What can you do when your doctor won’t look past a previous diagnosis? This is ESPECIALLY common (and sometimes detrimental) in cases of diagnoses involving mental illness or emotional distress, like Generalized Anxiety Disorder, Depression, Somataform Disorder, Bipolar Disorder, Schizophrenia. This can be frustrating because a patient may have their concerns of pain passed off as a byproduct of mental illness.
I am a licensed social worker and I have (had) the ability to make a diagnosis of mental illness…it is part of what I was trained to do in internships and in graduate school (sorry, don’t mean to sound hoity-toity). I am going to be the first to tell you that I DO NOT KNOW EVERYTHING and I DO NOT know how you are really feeling. These diagnoses are based on a set of criteria, so if you are in the midst of a very bad depression and you answer questions that meet the criteria for certain disorders, that is what my diagnosis is based on. That does NOT mean that you actually have this disorder. By that same token if I were to talk to you on a great day, your own perception of your symptoms may have you answering questions in a different way, thereby not meeting the criteria for the disorder. Diagnosis is all about your perceptions of your emotions and my (the clinician’s) perception of you.
The first thing to keep in mind is this: just because a clinician diagnosed you as Bipolar or Generalized Anxiety Disorder, etc., DOES NOT MEAN THAT YOU ACTUALLY HAVE THIS DISORDER. That being said, once you tell a doctor that diagnosis, it tends to follow you for a long time. I have had “mental illness” diagnosis applied to me before and about 8 years ago, I suffered for YEARS with pain that turned out to be related to nerve damage in my back, but since I was an “emotional/anxious” person, I was punted from doctor to doctor and eventually told to see a psychiatrist (which did little to help because the pain was in my spine, not my head…same body system, wrong end).
So, how do you get the doctors to look beyond a diagnosis that may not even reflect what is actually going on? First, what I did to get away from an incorrect diagnosis is I switched primary care doctors about 7 years ago. At my first appointment, I told her that I have had various health issues and I have records of all tests and labs that were done, but I was wondering if she (my angel in a white coat) would be willing to examine and speak with me WITHOUT my prior office notes so that I could get a fresh perspective on my health that was not already biased by notes and diagnoses from a doctor that, truthfully, I butted heads with.
One imperative thing to remember is that a diagnosis is nothing more than a code to get insurance to pay for treatment, be it physical or emotional. Just because your doctor says you have bipolar disorder or anxiety disorder, does NOT mean you do. Sometimes they may not even believe fully that you have a disorder, but need to give codes to insurance to get paid for treating you. I do believe there are people who repeatedly fit the criteria for mental illness, but just because one doctor says so, does not mean that you actually have the disorder. Get a second opinion.
Secondly, find a good, compassionate doctor (they exist, but like good men, they are a little hard to find). You have the right to interview doctors and you do not have to stick with the first one you find. Find a doctor whose style you like, who you feel gives you time and who you feel will understand you and your case and ask for an unbiased exam. Keep in mind, when your records are sent over from a previous doctor, they are sent over with office notes. I saw my chart from my original doctor and the doctor was NOT unbiased in his opinions in those notes. Those notes can tarnish a new doctor’s view of you. Some doctors may be suspicious of this request, but if they are, they are probably not right for you.
But what of you really do have a mental illness? Well, first off, you are NOT your diagnosis. It took me years to learn this, but a set of numbers and words is NOT who YOU REALLY ARE. You are still a human and you are still in pain and that pain may not be related in any way to mental illness. If you are taking several medications and know that this disorder has a strong impact on your life, be up front with doctors. Tell them, “I have been diagnosed and am being treated for X disorder, but I would like you to remove that from the equation when you examine and speak to me, please.” A decent doctor will appreciate your honesty and candor and hopefully do just that. If they still insist that your pain is the result of emotional distress and suggests you see a psychiatrist, politely thank them and find another doctor. I know this may present a financial issue, but some doctors who are not interested in taking you on as a patient will not charge for their consultation (had that happen a few times due to the complex nature of my pain).
The other option is to omit your disorder from your intake papers. You are NOT REQUIRED to tell a doctor that you were diagnosed as bipolar because, once again, that diagnosis is one professional’s opinion. The same goes for diagnosis like fibromyalgia and Chronic Fatigue Syndrome. I was diagnosed with Fibro when I was in my early 20s and quickly realized doctors would point the finger at that for EVERYTHING, so I stopped telling them.
I hope this helps because I know this can be a very difficult thing to deal with and it can lead to a LOT of frustration. It can also leave you feeling like a nut case every time you get a back ache, but in the end, there are good doctors, and suggestions to help you get past a diagnosis.