Archive for the ‘cure’ Category

“Yeah, but what’s my diagnosis?”

Tuesday, April 12th, 2011

Patients invariably want to know what diagnosis I’ve given them or the papers from somewhere else say they’ve been given. Some don’t ask. Many do. To those who do I’m really, really tempted to say, “What’s it to ya?” but I’d just be dismissed as being flip or, even worse, that I’m with holding some secret that will help do something, though I’m not sure what. Most of the time patients don’t know what that information is going to help either. I do tell patients that I’ll tell them but first I’d like to know what having that information is going to do for them. Most of the time the answer is something vague, like, “I just want to know what you’re writing about me,” or “I want to know what I’ve got.”

I know, you’re looking for an answer. You want to be told you’ve got Bi-Polar Disorder or Schizophrenia, or something, anything, as long as it has a name. Giving your condition a name explains what you have and then explains a course of treatment, right? That’s how it works when you go to the doctor. He says you’ve got Bronchitis, you take this prescription for antibiotic to the pharmacy, take a pill x number of times a day for y number of days and “you should feel better. If not, call me. Be sure to take all the pills.” OK, the doctor doesn’t say most of that, it’s written on the bottle the pills come in but it’s doctor (some doctor) who tells the druggist to put those labels on the bottle.

OK – you don’t really want to know you’ve been diagnosed with Schizophrenia or Bi-Polar Disorder because those are serious problems. So how about some depression or anxiety? Better? OK. Still, what does that tell you? There are clinical interpretations of those two words but I don’t really think that’s what you’re looking for because: there’s no antibiotic that you take for y number of days and it goes away. Medication can bring some relief, or so the pharmaceutical companies claim (more on that another time – I’m not anti-medication, just anti-miracle drug,) psychotherapy/psychoanalysis can bring some relief, the combination of psychotherapy/psychoanalysis and medication can bring more relief but, if you want real relief from what’s troublin’ ya (“What’s the matter bunkie? You say your brother hid your homework in the washing machine and now you algebra stuff is all over your underwear and the teacher is asking you to hand it in….”) you’ve got to change the things that are causing the condition, because that’s what your condition is a reaction to and a defense against.

We diagnose across five Axes (that’s acksees, not the things that have strings and make music), I-Clinical Disorders; Other Disorders That May Be a Focus of Clinical Attention II. Personality Disorders; Mental Retardation III – General Medical Conditions IV – Psychosocial and Environmental Problems and V – Global Assessment of Functioning.

When you ask me what is your diagnosis you’re usually asking me for the top item on the list. I hesitate to tell you because it doesn’t tell you anything about what’s going on. It barely tells me what’s going on. What it tells me is that your symptoms, your reactions to your General Medical Condition added to your Psychosocial and Environmental Problems, have been given this or that name and number by the taxonomists who need to track these things for statistical and other informational purposes, like whether you can have coverage under the new parity law or not (another post another time.) Same thing about Axis II except that’s more pervasive, more of a character style, than just a bunch of symptoms.

What you’d be asking if you knew what to ask is what do I see as the things that are pushing and pulling on you that are causing you to be this way. You’d be asking me ” How do I increase my GAF (Global Assessment of Functioning) so I can _____ (insert desired result here.)

Doesn’t matter. I’m still going to hear “What’s my diagnosis” or its variant “I took a test (looked it up, whatever) online. I’ve got this. Do you agree?”

I don’t know.  Please tell me more about it.