URGH I think my son was profiled- ADHD med issues

[Soror]

Ds used to see the dr at dh's clinic but they now only have a NP so we went to the Ped. That ped went out of practice and he had stopped taking his meds so I didn't get him another Dr. Well, when college started he decided with college he needed ADHD meds again (wanting to do Vyvanse as that worked the best previously), so he needs a doctor and at 19 is aged out of a ped. 

Now, they have this laundry list of tests for him to do- ischemic heart test, drug screening, lipid panel, and CMP> He had to sign a sheet saying he wouldn't sell them and also a sheet about opiod abuse. Plus, they say he has to go get tested for ADHD before they prescribe and then again after he's been on meds.

He already has a diagnosis with the pediatric neuropsychologist. They will be far more qualified than anyone they have in my small town.

We never jumped through any of these hoops before. The previous doctors looked at his diagnosis, talked to him about his issues and function, and then prescribed meds and that was that. We had to come in person every 90 days or so by law and they didn't send the prescriptions electronically but I don't remember anything else.

It feels strongly like they are profiling and harassing my long-haired, pierced son as a druggie to deter him from being a patient. He told my son that he had to do all of these things and his hands are tied.

I'm trying to find the laws in my state to see if he's lying to me because it sure seems like it.

Edited April 18 by Soror

[Toocrazy!!]

My DS had the same issues at about that age. I even went to his appts with him and it went about like that. He did not get good care. Switched to a new mental health office that could prescribe and they were much nicer to him, but he could never find the right formula. Lots of side effects. He did have to get a neuropsych evaluation. Took forever. 

[Catwoman]

Wow, that's insane! I have never heard of such a thing, but I would have your son go to a different doctor.

[kbutton]

My long-term diagnosed 19 y.o. with short hair who presents as very traditional got almost the exact same rigmarole. It’s CYA. He has not yet been asked for any drug testing in spite of the threats. It’s a system-wide policy.

 

Edited April 18 by kbutton

[Bambam]

My YA child, with ADHD, has to get tested every six months before doctor will write a new script. 
My DH, who is not young anymore and who is prescribed the same sort of medication, is also required to go in every six months for tests to get a new script. 

Here most of the practices require this six month testing before you get more scripts. They are checking to make sure you are taking the drug.  At least that is my understanding. 

Also somewhat annoying I cannot pick up their scripts for them. 
Due to the shortage of my YA child's med, they have to call pharmacies around to see who has it and if they have enough, then call the doctor, who hurries and get the script to that pharmacy. It's hard to find right now. 

Edited April 18 by Bambam

[Toocrazy!!]

Also- DS has either long hair nor piercings, I think they profile college age students in general. It’s very rampant on campuses. 

[kbutton]

Just now, Toocrazy!! said:

Also- DS has either long hair nor piercings, I think they profile college age students in general. It’s very rampant on campuses. 

Maybe that’s why my son hasn’t been followed up for testing that I know of—he’s not in school.

[Katy]

It’s normal for college age kids who either haven’t been on meds or who are newly diagnosed. DH went through all that 20 years ago. Sorry. The street value of those drugs is high. 

[sweet2ndchance]

Gently, that does sound like par for the course with drugs that have a reputation for being sold and abused.

My dh has to take opioids for his brain condition that causes severe pain. He has to be drug tested every 3 - 6 months, sign all kinds of agreements that make him sound like a drug addict, and keep all appointments without fail less they will take away his meds. He is neither young nor does he look like a typical druggie if there is such a thing.

[prairiewindmomma]

In my area, it’s a mix of procedures among different clinics. Most of the places my friends take their kids do require all of the testing. Our kids who take meds have taken them since they were preteens so we havent had to hoopjump. We have to be seen every 90 days, but no additional testing.

Add this to my soapbox list. Patients who need the meds in order to be able to coordinate all of the appointments and tests and refills cant get the meds or keep them until they hop through a crapton of very expensive hoops.

[MEmama]

Wow that's awful! Mine was diagnosed at 18/19 and didn't go through anything like that. He gets his meds from the campus psychiatrist every 90 days when he's at school, and from his regular doctor when he's home. He's 21 now and the pharmacy lets me pick up his prescriptions, no problem. 
 

I wonder why it varies so much? Also if he's on vyvanse it's unlikely he's selling it; our doctor likes to try vyvanse first with students because it's not like adderall and not as tempting (not that DS would do that, I just found it interesting). 
 

I'm sorry it's such a pain! What are they thinking, let's add extra and unnecessary hoops for people with executive function challenges! 😡

[SKL]

I guess it's a hot commodity.  My kid's friend in high school got suspended for handing out her ADHD meds to her classmates for Christmas last year.

My kid no longer takes her OCD med, but because it was supposedly believed helpful against Covid (and thus potentially trafficked), her requests were looked upon somewhat suspiciously too.

[Alice]

I have a lot of patients that have run into similar situations as they transition to adult medicine. Around here a lot of family docs and internal medicine docs will not prescribe ADHD meds and require people to see psychiatry. So like others have said, I don't think they are necessarily targeting your son in particular. 

I don't know of any laws that require testing for Vyvanse or other ADHD meds. I do think some practices require it and if the doc is part of a large practice (especially a very large group like Privia or Kaiser) they may have a protocol he has to follow. I can't imagine what they are looking for with the lipid and CMP unless they are just looking for very general signs of liver damage from drug/alcohol use but Vyvanse shouldn't directly cause any effects on liver/kidneys. The drug screen is probably to look for signs of other drug use or I think some practices use it to test to see if the person is taking the med as opposed to selling it. Which is kind of stupid, IMO as Vyvanse is metabolized very quickly and you would only have to take it for a day or two for it to show up in your urine. So  a scheduled drug test really does not prove you are taking it regularly. 

The EKG is more standard. About 10 years-15 years ago or maybe more there was a lot of concern about possibly arrhythmia with amphetamines due to a paper that came out. For awhile we screened everyone but that quickly was not recommended by most medical associations as more data came out. It is now thought to "unmask" arrhythmia so we only screen people with a family history and no longer screen everyone. But I know some doctors who are very worried about litigation and so screen everyone as a protection. 

I would ask if they can use the diagnosis from the neuropsychiatrist if you have that letter. Sometimes I do have people come to me saying they have the diagnosis. I usually do ask them to provide the information from the previous doctor rather than just prescribing. But if they have that data, I don't require retesting. 

If the practice at large requires these tests for everyone, it's not surprising that they just make it a blanket policy. I do think the requirements seem on the harsh side and possibly designed on some level to have people seek care for this diagnosis elsewhere.However, in some ways, it's better to not have the doctor judging who needs extra monitoring/information and who doesn't. Similarly, we require a pregnancy test on every teen girl we start birth control on even if they are not sexually active. Some get upset but I just tell them it's our policy. I know for some patients it seems we aren't trusting them but the sad fact is that people lie all the time to doctors. So instead of making the judgment that "this girl seems like she might be lying" and "this one seems like she's telling the truth" they all get a pregnancy test. And having it be practice policy does make it easier for me as an individual physician. 

And Vyvanse is definitely abused. It's not as easy to get a quick high as Adderall which is the most diverted (sold to someone who it isn't prescribed for) medication in the country but you can get high on it and people do abuse it. Doctors are very wary of being used as a way of getting drugs. 

And if it makes you feel less targeted...my 76 year old father has to go through similar hoops for Gabapentin which is also a controlled substance. He has been on it for 20+ years for neuropathy and he still has to go in and get the prescriptions and can't get it filled at all early, etc. And it drives him crazy. 

[saw]

So weird. DS (17) has been on Vyvanse for ages but we were using our out of US provider for the meds because our insurance didn't cover it. They supposedly do now so he went to a pediatrician (new one because old one went out of network) and she had him do a drug test but gave him the prescription. Insurance refused to cover it anyway so we're back to square one lol. DS presents as a supernerd though so maybe that does make a difference.

[SanDiegoMom]

My daughter was diagnosed by a psychologist and needed a second diagnosis when she started with a new on campus doctor.  When she started law school she read the undergraduate rules for getting meds and they required a new diagnosis as well.  She is seeing an outside psychiatrist who accepted both her diagnoses and did not make her re-test.

I would find every six months ridiculous, but I am becoming not as unsympathetic to wanting to retest.  My daughter has now experienced three or four young adults in her life who have gone through a very shoddy process of evaluation and have been prescribed adhd meds.  Though you can never really know what's going on in a person's brain, one of them was her roommate for two years and it was very clear she did not struggle with adhd.  It is very frustrating to my dd whose Adhd impacts her life in a substantial way, who has achieved so much more (with so much less stress) because of the meds, to see others who really don't need them get prescribed them.  And then suddenly we have a national shortage. 🤷‍♀️

[SanDiegoMom]

2 hours ago, MEmama said:

 

I wonder why it varies so much? Also if he's on vyvanse it's unlikely he's selling it; our doctor likes to try vyvanse first with students because it's not like adderall and not as tempting (not that DS would do that, I just found it interesting). 
 

 

Enterprising ppl can still break it open and (snort? ingest?) the contents so they feel the effects more strongly/quickly. Gotta love the ingenuity. 🤦‍♀️

[TechWife]

4 hours ago, Soror said:

…

Now, they have this laundry list of tests for him to do- ischemic heart test, drug screening, lipid panel, and CMP> He had to sign a sheet saying he wouldn't sell them and also a sheet about opiod abuse. Plus, they say he has to go get tested for ADHD before they prescribe and then again after he's been on meds.

He already has a diagnosis with the pediatric neuropsychologist. They will be far more qualified than anyone they have in my small town.

We never jumped through any of these hoops before. The previous doctors looked at his diagnosis, talked to him about his issues and function, and then prescribed meds and that was that. We had to come in person every 90 days or so by law and they didn't send the prescriptions electronically but I don't remember anything else.

It feels strongly like they are profiling and harassing my long-haired, pierced son as a druggie to deter him from being a patient. He told my son that he had to do all of these things and his hands are tied.

I'm trying to find the laws in my state to see if he's lying to me because it sure seems like it.

I do not believe your son is being profiled or harassed due to his appearance. It sounds like the physician is using best practices for an adult, which are often different than best practices for children. It’s not realistic to expect an adult medicine practitioner to do things the same way a pediatrician does them. This person is treating your son like the adult he is. 

Here is information on what can be expected when diagnosing an adult with ADHD. Everything you’re describing is detailed in this explanation. 
https://chadd.org/for-adults/diagnosis-of-adhd-in-adults/#

He’s with a new practice and they are doing a thorough work up to diagnose ADHD, which they do in order to make sure they provide appropriate treatment.

No practitioner is obligated to accept the diagnosis of any other practitioner, or to treat a condition that they have not personally documented. His “hands are tied” by the standards he is following, and whether the standards  are derived from best practices, laws, based on education and experience or any combination of those, it doesn’t really matter. A physician doesn’t have to adjust their standards for any of his patients. 

 

 

[kbutton]

33 minutes ago, TechWife said:

No practitioner is obligated to accept the diagnosis of any other practitioner, or to treat a condition that they have not personally documented

I can’t fathom someone making my kid get re-diagnosed for his genetic condition ($$$), nor do I think insurance would allow it. If my kid’s orthopod retired, does that mean my son has to give back his scoliosis rods because the next doctor didn’t personally implant them?

There must be standards to meet if someone doubts a diagnosis.

I don’t think people with ADHD should have to jump through significantly higher hoops than people with other conditions have to.

 

 

[SanDiegoMom]

13 minutes ago, kbutton said:

I can’t fathom someone making my kid get re-diagnosed for his genetic condition ($$$), nor do I think insurance would allow it. If my kid’s orthopod retired, does that mean my son has to give back his scoliosis rods because the next doctor didn’t personally implant them?

There must be standards to meet if someone doubts a diagnosis.

I don’t think people with ADHD should have to jump through significantly higher hoops than people with other conditions have to.

 

 

There is not a medical test for Adhd -- it is much more subjective - based on parent report, patient report, and psychologist's own analysis. Unfortunately, not all psychologists are created equal, and some are laxer with their diagnosing.  

Plus, there's not exactly a hot market for scoliosis rods.  

[kbutton]

1 minute ago, SanDiegoMom said:

There is not a medical test for Adhd -- it is much more subjective - based on parent report, patient report, and psychologist's own analysis. Unfortunately, not all psychologists are created equal, and some are laxer with their diagnosing.  

2 minutes ago, SanDiegoMom said:

Plus, there's not exactly a hot market for scoliosis rods.

The existence of a market is not the fault of the patient. They use baby formula to make meth. Not the baby’s fault. When a mother of twins is prevented from buying enough formula at a time without showing up at the store without a doctor’s note, the world has gone whacko.

I live with three people with ADHD. We have a lot of expensive documentation spanning multiple timeframes. Documentation necessary for diagnosis that is not always covered by insurance.

BTDT

There are also PLENTY of medical conditions that are subjective. There are plenty of objective conditions that people are doubted for.

I don’t think most doctors would be in business long if they didn’t accept the vast majority of existing diagnoses that come their way because patients and insurance companies would get tired of watching which way the wind blows. Do they change treatment plans sometimes to optimize new information or being fresh eyes? Sure! 

[SanDiegoMom]

3 minutes ago, kbutton said:

I live with three people with ADHD. We have a lot of expensive documentation spanning multiple timeframes. Documentation necessary for diagnosis that is not always covered by insurance.

BTDT

There are also PLENTY of medical conditions that are subjective. There are plenty of objective conditions that people are doubted for.

I don’t think most doctors would be in business long if they didn’t accept the vast majority of existing diagnoses that come their way because patients and insurance companies would get tired of watching which way the wind blows. Do they change treatment plans sometimes to optimize new information or being fresh eyes? Sure! 

But with the drug being one that could possibly be abused, I can understand a new doctor being hesitant. 

I would assume length of diagnosis and length of treatment would be something a doctor would take into account. Long standing diagnosis and stable on a med for years would look very different compared to say a recent diagnosis of a college student and a not very robust medicine history.  It sounds like the OP's son had a diagnosis as a child, was prescribed meds but was not taking them currently.   My daughter has been diagnosed twice, at age 18 and 19, and is now 24 and was stable on Vyvanse for about four years before getting her next psychiatrist. The psychiatrist accepted the two diagnoses and current treatment plan, while the OP's son does not have a current diagnosis or a current treatment plan. 🤷‍♀️

[City Mouse]

My DD who is nearly 30yrs old. She was diagnosed and started on meds for ADHD in the 4th grade. She has gone through diagnostic testing two time as an adult, and she is about to have to go though it again to get back on meds. I don’t think it is profiling as much as it is just the system that we have. Every time she sees a new doctor, they make do it all again.

[SKL]

There's been a lot of recent scrutiny of doctors who prescribe drugs that are at risk of being trafficked.  There is also a lot of press about ADHD being over-diagnosed and over-medicated.  So I don't blame doctors for being extra careful about prescribing ADHD drugs to new patients.

Also, doesn't ADHD change with age, and don't biological changes impact which drugs are best?  I would think that one wouldn't want their doctor to blindly sign the same script that's been used for years.

[Soror]

12 hours ago, prairiewindmomma said:

In my area, it’s a mix of procedures among different clinics. Most of the places my friends take their kids do require all of the testing. Our kids who take meds have taken them since they were preteens so we havent had to hoopjump. We have to be seen every 90 days, but no additional testing.

Add this to my soapbox list. Patients who need the meds in order to be able to coordinate all of the appointments and tests and refills cant get the meds or keep them until they hop through a crapton of very expensive hoops.

 

8 hours ago, kbutton said:

I can’t fathom someone making my kid get re-diagnosed for his genetic condition ($$$), nor do I think insurance would allow it. If my kid’s orthopod retired, does that mean my son has to give back his scoliosis rods because the next doctor didn’t personally implant them?

There must be standards to meet if someone doubts a diagnosis.

I don’t think people with ADHD should have to jump through significantly higher hoops than people with other conditions have to.

It's the American Way. Our fine healthcare system at work. The war on drugs, helpful as always.

Only the privileged and rich can get treated. No telling how much money all these tests will take and all the coordination. But hey, that's fine, pile a bunch of tests of questionable benefit and stick patients with the bill and hassle of making all these appointments.

I see reasons for some of these requirements, but not all. I don't see a reason why he needs to get tested multiple times within a few months with the same doctor. I don't see reasons for half of these blood tests. The drug tests aren't even testing for the drug he's taking. The form for opioid abuse doesn't even apply because Vyvanse isn't an opioid.

My son stopped taking meds in upper high school (he's a freshman at college now) because he decided it wasn't worth the side effects. He could skate by enough to pass (even though he performed well below his ability). He tried multiple different meds and the Vyvanse had the least side effects but it still left him with reduced appetite and not great sleep. Believe me, it wasn't the first choice as it was $300 a month. Now, he's in college and it requires more of everything and he can't skate by as well.

[kbutton]

48 minutes ago, Soror said:

I don't see reasons for half of these blood tests. The drug tests aren't even testing for the drug he's taking. The form for opioid abuse doesn't even apply because Vyvanse isn't an opioid.

And to further chap one’s hide, getting TREATED for ADHD supposedly makes a person less like to abuse substances.

 

[EKS]

My son had similar issues at age 22, though in his case, he was getting a first time diagnosis.  His therapist diagnosed him, but, obviously he needed a medical diagnosis as well.  He asked his pediatrician who told him he wasn't allowed to prescribe ADHD meds.  Then he waited for months to get in with a psychiatrist.  When he finally did, he was given a whole battery of tests, one of which I know is to filter out people who are faking.  Then he was prescribed Strattera, a non-stimulant even though that is considered a second line treatment. 

When he eventually established care in the state where he is now attending college, that psychiatrist expressed surprise that he wasn't offered a stimulant first.  After developing some disturbing side effects with the Strattera a few months later, he was finally offered Adderall, and one thing it has done is allowed him to learn how to cope with life without any medication because unlike with Strattera, which needs to be taken daily, he can take the Adderall or not depending on what is going on that day.  So, by prescribing Strattera, the first psychiatrist was actually tying him to medication rather than potentially freeing him from it.

Anyway, I hope your son gets the care he needs without too much trouble.

[stephanier.1765]

16 hours ago, sweet2ndchance said:

Gently, that does sound like par for the course with drugs that have a reputation for being sold and abused.

My dh has to take opioids for his brain condition that causes severe pain. He has to be drug tested every 3 - 6 months, sign all kinds of agreements that make him sound like a drug addict, and keep all appointments without fail less they will take away his meds. He is neither young nor does he look like a typical druggie if there is such a thing.

Same for me. I was just at my doctor's yesterday where I had to do a urine test. They don't do it exactly every so many months, I guess so you can't anticipate it, but I had a feeling it was due and loaded up on liquids ahead of time. LOL Too many times, I've got there and had a difficult time giving a specimen. But it is between every 3-6 months like @sweet2ndchance said. They want to make sure you are taking them and not dealing them. For the longest time, my pharmacy treated me like an addict but they've stopped now that they've gotten to know me. Good thing because I dreaded going.

[EKS]

54 minutes ago, stephanier.1765 said:

They want to make sure you are taking them and not dealing them.

Just because you're not taking them every single day certainly does not mean that you're dealing them.

[Kanin]

20 hours ago, Bambam said:

My YA child, with ADHD, has to get tested every six months before doctor will write a new script. 

That is crazy! Such an unreasonable burden. And... requires someone who may have trouble managing appointments to manage so many appointments!

[kbutton]

15 minutes ago, Kanin said:

That is crazy! Such an unreasonable burden. And... requires someone who may have trouble managing appointments to manage so many appointments!

My young adult son with ADHD and ASD technically has really good EF. For him it’s about attention, but it’s still a series of hoops that do not necessarily go smoothly that he has to coordinate for and ask off for, and then sometimes there is shortage of the the med. It’s hours of his life, often.

For my other younger kid, EF and black and white thinking are going to be problematic, and he is going to have to manage multiple specialist appointments per year, none of which are on the same interval and some of whom don’t have hours at the same hospital. He has a med that requires regular adjustment for dosages and tons of communication and labs to do so. Asking him to add hours and hours per month to his schedule to locate ADHD meds on top of all this is insane. He didn’t ask to be neurodivergent in several ways and have three rare diseases, two of which are life-threatening (and the third could become so eventually).

[Lawyer&Mom]

I’m a 44 year old white woman and a lawyer.  I had a sign the document consenting to drug testing and promise not to sell my prescription to get my ADHD meds.  It’s just standard procedure.  (I didn’t have to jump through diagnostic hoops, my doctor had already diagnosed my non-ADHD condition.  The same drugs are used for other neurological conditions.)

[TechWife]

18 hours ago, kbutton said:

I can’t fathom someone making my kid get re-diagnosed for his genetic condition ($$$), nor do I think insurance would allow it. If my kid’s orthopod retired, does that mean my son has to give back his scoliosis rods because the next doctor didn’t personally implant them?

There must be standards to meet if someone doubts a diagnosis.

I don’t think people with ADHD should have to jump through significantly higher hoops than people with other conditions have to.

 

 

No it doesn’t mean that a doctor has do it, it means that if they need to they can do it. Some things, like providing genetic test results are straightforward. A genetic test is going to present the same results no matter what age the person is when it is originally conducted. Others conditions can’t be diagnosed that objectively. The OP admits these tests have never been done before, thinking they are unnecessary or being required for prejudicial reasons, but the provider is simply meeting the standard of care for adults, and relying solely on previous test results doesn’t meet that criteria.  This happens when people do to specialists and more extensive blood work is ordered to gain additional information, updated results and/or tailor treatment. The referring GP met the standard of care through an initial test or evaluation, and the specialist meets the standard of care for the specialty.

Your example of repeating surgery is unrealistic. I can however, tell you that when my husband had a heart attack one year after bypass surgery they did a heart Cath, which is an expensive, invasive and dangerous procedure, not only to look for new or missed blockages, but to to make sure the previous grafts were holding and that the plates & wire that put his ribs back together were holding & in the right place. They had the images from his last Cath, which were a year old at that time, no one doubted he had the surgery, or that the surgery was done correctly, but they repeated a test that had been done before to meet the standard of care for the current situation. The attending cardiologist would have been foolish if he had relied solely on previous medical records to diagnose a current condition that has the potential for a variety of presentations and potentially a variety of treatment options. 

[kbutton]

1 hour ago, TechWife said:

No it doesn’t mean that a doctor has do it, it means that if they need to they can do it.

You made a very black and white unqualified statement, which is why I put it in a context that obviously wouldn’t apply. 

1 hour ago, TechWife said:

The attending cardiologist would have been foolish if he had relied solely on previous medical records to diagnose a current condition that has the potential for a variety of presentations and potentially a variety of treatment options. 

Many people have lifelong ADHD. Many people have adjustments to meds for other conditions where bloodwork and testing are overkill when symptoms will do. Some docs hand out antibiotics like candy and never culture or X-ray anything. Antibiotic resistance has implications just as big or bigger than the war on drugs, but providers don’t like bad Press Gainey ratings when a patient walks away mad that they didn’t get an antibiotic. I got an antibiotic last week for something serious where I basically had no typical symptoms and had to say, “I will not take that unless you do xyz test.” And I bet there is a lot more evidence for treating ADHD symptomatically than for handing out antibiotics like it’s Tylenol.

I think no one stops to listen to themselves talk about why we treat this so very differently (and in a way that immediately assumes bad will) from every other part of medicine except that some people abuse stuff. Some difference and safeguards? Sure! Repetitive stress, suspicion, presumption of guilt, and requiring many hours of someone’s time that they likely have to take off of work on a regular basis? That’s discriminatory and hostile.

There are so many areas in life with rampant exploitation that we give far less concern to because no one cares. It’s time the medical field meets people halfway.

Paternalistic CYA medicine is often short-sighted and not very grown up.

[TechWife]

On 4/18/2024 at 9:04 PM, TechWife said:

…

No practitioner is obligated to accept the diagnosis of any other practitioner, or to treat a condition that they have not personally documented. 

 

 

I stand by this. It’s an accurate and straightforward statement. It’s a fact. It doesn’t mean they won’t accept it, but they don’t have to. 

23 hours ago, kbutton said:

…

There must be standards to meet if someone doubts a diagnosis.

I don’t think people with ADHD should have to jump through significantly higher hoops than people with other conditions have to.

…

 

There are standards. They’re called best practices. People with ADHD don’t jump through “significantly higher hoops” than people with other conditions. There are a lot of hoops coming from a lot of different places and every person or organization holding one has the power to say “no.” 

4 hours ago, TechWife said:

No it doesn’t mean that a doctor has do it, it means that if they need to they can do it. …

Still accurate. Still true. Still a fact. You don’t have to like it, but it’s there. 

3 hours ago, kbutton said:

You made a very black and white unqualified statement, which is why I put it in a context that obviously wouldn’t apply. 

Many people have lifelong ADHD. Many people have adjustments to meds for other conditions where bloodwork and testing are overkill when symptoms will do. … And I bet there is a lot more evidence for treating ADHD symptomatically than for handing out antibiotics like it’s Tylenol.

…That’s discriminatory and hostile.

…

Paternalistic CYA medicine is often short-sighted and not very grown up.

It is and remains a black and white statement. Physicians are not obligated to accept a diagnosis made by another practitioner. This is not hard to understand. It’s why people are able get second opinions & why sometimes that’s a very wise thing to do, frankly.
Additionally, there is an obvious difference between diagnosis of an illness and surgical treatment of a diagnosed condition. They are not the same thing.  Agreeing, disagreeing  or making a more accurate diagnosis doesn’t treat anything. 

Not being a physician, I’m not in a position to determine what tests “will do.” I also think that accepting a path that “will do” can close the door on what is better or best. “Will do” is not a criteria I use for quality healthcare.

All of the evidence regarding treating ADHD revolves around treating the symptoms. There may be studies in progress to determine the cause of ADHD, but until that is determined , if it’s ever determined, the only thing to do is treat the symptoms. Antibiotics treat the cause of the symptoms. Other medications are added to treat symptoms. Comparing prescribing ADHD meds to prescribing antibiotics is like comparing  “apples to oranges.”

It’s very often legislation and rules put in place by people who don’t practice medicine that result in this paternalistic behavior. Reform has to start there. 

Edited April 20 by TechWife

[katilac]

23 hours ago, kbutton said:

 I don’t think people with ADHD should have to jump through significantly higher hoops than people with other conditions have to.

It sucks, but it's about the drugs, not the patient. The medical system played fast and loose with prescribing opioids and stimulants, and now they've probably swung too far in the opposite direction, as though it would change what happened in the past. 

Anyone who is taking a drug with a high rate of abuse is jumping through hoops. What the doctors have to do specifically varies by state and by practice, and I disagree with a lot of the specifics, but the hoop-jumping is pretty standard for any such drug, regardless of the diagnosis. 

[kbutton]

18 hours ago, katilac said:

It sucks, but it's about the drugs, not the patient. The medical system played fast and loose with prescribing opioids and stimulants, and now they've probably swung too far in the opposite direction, as though it would change what happened in the past. 

Anyone who is taking a drug with a high rate of abuse is jumping through hoops. What the doctors have to do specifically varies by state and by practice, and I disagree with a lot of the specifics, but the hoop-jumping is pretty standard for any such drug, regardless of the diagnosis. 

Not nearly so much in pediatrics, as numerous people in this thread can attest, and if we’re so sure people are abusing drugs, why aren’t we testing kids to be sure their parents aren’t selling their meds?

It’s mind boggling to me that ridiculous rules are being defended so steadily.

18 hours ago, TechWife said:

It is and remains a black and white statement. Physicians are not obligated to accept a diagnosis made by another practitioner. This is not hard to understand.

Don’t quote the rest: 

 

Edited April 20 by kbutton

[katilac]

40 minutes ago, kbutton said:

Not nearly so much in pediatrics, as numerous people in this thread can attest, and if we’re so sure people are abusing drugs, why aren’t we testing kids to be sure their parents aren’t selling their meds?

It’s mind boggling to me that ridiculous rules are being defended so steadily.

As I stated, I disagree with a lot of the specifics, I think they've probably swung too far in the other direction, and over-regulating now doesn't make up for under-regulating in the past. I'm not sure how you went from that to me steadily defending the rules - although I certainly do think that a change to more oversight was required

My point, which I highlighted in my very first sentence, is that it's not ADD/ADHD specific. It is specific to drugs that are controlled substances and at high risk of abuse.

[gardenmom5]

I'm sorry you're having to go through this.

The reality is even a lot of 'clean cut' college age kids are getting ahold of adhd meds to help them function in college, not because they actually have adhd.  so there has been more cracking down. (this is often happening across the board for controlled rx. )
and it hurts patients who actually NEED those RXs.  (I can tell horror stories from our own family, where pharm techs refused to fill RX without authorization from a PharmD.)

and . . there's been a shortage of meds.

Edited April 20 by gardenmom5

[TechWife]

7 hours ago, kbutton said:

….

Don’t quote the rest: …

 

I’m sorry your family member doesn’t think he can disagree with his peers. I think that’s weird.  He must not ever give a 2nd opinion I guess. 

[Pawz4me]

On 4/18/2024 at 9:42 PM, kbutton said:

I can’t fathom someone making my kid get re-diagnosed for his genetic condition ($$$), nor do I think insurance would allow it. If my kid’s orthopod retired, does that mean my son has to give back his scoliosis rods because the next doctor didn’t personally implant them?

There must be standards to meet if someone doubts a diagnosis.

I don’t think people with ADHD should have to jump through significantly higher hoops than people with other conditions have to.

 

 

Hang around on autoimmune forums for awhile. It's not uncommon at all for people with seronegative AI diagnoses who (for whatever reasons) need to change providers to have that new provider say "No, I don't think you have X disease" or "I think you never had X, I think it's Y." And the patient has no recourse (except to go doctor shopping) even if they were doing well on a treatment plan for the disease the new doc insists they no longer have.

But I know (IRL) of a case where someone was diagnosed with RA years ago and now the person has a new provider saying no, I don't think you ever had that. In this case my guess is the new provider is absolutely correct. So I guess it can work both ways.

Edited April 20 by Pawz4me

[TechWife]

9 minutes ago, Pawz4me said:

Hang around on autoimmune forums for awhile. It's not uncommon at all for people with seronegative AI diagnoses who (for whatever reasons) need to change providers to have that new provider say "No, I don't think you have X disease" or "I think you never had X, I think it's Y." And the patient has no recourse (except to go doctor shopping) even if they were doing well on a treatment plan for the disease the new doc insists they no longer have.

But I know (IRL) of a case where someone was diagnosed with RA years ago and now the person has a new provider saying no, I don't think you ever had that. In this case my guess is the new provider is absolutely correct. So I guess it can work both ways.

Likewise my sister was diagnosed with lupus. She changed insurance and had to change providers. This resulted in her being diagnosed with and treated for RA. The new MD said he didn’t think she has lupus and over the years he has been proved correct. She’s a different person now that she’s being treated correctly. 

[kbutton]

16 hours ago, katilac said:

I'm not sure how you went from that to me steadily defending the rules - although I certainly do think that a change to more oversight was required

Nope, the bent of the thread.

 

9 hours ago, TechWife said:

I’m sorry your family member doesn’t think he can disagree with his peers. I think that’s weird.  He must not ever give a 2nd opinion I guess. 

That’s not even remotely what he said. We both think your unqualified statement is what is bizarre. Your unqualified statement essentially leaves room for every doctor to question every diagnosis with no good reason except the doctor doesn’t have to take the word of another doctor. That’s all. 

9 hours ago, Pawz4me said:

Hang around on autoimmune forums for awhile. It's not uncommon at all for people with seronegative AI diagnoses who (for whatever reasons) need to change providers to have that new provider say "No, I don't think you have X disease" or "I think you never had X, I think it's Y." And the patient has no recourse (except to go doctor shopping) even if they were doing well on a treatment plan for the disease the new doc insists they no longer have.

But I know (IRL) of a case where someone was diagnosed with RA years ago and now the person has a new provider saying no, I don't think you ever had that. In this case my guess is the new provider is absolutely correct. So I guess it can work both ways.

My problem is with Techwife’s unqualified black and white statement, which is what I’ve said multiple times, like a broken record. I do think that doctors make mistakes and other doctors sort it out. I don’t think that equates to a blanket statement that doctors don’t have to accept what another doctor does. That would be totally inefficient, ineffective, and wasteful.

To single out specific diagnoses for extra scrutiny from another provider is discriminatory unless there are extenuating circumstances, such as care plans not adding up, specific practices diagnosing enormous rates of xyz condition that is not in their domain, etc.

[kbutton]

9 hours ago, Pawz4me said:

Hang around on autoimmune forums for awhile.

BTW, I do. I have a kid with a rare autoimmune condition that doesn’t have any set diagnostic criteria in pediatric populations. Fun times. 

[wathe]

It's true though that doctors don't have to accept a previous doctor's diagnosis.  They usually do; because starting from scratch every time would be inefficient and wasteful and completely impractical.  But each doctor is responsible for their own assessment and disposition, and that includes scrutinizing past medical history.   Differences of opinion are common.  EMR's are famously full of errors, and erroneous diagnosis have a way of being sticky and persisting through copy-pasting by rushed clinicians.  "Trust no-one, believe nothing, not even the EHR".  

It's also true that misuse and diversion of prescribed stimulants is common, especially on college campuses; this is supported by the literature.   In a litigious environment like the US, MD's really are stuck with defensive practice.   

From the other side of the gurney:  One of my most awful career moments was getting a call from a coroner asking me about a Rx for a controlled ADHD med that I had written for a pt with a reasonable, believable story.  It had been diverted, with a fatal outcome.  The reasonable-sounding story was a set-up, and I got caught.  I am now a  controlled-medication defensive hard-a$$.

[kbutton]

45 minutes ago, wathe said:

It's true though that doctors don't have to accept a previous doctor's diagnosis.  They usually do; because starting from scratch every time would be inefficient and wasteful and completely impractical.  But each doctor is responsible for their own assessment and disposition, and that includes scrutinizing past medical history.  

This is the nuanced part that was missing. I do find it relatively arbitrary what doctors do and do not scrutinize, and I live in fear of what will happen when my medically complex teen “graduates” to adult medicine. The condition he has that has no consensus criteria for pediatric diagnoses could be a problem. A doctor might read that and think he/she needs to be rediagnosed as an adult (and antibodies wax and wane even in people with active disease). In reality, the reason that there is no consensus is that pediatric presentations are usually more severe in the long-term, so adult criteria excludes too many kids.

I’m sorry you had a bad outcome from diversion. That stinks.

 

[Halftime Hope]

Never mind, others have said it better than I did.

Edited April 20 by Halftime Hope

[TechWife]

2 hours ago, kbutton said:

Nope, the bent of the thread.

 

That’s not even remotely what he said. We both think your unqualified statement is what is bizarre. Your unqualified statement essentially leaves room for every doctor to question every diagnosis with no good reason except the doctor doesn’t have to take the word of another doctor. That’s all. 

My problem is with Techwife’s unqualified black and white statement, which is what I’ve said multiple times, like a broken record. I do think that doctors make mistakes and other doctors sort it out. I don’t think that equates to a blanket statement that doctors don’t have to accept what another doctor does. That would be totally inefficient, ineffective, and wasteful.

To single out specific diagnoses for extra scrutiny from another provider is discriminatory unless there are extenuating circumstances, such as care plans not adding up, specific practices diagnosing enormous rates of xyz condition that is not in their domain, etc.

Every nuance starts with a blanket, black and white statement. Starts. Physicians can question every diagnosis. As I said before, this is when best practices come into play. A physician looks at a record, examines the evidence, talks to the patient and makes a judgement. That’s their job - to be curious and thorough. If anything doesn’t add up - that’s when there’s a possibility for changes. Without doing this, countless people would be treated incorrectly and systemic problems would never be identified. Both you and I know, as does your family member, that this doesn’t mean they disregard the patient’s history. It does mean that they don’t have to accept the current diagnosis. IME, APPs function very differently than physicians and are less likely to take the curious route. I’ve always attributed it to training and the function of their role. I don’t know if that’s where your family member is coming from or not & it doesn’t really matter to me. Perhaps you’ll never understand what I am saying, but my black & white statement is true and I stand by it. 

[kbutton]

18 minutes ago, TechWife said:

It does mean that they don’t have to accept the current diagnosis. IME, APPs function very differently than physicians and are less likely to take the curious route

That’s insulting. My husband had been catching errors in diagnosis and treatment since he was in training.

19 minutes ago, TechWife said:

As I said before, this is when best practices come into play. A physician looks at a record, examines the evidence, talks to the patient and makes a judgement. That’s their job - to be curious and thorough. If anything doesn’t add up - that’s when there’s a possibility for changes.

A presumption that anyone seeking  ADHD meds, is more likely than not to be seeking to use the meds nefariously is NOT that, especially if that person has a diagnosis or is moving from pediatric care to adult care. It’s discriminatory.

None of the CYA scenarios assess the likelihood of abuse, they assume it from the get go and then rule it out.

 

[TechWife]

53 minutes ago, kbutton said:

That’s insulting. My husband had been catching errors in diagnosis and treatment since he was in training.

…

 

So - He’s not obligated to accept the diagnosis of another provider, then? My point exactly. Thank you.

Also, IME means in my experience. 

[Ivey]

If the doctor has a copy of the neuropsych report and it's fairly recent, requiring him to be retested for ADHD does seem extreme.

Otherwise, this sounds pretty similar to what my son experienced when seeing a new doctor to request ADHD meds. She ordered an EKG (and seemed surprised this hadn't been done the first time he was prescribed stimulants) and a drug screening along with some other blood tests, then had him fill out questionnaires about anxiety, depression, and his current ADHD symptoms.