How many minutes do PDocs need for a diagnosis?

AspiringAuthor,

I agree I will have had something other than mania during the completely blank period. Just as you say, it's complicated. I would quite probably benefit from psych meds, but shouldn't take any without careful monitoring and assessment. One would think that those were the cases that warranted some psychiatrist's time, but seemingly not in our public health system.

My initial visit took one hour.

Well my initial diagnosis was maybe 30 minutes filling out paperwork and talking with the assistant, 30 minutes with the psychiatrist? He was thorough, but also my symptoms met the criteria for MDD/GAD so I got misdiagnosed. Not his fault based on my symptoms i reported, really. Took another 6 months maybe of trying 2 meds and frequent appointments to figure out I had bipolar, then another 4 months or so before we discussed it seems like I might also have OCD.

I would say that 15 minutes and a ? Diagnosis ? Likely indicates a sub optimal “p”doc.

I received an adequate service and diagnosis when I paid a shrink for one hour.

My initial intake appointment was 90 minutes, and the psychiatrist and I covered a LOT of ground. At the end he diagnosed me with bipolar NOS, which was a provisional diagnosis that basically meant it looked like bipolar, but it didn't fit into any other category. Two and a half years later I was given the bipolar 1 label in the hospital and have been re-diagnosed with it by several more providers. Sometimes it takes months or years to flesh out the picture of a particular patient's illness, which is how it was for me. I'd be highly suspicious of any pdoc who gives a diagnosis in 15 minutes.

I myself definitely would not trust that. It took 6 months or more of treatment going horribly for depression(many IP stays thanks to antidepressants) to be officially diagnosed by pdocs as bipolar nos and personality disorder with borderline traits.

I recently spent almost a month in a psych ward at a larger hospital far from my home that I was sent to because of how badly I hurt myself. Their staff were so much more competent and the pdoc I seen on the ward there offered to take me on because of how badly my treatment had been up to that point.

My new pdoc does roughly hour long appointments and asked me how often I want to see her, this time I said 3 weeks and thats what she booked for me. The pdoc I had did 15min every 3 months no matter how I was doing and it was just a pill review. Add more, leave it the same, that was all. Maybe for some people a pill review is all they need with a pdoc but I have major issues trusting them so in order to do what they say I need to do I need a better relationship than that. I also see my GP to review how I am doing I trust her and I feel the more people I have that I trust the more likely I am to be able to keep myself safe.

I seen her a couple weeks ago again and she said that during my stay there I confused them at first. She said that between my intelligence and ability to lie so well(especially when on the manic side) it was hard to get a really good picture of what was going on. Some of them were leaning towards the borderline thing at first apparently but after a while they were able to rule that out because of the way I related to people there. Only after almost constant monitoring, looking at my history, reactions to medications and a lot of discussion did they decide on the diagnosis of bipolar 1.

This was a team of people doing psychiatry assesments in emergency and medical ward for a week and then psych nurses, a pdoc and resident pdoc working under her. All of that and it sure as hell took all of them a lot longer than 15min to decide.

With the history you have given I have no clue how anyone could feel that was enough time to decide what they believe is going on and what to do to help you.

I hope I'm not coming across as a cynic for what I believe is the reason for their indifference. The assessment printout contains keywords - in that same order:
- patient works
- immigrated to Canada
- is not suicidal

And I think the logic is here that I will therefore continue to pay taxes, unless perhaps I got help. Never change a running system. Also, immigration forms have questions for mental health, so probably they assume I was lying.

Thats sh**ty and you dont sound cynical. The system and people can be horrible. I hope you can get a second opinion because there are some good docs out there. It took me being lifeflighted to a bigger city for me to finally get a good pdoc and she only took me on because I was completely hopeless and told them to just send me home if they were gonna send me back to the hospital closer to home where my previous pdoc was. They were supposed to transfer me back there to open up the bed but kept me on the basis that the transfer would be detrimental to my health. Its all pretty sad, had to get beyond bad before I got proper help.

Also just read through again. I have never heard of mood stabilizers being abused. More likely for an antidepressant and even that is pretty much unheard of. Also from my understanding there is less likelihood of adverse reactions regarding mood from stabilizers than antidepressants. Please keep in mind I am not an expert though and this paragraph is just my understanding of that.

First consultation 1hr. All others in the past 4+years have been 30mins every 1-4 weeks depending on how well I am.

So my family doc no longer wants to see me because I'm such an unpleasant patient. Well yea, I'm an aspie and asked for help with a mood disorder. Feels a bit like being pushed out in a wheelchair because the doctor doesn't like wheelchairs. Aside, she already looked grumpy and miserable before we had our argument last time, wouldn't have been all my fault.

Clear case of good riddance.

Sorry to hear that your family dr is an @ss. Sounds like you dodged a bullet though.

I don’t know what you said or she said, but if she let her own grumpiness get in the way, then that’s 100% her fault. No doctor is required to have bedside manners, but they’re also not supposed to let their emotions take charge of their decisions, either.

If I were a doctor and I genuinely had an “unpleasant patient,” I wouldn’t say it to their face. I would try to figure out *why* they’re so “unpleasant,” because people simply aren’t “unpleasant” for no reason. Maybe the person has something going on medically or emotionally or both. It is pure ignorance to call someone unpleasant. She should have said “sorry, but I don’t think I’m the right doctor for you,” referred you to someone else, and moved on

If I recall correctly, she first complained about my attitude and how just reading my name on her appointment list makes her feel. Then I don't know if she first said she couldn't be my family doc "for much longer" and then that I was unpleasant, or vice versa.

I asked her for an example of my attitude during our presumably last meeting and she had to think for some time. I was told by an orthopedic surgeon during an examination for an insurance claim that I should ask my family doc for an X-Ray referral for a possibly still not healed hand bone. She snapped at me why I hadn't asked the surgeon. I said because that wasn't her job. Then we discussed which hospital and I said something along the lines of me not being in a position to just go there by myself and say: "Hey, I need an X-Ray."

From the doctors I've seen at the clinic, she looks the most miserable.