Super Shrink hands out 15 minute diagnosis!
 

I've recently been in the irritating position of being passed around from one locum psych to another at my outpatient appts since my consultant left last summer. Up until then, I had been under his care for about two years and had been going through the slow process of closely monitoring my symptoms and figuring out how best to treat them, with the aim of eventually gaining an accurate diagnosis. And I was fine with that; I understand that obtaining a psychiatric diagnosis is often a complicated and lengthy process and have never been to eager to be labelled and "put in a box" so to speak. Granted it was frustrating at times, but I respected him for it and was comfortable with his style, and did in fact make significant progess.

Anyway, so during my most recent appt (with yet another locum whom I had never seen before) it was suggested to me that I may have cyclothymia. Fine, "a bit of food for thought" I said to myself. But obviously had some reservations/questions at the same time, primarily; 1) According to the diagnostic criteria, you can't be dx'd with cyclothymia if you have met the criteria for MDD during recent times (which I have). And 2) he's only just met me so surely needs to gain more familiarity of me and my history before he slaps a diagnosis upon me? Apparently not.

It would seem that cyclothymia was actually more than just a suggestion (a suggestion which I was perfectly happy to accept & consider) and following his first contact with me in a 15 minute consultation he has actively changed my diagnosis and has written off to my GP stating that I now officially have cyclothymia, diagnostic code and all! I might just be making a mountain out of a molehill of this, but can honestly say that I have never had this happen before. During the past three years I have had regular contact with two different psychs (not simultaneously) and they have always mentioned my "possible diagnosis" or how I "currently meet the criteria" for something or other, and this will be after months of history taking, discussion and monitoring. Not a 15 minute appointment and a glance over my notes.

I am honestly not particularly bothered by what my diagnosis is (although naturally like to be kept in the know as to where its headed). I want relief from my symptoms, not a label. But since my psych left and I have been seeing random locums, I am fast becoming more and more dissatisfied and frustrated with the outpatient services and frankly do not gain anything from attending them other than wasting petrol and having to work late for the privilege. I'm about to throw in the towel now and can't even muster up the slightest bit of motivation to attend another appointment and speak to another flippin' locum/complete stranger. I have lost all interest and in all honesty I have been thinking of discharging myself for quite sometime now. Primarily because I find the services to be of little benefit to me and also because I genuinely feel as though I am ready to go at it alone now.

Hmm, this was mean't to be a quick question but seems to have morphed into a huge rant. But all I wanted to ask really was if anyone has ever had some miracle 15 minute diagnosis and whether I am right to be slightly put off by his "trigger happy" diagnostic style?!

Thanks for reading all of this drivel!

yes, this happenned to me, but was changed when reviewed by another psych, and that diagnosis was taken off my record. 15 minutes diagnosis' aren't acceptable in my opinion, i thinkt hey like to throw around cyclothymia because it's a moderate illness that can probably just use some mood stabilizers, it's nice and easy kind of thing for them....

but yeah, i would too be sceptical. x

Lol yeah. One super shrink decided I had bipolar II during our first appointment. Another decided I had borderline personality disorder (my therapist, who I've had for years and specializes in that disorder, disagreed!). Finding a good psychiatrist is just damn hard. Why are you getting seen by so many diff psychiatrists? (And btw, what's a "locum"? I haven't heard of that b4?) Are you seeing a therapist who could recommend a good psychiatrist? That's how I found mine.
It's just frustrating that someone you met 15 minutes ago can put down a name on your record without you having any say-so :( You have my sympathy on that <3

I have to confess the, 'Super Shrink hands out 15 minute diagnosis!' made me laugh, alot!
I'm really sorry you are being passed around, I know this can be very unhelpful. I do hope you settle with one psych soon and can get to the bottom of your symptoms and address them. I agree with your not really wanting a label, some Drs are very happy to label, others arn't. But relief from your symptoms would make a label worth while.

Good Luck! X

Heh, actually I'm surprised it's taken so long for you to come into contact with one of these Super-shrinks! Having a God Complex seems to be a prerequisite for becoming a psychiatrist I think ...

Go super shrink lol! Anyway, thank you both for your replies, it's a frustrating situation to be in isn't it?!

A locum is basically a temporary dr who stands in for the permanent dr in their absence. In my case this is because my regular psych left (who was considerate & patient and I got on very well with him) and they are yet to find a permanent replacement, hence all the locums. They are currently on number 3... nothing like a bit of continuity now is there?! Although in their defence I have heard that there is a shortage of consultant psychs nationwide so can only assume that it has something to do with that.

Anyway, I spoke to this locum over the phone earlier on as I had a another issue as well as this one to clear up with him. I told him that I felt mislead in that I had been given the impression that cyclothymia was a possible dx and something to monitor and explore over time, which I would have been happy to do. I also explained that I was alarmed by the fact that he had slapped a firm diagnosis on my file after one 15 minute appointment, especially when you consider that I had never had an absolute rock solid dx off my previous psych whom I had seen for the best part of 3 years. I also brought up the other issue that I had with him and he has agreed to send a revised letter to my GP. I don't think much will change with regard to my dx but at least they will have it on file that I am unhappy about the situation.

I have felt dissatisfied with the service for quite some time now and have finally asked to be discharged, and feel hugely relieved having done so. What can I possibly gain from being bounced from one psych to another? Each of them with different styles and opinions and none of them spending enough time with me to get a clear picture of what's really going on. That just doesn't help anyone, it merely leaves my GP misinformed and me feeling pissed off about it! It's counterproductive and only leads to frustration and confusion, and that is certainly something that I could do without.

Ranting on once more! Thanks again for the replies, it really helps to get things out and be listened to. Take care x

LOL! I think you're quite right there; it is somewhat of an arrogant profession isn't it!

The trouble is, when you actually get a good psychiatrist (a rare commodity I know) it really makes the ***** ones stand out!

It is comical though, I mean, what flippin' planet are some of these people from?!

Ugh - I hate locums for this very reason, and avoid them wherever possible.

Glad they are sending a revised letter, and hope it is sorted and made less of a permanent fixture on your records. Did they try to change your meds or treatment at all in line with the 15 mins dx, and has this been re-viewed since?

Roiben x

They are useless aren't they? Ironically I read an article a short while ago regarding locum psychiatrists and how apparently the vast majority of complaints that are received by NHS metal health services are actually concerning locums. They are also paid on an hourly basis and are not salaried and therefore earn about double the amount of what consultant psychs do, which quite frankly stinks when you consider how inadequate some of them are. This article had actually been written by a somewhat disgruntled sounding head of psych services somewhere in the UK.

But anyway, rant aside! Thankfully no he didn't propose to alter anything medication wise, although had wanted to review things in a couple of months time. Which obviously wont be happening now as I am no longer under his care. The term "care" is loosely applied. He also did enquire as to whether I had received any talking treatments. I told him that I wasn't eligable for cbt (this was actually explained to me by a cbt practitioner) and also that I had tried counselling but didn't find it helpful. He seemed to accept this and didn't suggest anything further.

Having said I have been off my meds (a decision I made without consulting a psych, although soon confessed) since October of last year and am quite eager to see how I get on without them. Admittedly it hasn't all been plain sailing, but I feel confident enough to continue without them for the time being and it would take some heavy persuasion to get me back on them.

Thanks Roiben, hope you're well. x

although this situation is pretty grim you sound like you may be in a fairly level headed and positive place with yourself where you can admit when things aren't great, but sometimes we are best of coping on our own without psych services in the way that if you can manage it on your own, then great. Recovery is ultimately about managing I think, so you sound like maybe being thrown in the deep end might serve a good challenge for you. It happenned to myself in the past and even thought I REALLY struggled, after about 3-4 months I learned to cope and got on quite well for a good while.

Here especially, it sounds like the services are being more detrimental to you, which is why I say that.

DOllyPOp

Thats pretty much exactly how I feel. I seriously haven't gained or learned anything at all by attending my recent appointments. Frankly they have become a burden which I am glad to be rid of! I have however been sort of "training" myself to cope without support by looking after myself healthwise, tracking my symptoms and implementing various stategies to try and counteract any potential consequences that may arise from my random moods! And I now feel confident enough to be able to go at it alone and be less reliant upon (unsatisfactory) professional support.

Cheers DollyPop

Wow- well to be honest, you seem extremely level headed and self aware. I say go it alone as best you can and try to work things out on your own terms. You seem to be doing a pretty damn good job of it from where I'm sitting. Its really great you have decided on this and are feeling positive for the future.

All the best, Roli xx

Thanks for your positive comments Roli, certainly gave me a bit of a confidence boost!

Well, he has written to my GP again and to be fair he was apologetic and corrected some discrepancies that I had noticed. He is still adamant however that my official diagnosis is to be cyclothymia, so I've sent off a letter to the complaints department at the hospital explaining how I feel and have asked for the diagnosis to be referred to as provisional.

I checked in with my GP today and she was also baffled/concerned that he had firmly diagnosed me after one appointment and fully understood why I was annoyed. She also pointed out how such a diagnosis could effect me in the future (in terms of getting certain insuarances or a mortgage for example) and encouraged me to contest it.

Anyway, just thought I'd give a quick update/have a whinge! Thanks for listening guys.

Sometimes there are 'less good' professionals than others, or sometimes they just have a bad day, or don't really understand what you're saying. Nonetheless, as this really seems to be bothering you, it might be a good idea to ask to be refer to a different one.

It sounds like your GP is quite supportive, so it might always be worth booking a double-appointment and chatting to her instead.

This is pretty much the kind of doctors I've always been seen by, which is why I was seriously misdiagnosed and made much much worse by being told to take medication that not only did I not need, but harmed me mentally. It really bothers me and the correct diagnosis for me was only found pretty much on accident and because I kept arguing with the psychiatrist and actually making him listen to me instead of just letting him hand me out a diagnosis after 15 minutes like all the others. After 4 years I got sick of it and I got lucky that he finally hit on it, but he wouldn't have had I not been very pushy. Now when I go in I just get them to refill my meds and talk as little as possible because I have not had a stable psych ever and they have all done this. I had to choose to take myself off my medications in order to get back to where I was before I started seeing them, which you shouldn't have to do, but they had been so negligent with my care that I had to be the one to realize after 3 years the medications were making me immensely worse. Trusting doctors shouldn't be a mistake, but it was for me and that needs to drastically change. So I just suffered through my real symptoms until I finally got lucky with the one I mentioned and found out what was really going to help me.

I don't know why they are so bad in the system I am in, but I agree it's ridiculous and in my case it had horridly bad consequences of inducing an illness that wasn't there while not treating the problem that did exist. Also like you said these things go on your medical records, and I think it's outrageous doctors can legally put things on your medical records so flippantly. I've had them put outright false stuff (so bad that if it ever came up to affect me in any way I would seek legal action), let alone flippant diagnoses. Although I have a feeling if someone were to ever go through my medical records they would just laugh because almost every psych I have seen is like this so the records would make no sense and be entirely contradictory.

So yes it's so ridiculous how this is allowed for psychs to not take diagnoses seriously as it has so many possible bad consequences, and I hope you find one as good as the one you used to have, cause at least around here they are very very rare to be that thorough and devoted to helping you. Psychiatry has the potential to help people, but when it's treated with such disregard like this by people who are supposed to be doctors, it does more harm than good imo. I really hope some day psychiatrists have to have second/third opinions to do treatments and that they have much more legal restrictions with how quickly they can diagnose and that they are legally responsible for the accuracy of what they write. But for now, it's more of a hunt and search until you happen to find a good one.

Well Caz23,
I suppose you never had a care plan or key worker then? Once you keep an open rapport with your GP, especially after coming off your meds and self- monitoring, I suppose that is the best you can do for now. I had to go with an advocate when I got pissed off seeing different senior health officers? (junior doctors) rather than the consultant, and a different one each time- who obviously never read my file, and asked me the same questions- which were in my file!! I am very proud of you for following process and getting out of a frustrating situation. It should become more common for persons to direct their care, after all they are the only true experts.