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Patients who self-diagnose!

Discussion in 'Psychiatry' started by halflife, Apr 18, 2007.

  1. halflife

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    This is a reasonably lighthearted thread (rather than a serious rant) but does anyone else find this annoying?

    It seems the lovely World Wide Web has a lot to answer for. Just one or two clicks, and Joe Public can catastrophise themselves into feeling they have a myriad of disorders which THEY HAVE ABSOLUTELY POSITIVELY CORRECTLY SELF-DIAGNOSED.

    Never mind that many available as self-tests are designed to be administered by professionals! And by the time they manage to find their way to a psych-type person, the diagnosis (utterly reliable and valid, of course) is rather firmly entrenched into their own delicate psyche. Even though they may have come through several health / MH steps to get to us, it still seems to figure quite strongly for the odd individual (no pun intended).

    My question is whether self-testing by the general pop is a help or a hindrance to those of us in psyc-based professions. Is it beneficial that people recognise an issue and visit a professional thanks to an anonymous 'pre-test' (whereas they may otherwise not have bothered), or is it a pain in the proverbial that they may come feeling they already know what is wrong?

    I am new to these boards, so please time-line me if such a thread has already eventuated :) Also, it is as light-hearted or as serious as you wish it to be.

    Please share ... :)
     
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  3. whopper

    whopper Former jolly good fellow
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    Could be either.

    If the patient is self diagnosing based on objective criterion and they are not over or underexagerating their own sx, then I think its probably a good thing.

    Also, several docs I've seen just want to get the patient out of the office ASAP. Anxiety?---oh here's some Xanax.

    If the doc won't spend the time to dx properly, then someone ought to be doing it. I've had a few cases of a patient come in as an inpt and their outpt doc just completely screwed up on handling the case and the pt or their family could tell and "self dx'd" correctly while their doc missed it.

    Patients, IMHO, especially in the outpatient setting need to be more involved than the inpt setting because the doc can only see them during limited times. The doc is going to miss a lot of sx.

    It could also be a bad thing--for example if a pt has hypochondriasis, malingering or Munchausen's and self dx's, or if they self dx and then want a medication that they might possibly want to use as a drug of abuse.
     
  4. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    I personally am seeing a spike in self-diagnoses of "bipolar" based on direct-to-consumer marketing by manufacters of branded "mood stabilizers" (e.g. what we used to call atypical antipsychotics).
     
  5. lusyd

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    Yes, this is a big problem. I have patients who fill out online questionnaires and then bring those to their appointment.

    Lusyd
     
  6. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Why do you consider it a "problem", though? I see it as an opportunity to educate re: sx, dx, rx, etc.
     
  7. whopper

    whopper Former jolly good fellow
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    I feel the same way as well.

    I'm not suggesting anyone on the board is doing it, but I've seen a lot of docs do this. They tell the patient the dx and give a med and them tell they're done.

    We're supposed to educate our patients on their illness, and this does increase compliance.

    A problem is that managed care is making us push patients out, often without enough time to educate them.
     
  8. halflife

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    The problem as I see it is that patients already believe they have a certain diagnosis before I see them, and are then resistant to alternatives. They do not have the understanding about how invalid such questionnaires are and how that compares to a physician's clinical interview.

    T1/2
     
  9. MBK2003

    MBK2003 Senior Member

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    My biggest complaint is the number of pt's who self diagnosis bipolar "spectrum" disorders with "ultrarapid cycling", but from the first 15 minutes of the evaluation clearly have affect dysregulation due to borderline personality organization and meet criteria for an axis II disorder. I agree meds can be helpful in borderline PD, but I hate continually having this discussion with patients that a little abilify or geodon may slightly improve things, they really need intensive evidence-based psychotherapy, which usually costs much more money, time and motivation, than a pill at bedtime. Wonder why pharma doesn't include references to psychotherapy in their "literature"?

    MBK2003
     
  10. whopper

    whopper Former jolly good fellow
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    Happening in my neck of the woods.

    I'm seeing a lot of patients claim they have bipolar and when I go down the DSM IV criteria they don't have any of those sx.

    The only thing their primary doc used to dx them with bipolar was that they shifted their mood moment to moment. As we know that is NOT bipolar. Shifts in mood don't go moment to moment. Mania usually lasts several days straight as well as the depression.

    Reason why I'm ranting about this is becuase this appears to be lots of patients, maybe on the order of about 20-50 a month I see with this BS dx, and then their doc medicates them for it.

    Pretty sad. Actually it'd fit the criterion for malpractice if that patient actually got a bad side effect from one of the meds.
     
  11. halflife

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    Here in south-hemi as well.
     
  12. lusyd

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    It just makes our jobs harder when we have to fight against phony diagnoses either from online questionnaires or from mental health providers who do not know any better.
     
  13. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Have you all noticed the increased number of ads/mailings recently "educating" us about the co-morbidity of ADD with depression?

    A "friendly public service" from Shire Pharmaceuticals...who are motivated solely by (Adderall) compassionate (Daytrana) concern about the (Adderall) well-being of your (Adderall) patients. :rolleyes:
     
  14. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Same thing in my neck of the woods, except the primary docs also fail to point out that little things like methamphetamine might contribute to "shifty moods", too. :eek:
     
  15. halflife

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    Are you referring to spam / pop-ups / ads on certain sites that ask questions like 'Is your depression really bipolar disorder? Take this quiz to find out if [drug X] may be right for you'?

    T1/2
     
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  17. musm2008

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    I've seen people who find out that these mood stabilizers have SEs, especially women and weight gain, and they don't want to take them anymore.
     
  18. Demosthenes

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    And I've seen the other, too: women who come in saying they're BPD, and ashamed about it, when all I can find is anxiety and depression. Go down the list, and they meet not one of the criteria for BPD -- except maybe suicidal ideation, or a previous attempt. (And why do they all seem to have OCD? They get into obsessive ruts on this one dx, and won't believe it's not true. sigh)

    But yes, the self-dx bugs me. It wouldn't be so bad if it didn't seem so highly skewed towards ADD at this point. Hello? Maybe if you made some hard choices about what's really important to you, and got some more sleep, you wouldn't be quite so easily distractible? And might not get quite as much benefit from speed? sigh

    Bah. I'm gonna get a job growing catnip or braiding rugs.

    PS: around here, it seems the self-dx du jour for BPD is DID. "Let's talk a bit about your behavior..." "You can't say that to me! I have little children living inside me!" "OK, but those little children will have to stop this behavior, too..."

    Basketweaving suddenly has more appeal. Or maybe ceramics...

    Any openings for an ornamental hermit where you are?
     
  19. Doctor Bagel

    Doctor Bagel so cheap and juicy
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    That's interesting. At this other non-medical message board I go to, this woman was having some mental health issues and immediately jumped to the conclusion that she was bipolar. I guess this explains where it's coming from -- to me, it just didn't seem like the most logical conclusion to immediately jump to.
     
  20. Anasazi23

    Anasazi23 Your Digital Ruler
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    They're only calling them that because we avoid diagnosing a personality disorder until the age of 18.

    ;)
     

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