The following will be an account of an appointment I had today, from my perspective, which is the perspective of a student of psychiatry in the hands of, and at the mercy of, a psychiatrist of 15+ years.
Disclaimer/ThingsYouShouldn’tBitchAtMeAbout: 1) If you feel any of the following medications actually help you, wonderful; what I say in regards to them has no reflection on you, so don’t act like I should take them just because you do. 2) If you feel any of the following diagnoses actually revolutionized your life, I am genuinely happy for you; what I say in regards to them has no reflection on you, so don’t act like I should accept them just because you do. And last but not least, 3) Do not waste your typing breath telling me “all psychiatrists aren’t like that” because I’m very, very aware of this. This will be an account of one who is not so keen on her own arrogance.
Disclaimer Part 2: If you feel offended by anything I said above, for God’s sake, you probably will have trouble getting through my blog.
*Brushes off hands* Alright. We’re all on the same page? Deep breath. Let’s take a mindfulness observation moment together: pick a natural object around you. That could be a flower, an insect, the clouds, e.t.c and focus only on that object. Watch it for a minute or two, noticing only the object and not the environment around it, as if you’re watching it for the first time. Let yourself be fully immersed in the visual stimulus of that object, connect with its energy, and breathe.
Now that you’re calm, I’m calm, and everything is alright, let’s together explore the very question I find myself plagued with on a daily basis: why do some people exist at all? Why? To fuck with you? To feed their ego? To sit back in their chair, roll in the dough, and not give two shits who they affect? Is that it? Is that what it is?
I’m going to need a lot of mindfulness moments today.
This new psychiatrist I see gave me weird vibes from the moment she placed a diagnostic PTSD code (among two others) on my invoice sheet within ten minutes of meeting me. This was my second visit with her today, and I’m done. Yep, you heard me. I’m done.
Her ears have bricks in them. They’re filled with cement. She hears her own thoughts very, very clearly, and values her opinion like any confident person does. Unlike what other confident people do, she does not seem to value other’s opinions very well.
First of all, let’s talk about the service codes.
Let’s talk about the fact that, one, I got charged with the 99213: basically, a level three office visit. For those of you with insurance in the U.S, you probably don’t see these things. I don’t have insurance and pay out of pocket, so I do. I’m okay with getting charged as an outpatient office visit; that was 125 dollars in itself.
She charged 25 dollars under a 90836. It’s an add on code under the 90834 code. Essentially, the 90836 is for is individual “psychotherapy” that occurred during the visit that was “insight orientated, behavior modifying, and/or supportive” if the visit is 38-45 minutes.
I paid a doctor 25 dollars to be supportive towards me for 30 minutes. The kicker? She wasn’t even that supportive. In fact, half the time she didn’t know what to say. In fact, half the time she just spewed useless information at me. Rather than taking a moment to relate or acknowledge some difficulties in my house hold, she told me my father could easily be put in a nursing home if he has insurance.
Why “psychotherapy” or “insight” or “support” isn’t included in the fucking OFFICE VISIT of a PSYCHIATRIST, I will never know. I understand they are technically “doctors”. I understand their main gig is (but shouldn’t be) medication. However, I’ve gotten better support/empathy talks from a general practitioner and they didn’t charge me shit.
Seems like a good money grabbing scheme to me. No wonder she kept me fucking talk. She needed to hit that time limit. I see the game, bitch.
Which, technically, she didn’t even hit the time limit. My appointment was at three. I was at my car door at three-thirty-seven. That’s 37 minutes bitch, not 38, I want my fucking 25 dollars back.
Like I don’t know diagnostic codes. Like I don’t know service codes. Give me a break. The more diagnoses you get and the more service codes listed on your invoice, the higher your price is going to be (if you pay out of pocket), and the better your insurance company loves you (if you have insurance), and the more regular your visits will be with your psychiatrist. I received three diagnoses in about ten or fifteen minutes in my first visit with her a few weeks ago, none of which she told me about. She just kind of wrote the diagnostic codes and said nothing on them.
Clinical arrogance is a disease.
Alright. Still breathing? Take a mindfulness moment if you need one, I won’t mind. Go ahead. Go right ahead.
. . .
Oh good, you’re back, I was getting worried.
As you remember, last time she tried placing me under the restraint of five different medications within about twenty to thirty minutes: Seroquel, Effexor, Praoxin, Propranolol, and Ativan. I took the Effexor which helps greatly with my energy and apathy issues. I told her no on everything else.
She has it stuck in her head I have performance anxiety. I kept saying I didn’t. None of what I describe is ever related to that. I reiterated myself today. I, once again, rejected all the medications and yet as I look down on my prescription list, I see very evidently the Propranolol prescription underneath the Effexor dosage raise.
She said she was going to give it to me anyway. And she put it on the list.
At this point, I was done.
There were some things I wanted to ask her opinion on but the moment the medication pushing came, and the moment she completely invalidated every word I said, I knew I would either get five more diagnoses and six more medications, or I wouldn’t be heard, so I decided to keep my mouth shut.
I will say this once more: Clinical arrogance is a disease.
I spoke a bit about my sensory issues. I couldn’t explain what I really experienced with them (how overwhelmingly strong they are, and how they keep me from functioning sometimes) before she interrupted me and asked if I ever thought I had ADHD. I said very flatly, NO. She asked me if I had trouble focusing and concentrating. I said yes–when I’m being overstimulated, yes, when I live in a hostile environment at home, yes, when I’m fatigued and exhausted all the time, YES. I gave her environmental reasons for two things she tried pinning on biology.
She said nothing after that. She said nothing until she got on her computer, went through my files, noticed that I have a lot of fatigue issues, and said “well, stimulants also help with energy sometimes. People also sometimes feel more relaxed with them. Would you like to try Ritalin?”
NO BITCH, would you like to try my FIST in your MOUTH? Because it’s fucking HEADING THERE.
I said, once again, NO.
And that was the end of that.
Don’t ever let a health professional run you. You run yourself. You know what bothers you and what doesn’t. You know how your environment contributes to your mental health and how it doesn’t. If you let someone ELSE start giving you reasons for your behavior, without you first reflecting on yourself, THAT’S when you’re no longer in control of your own treatment.
The funny thing is, the two major things that have really been bothering me, my anxiety/thoughts and my paranoia, are the very two things I didn’t get one moment to speak about in between her ramblings.
I’m not going back.