report measures) would be much more likely to give you better insight and behavioral / organizational recommendations (or maybe referral to another clinician that does coaching around those things). I think that's the road I would go. avoids the psychiatry conundrum, and if you end up with an ADHD dx, just take the report to your PCP. No reason that a psychiatrist is needed to manage run of the mill ADHD / stimulant rx.