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Hello everyone,
I am in a perplexing situation at the intersection of the personal and professional.
My mother and brother reside in another country, and my mother has a friend there who is a psychiatrist. He has treated my brother for years. (Yes, ethically this is problematic, but it’s actually the least of my concerns. His treatment is indicated for my brother’s diagnosis, though certain side effect monitoring is neglected. As a practicing psychiatrist, I’ve tried to correct this by telling my mother and brother what side effects to watch for).
I personally know this man because he’s been a visitor to our home when I was a child, and I interned at his practice before medical school.
In general, however, he is a walking case study in how not to practice medicine. When I shadowed him in clinic, he was in an appointment with a patient and took a video call from a different patient, and had an extended conversation with the latter without stepping out of the room, or telling the patient on video that they could be heard by another patient. He has routinely taken calls from patients in the presence of my mother and myself. He assigns diagnoses to various people he knows, celebrities, and historical figures. He believes there is nothing wrong with self-prescribing psychotropic medications. He has never explained any side effects to my mother or brother. When my mother asked him about relevant side effects, he yelled.
He has even attempted to assign a diagnosis of Tourette’s to me, when I clearly do not meet the cardinal diagnostic criteria. He has not interviewed me as a patient, and he based his deductions on observations he’s made of me as a child, as his intern, and my mother’s reports. This last part is causing strife in our family because my mother is completely on his side and thinks I should follow his treatment recommendations.
And finally, this man has an… interesting view of Tourette’s, let’s just say. He believes that tics are wholly unnecessary to make the diagnosis. I have searched the medical literature, including foreign journals, but have found no evidence to suggest this. I recognize that Tourette’s can be comorbid with other conditions like ADHD and OCD, and anxiety, insomnia, and emotional outbursts can be part of the spectrum of symptoms. But per every source I’ve ever seen, tics are a necessary unifying symptom. I feel bad for other patients he diagnoses with “ticless Tourette’s” and goodness knows what else.
So my questions in this case are twofold:
—am I in fact missing something with regard to Tourette’s? Can the diagnosis really be made sans tics? And if so, what is the value of making or attempting to make such a diagnosis?
—I am seeking outside perspectives and feedback about the poisoned dynamic that his questionable care and trashy ethics have created. I am not expecting actionable advice or counsel per se. But thoughts and ideas, or even commiseration would hit the spot right about now. I am very concerned that my mother sees nothing wrong with this man’s unprofessional behavior, and continues to have him treat my brother. What this man does seems so far out of the medical norm that I struggle to imagine it would be acceptable in any country.
I am in a perplexing situation at the intersection of the personal and professional.
My mother and brother reside in another country, and my mother has a friend there who is a psychiatrist. He has treated my brother for years. (Yes, ethically this is problematic, but it’s actually the least of my concerns. His treatment is indicated for my brother’s diagnosis, though certain side effect monitoring is neglected. As a practicing psychiatrist, I’ve tried to correct this by telling my mother and brother what side effects to watch for).
I personally know this man because he’s been a visitor to our home when I was a child, and I interned at his practice before medical school.
In general, however, he is a walking case study in how not to practice medicine. When I shadowed him in clinic, he was in an appointment with a patient and took a video call from a different patient, and had an extended conversation with the latter without stepping out of the room, or telling the patient on video that they could be heard by another patient. He has routinely taken calls from patients in the presence of my mother and myself. He assigns diagnoses to various people he knows, celebrities, and historical figures. He believes there is nothing wrong with self-prescribing psychotropic medications. He has never explained any side effects to my mother or brother. When my mother asked him about relevant side effects, he yelled.
He has even attempted to assign a diagnosis of Tourette’s to me, when I clearly do not meet the cardinal diagnostic criteria. He has not interviewed me as a patient, and he based his deductions on observations he’s made of me as a child, as his intern, and my mother’s reports. This last part is causing strife in our family because my mother is completely on his side and thinks I should follow his treatment recommendations.
And finally, this man has an… interesting view of Tourette’s, let’s just say. He believes that tics are wholly unnecessary to make the diagnosis. I have searched the medical literature, including foreign journals, but have found no evidence to suggest this. I recognize that Tourette’s can be comorbid with other conditions like ADHD and OCD, and anxiety, insomnia, and emotional outbursts can be part of the spectrum of symptoms. But per every source I’ve ever seen, tics are a necessary unifying symptom. I feel bad for other patients he diagnoses with “ticless Tourette’s” and goodness knows what else.
So my questions in this case are twofold:
—am I in fact missing something with regard to Tourette’s? Can the diagnosis really be made sans tics? And if so, what is the value of making or attempting to make such a diagnosis?
—I am seeking outside perspectives and feedback about the poisoned dynamic that his questionable care and trashy ethics have created. I am not expecting actionable advice or counsel per se. But thoughts and ideas, or even commiseration would hit the spot right about now. I am very concerned that my mother sees nothing wrong with this man’s unprofessional behavior, and continues to have him treat my brother. What this man does seems so far out of the medical norm that I struggle to imagine it would be acceptable in any country.
