Family practitioner or internist for diagnosis?

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Straight up, psychologists and psychiatrists tend to be dogmatists, tend to be "be righters" (once they have spoken and made a diagnosis, god help you) We have had enough negative stories here that we can take a deep breath and begin thinking of alternatives.

For example, depression. That is widely enough known, that a good family practitioner or internist with some snap can be helpful. Esp since the whole game with depression is to keep trying combos of medication, maybe change in diet, maybe short-term here-and-now counseling (which the doctor could send you to a PhD or an MA). That is, as I unnderstand it, the body's biochemistry is a tricky thing, and an antidepressent which might work great for one person, might hardly work at all for another. And four weeks is about enough time to tell. So, basically you want a doctor with the patience to keep tinkering, not some guy or gal so proud of their 'brilliancy.'

Now, Asperger's is not as widely known about as depression, but there have been movies, books, etc. So, I don't know. I'm asking as a real question. Could a family practitioner or internist potentially be helpful?

(and Asperger's advocacy primarily as self-advocacy in the model of the Civil Rights Movement, with professionals helping in a supporting role. But that is a topic for another post )

internist and genreal practicioner likely wont have the knowledge to say something along the lines of a diagnosis. Id say visit more than one psych and get an average.

Okay, we recently had a post "Self-diagnosis was not confirmed by psychologist" http://www.wrongplanet.net/postt151283.html in which the so-called psychologist took the position that a person cannot be Aspie if he or she has had even one relationship. (!) (!) Wow. I mean, that is way out there.

And so the usual response of getting a specialist, yes, it may work. You may get someone who is knowledgeable, who's a pretty good listener, and who's somewhat humble about how much he or she doesn't know. Or, you may get someone who's even more of an egoist and who has even more invested in "being right."

So at least three potential approaches:

1) Find another psychologist or psychiatrist, yes, take your time, a series of medium steps, and trust your gut on whether or not this individual is a reasonable person.

2) Take an average like MXH suggests. Just throw out the clearly ridiculous opinions like the above, and go with the opinions which have at least have some chance of being right.

3) And thirdly, if a ‘regular’ doctor (family practitioner) has read even two journal articles on Asperger’s syndrome, has some horse sense, has some general understanding of the range of human differences, and importantly, has long-standing habits of respecting people and respecting these same human differences, he or she might well be an excellent resource. For afterall, respect and broad knowledge are substantial positives. And so, if your ‘regular’ doctor is a generally reasonable individual, and if you feel you can halfway talk with him or her (even good doctors are often rushed!), you might want to consider it. Again, trust your gut (that is, right-brain sense of feel-and-texture). This ‘regular’ doctor might feel comfortable making a diagnosis, or he or she might not. But it might well be worth light-touching the situation and asking. That is, if you want a more formal diagnosis. For me personally, I am self-diagnosed and in some ways, I'm more aspie, in other ways, less aspie, and for the time being, I'm comfortable with that situation. At a later occasion, I may want to pursue something more formal. Both can be valid.

On a pure numbers basis of developing expertise, we might assume that general practitioners have between 3,000 and 6,000 current patients and an annual turnover of 2%. If the rate of autistic spectrum disorder is 1% of the population, then a general practitioner will have between 30 and 60 patients (of all ages) with ASD and encounter between 6 and 12 new cases every decade - which is a minute fraction of their diagnostic encounters. If we just consider school-age patients, then a general practitioner will see just one or two new cases every decade.

My personal experience was that when my psychiatrist sent the diagnosis to the GP, the GP said "Oh yes, that makes an awful lot of sense", but had never actively considered the diagnosis despite issues that were, in retrospect, bright red flags. I do not think GPs have the time or the training, and I do not think that ASDs should be a priority in primary care.

I do think that psychiatrists are often very poor at recognizing ASDs, and many people with an ASD have a history of unpleasant and ineffective psychiatric treatment (for depression, anxiety, psychosis, self-harm, etc) before the ASD is recognized.

And that's the rub. At what point do we decide that the profession of psychiatry is so lousy that we're better off doing things on own?

StuartN,

You gave me a very thoughtful reply and I do appreciate it.

Okay, one thing, the numbers are actually better than I thought they would be. So, the average family practitioner might see more cases of Asperger's than he or she sees of tuberculosis?---at least in many parts of the developed world.

Okay, the part about "psychologists" and so forth not only not being helpful, but at times being a positive hinderance, or at best a distraction http://www.wrongplanet.net/postt151283.html
This is something I've talked about at times. And on this recent post, several different people talk about their experiences.

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Let's suppose a person wishes to get a diagnosis in order to receive the services and supports from a University disABILITY Center (even though Asperger's is a difference, not a disability). Okay, so be it, you play the game. But isn't is advantageous that a diagnosis from a 'regular' doctor in a sense provides a "soft" diagnosis? If you later wish to be un-diagnosed for some reason, you could shop for a psychiatrist and get a diagnosis of not on the autism spectrum. Please don't overdepend on this, if you need security clearance, a form might ask, have you ever been diagnosed . . . I wish institutions would just accept people for being who they are, but institutions have a very hard time doing this. (I think you should be able to identify as Aspie on not according to your own choice. Afterall, people do go through various seasons of their life. And I think there should be more good jobs for everyone. And I tend to think things should be multi-path and not single-path; on a later occasion I'll be happy to explain what I mean by this.)

Tuberculosis was about 12 per 100,000 per year here, so a GP might see a case a year (actually some GPs see more cases in city districts).



I recently posted a link A National Report on the Needs of Adults with Asperger Syndrome http://www.aspectaction.org.uk/ in particular page 15, Section 15 - Mental Health (with the detailed responses starting on page 291).

Section 15 - Mental Health
Key findings:
* 68% of individuals have had contact with Mental Health services
* Of those only 12% found it a positive experience
* Of those who have had contact with Mental Health services 10% did so as a result of attempted suicide or following suicidal thoughts, 38% for depression, and 12% for anxiety
* There is still clearly a lack of understanding of AS in MH services as a whole

Which is a harsh reality for all the undiagnosed adults, the majority of whom will have some form of mental health service contact. The detailed responses (page 291) are the full written answers of every participant in the survey. It is clear that many were not recognized as having Asperger's, and that recognition would have resulted in completely different treatment for many.

That is a different question from the one that you first posed. I don't think that expecting GPs or internists to diagnose ASD is a practical solution. It's hard to diagnose ASD in many cases, and giving them the appropriate training is a challenge.

For your new question, I think that the time is now. We can use professionals as a resource, and they are very helpful, but ultimately, we have to handle things ourselves.

If you are looking for a diagnosis for the sake of getting appropriate medical/psychological treatment, accommodations through school or work, etc. a pcp, internist or regular psychologist won't be able to do that for you. You will need to see a neuropsychologist (according to my new therapist).

I'm going through quite an ordeal right now. Here is an excerpt from my blog today explaining the ordeal I went through earlier:

"I called the diagnostic testing center and they said BC/BS would likely cover it if my primary care physician wrote a referral saying I need it for proper therapeutic treatment and adjunctive medication management. Called my pcp. They said BC/BS doesn't require a referral. Called the insurance. The made me endure an over the phone evaluation to see if a diagnostic test was necessary. Passed that so I am now preauthorized for treatment. Called the testing facility back. They informed me that it is not a 'referral' I need but a 'prescription', faxed in by my pcp, for billing purposes. Then why in the world did she originally refer to it as a referral? So I called my pcp and he/she/whomever responds is going to fax that. Hmph!"

According to my new therapist it is nearly impossible to get a neuropsychological evaluation covered by insurance. And cost can run upward to 2,000. But you, of course, can shop around.

Now, the polite way to do this is to tell you ahead of time, 'Now, I'm going to need to ask you about 12 to 15 questions as part of our preauthorization process. Is that alright? [pause] Okay, now the first question is . . . ' And they may or may not have done this. If they did this even a little bit, they are ahead of the curve.

And the whole thing, wow, this is disenfranchising people or rationing health care or whatever by means of bureaucratic hurdles. I mean, just incredible.

And the hard part, once you "hike" all this distance so to speak and go through all these steps, you might get a so-called counsellor who's an egoist or a pontificator and mainly just interested in hearing himself or herself talk. Yeah, really. Or some other problem and you just pick up that this person is just not very good (and please trust your gut regarding this). In which case, you need to fold the hand as easily as a seasoned poker pro. And you have a right as a patient to see someone else.

Good luck! Please keep us informed as it feels right to you. Use us as a resource.

And my doctor said that when talking to your insurance by no means make mention of needing accommodations for work, school, etc. Insurance will only cover it as deemed necessary for appropriate medical/psychological care.

Wow, all that. It's actually kind of good that your doctor told you how to gracefully maneveur through the system. I guess the diagnosis for work, school, etc, can be viewed as a side benefit.

Isn't it likely that a contributing reason, even a major contributing reason, is that many therapists just aren't that good? For some of the reasons outlined above. They are so married to a particular theory, yes, they tend to be dogmatists and pontificators. Or, the therapist is used to being the smartest person in the room. Well, we people with Asperger's tend to be pretty smart, too, esp on our areas of keen interests, speaking personally I tend to have patchy skills very smart in some areas, or at least very intense, and perhaps some therapists feel challenged by this and feel the need to . . . whatever (put us in our place, reassert their authority, can't stand to be wrong view it as a contest. Excuse me, this is my life we are talking about.)

And then merely a phrase I heard years ago from a college student slightly older than myself and I kind of got the idea he got it from his Dad "the people who gravitate to the field" I think that explains a fair amount about the so-called helping professions. And it's kind of sad, because these are people who want to help others and in the process help themselves. Maybe it's that they're overly ambitious, try and do too much

I think they're all idiots! I haven't even told my psychiatrist I'm seeking a diagnosis because I know from a decade of being treated by mental health care workers that she will just dismiss it as hypochondria. So what's the point.

well i dont have experience with an internist, but i will tell you what my sons pediatrician and fp said.

the pediatrician at the clinic our family goes to, when we first suspected autism and were trying to find out how to get started getting our 4 yr old diagnosed: "What do you want from me?"

and his fp, which is his usual doctor at the clinic, the second time we told her he was autistic during a physical for school: "He talks, in what way is he autistic?"

so from our family's experience, i'd say, no, a fp probably wont be helpful

we did use a local psychologist (who obviously didnt have experience with asd) to get his initial diagnosis, which was incorrectly done as asperger's, but it got his foot in the door for services at school. i then took my time (took me another 5 months of off and on research) and found a neuropsych about 2 hours away, had to go through the fp's office to get an out of network referral for insurance, and the neuropsych did a more thorough diagnostic session with him, and gave him an official diagnosis of autistic disorder (classic autism). my SO has since had 3 sessions with the neuropsych totaling 7 hours, and we go back in 10 days for his diagnostic results visit.

from all the visits we've done, and all the calling it took to find someone, the neuropsych who has some experience with asd was the best out of all that we've seen. out of all the psychs ive called, well over a dozen, only the one did diagnostics, and she did it poorly. part of it is also support staff, as i set up another appt at the same psych office for my oldest son, and an hour into the intake session, the psych (different one) tells me he doesnt do diagnostics, he just wanted to set my son up for therapy sessions. had the same experience at another psych clinic, set up an appt for my SO, and half way through the psych says the same thing, he only does therapy. both times i requested an appt specifically for diagnostic testing for autism spectrum disorder. even when trying to get a referral for my son to the neuropsych, i had to repeat the word autism three times and spell out asperger's for the referral clerk from the fp's office.

as for getting the neuropsych covered, we had no issues with that. both my son and SO are covered by medicaid, and were able to get diagnostics covered as part of mental health services. as it was out of network, we did have to get referrals. the referral was easy to get since there were no in network neuropsychs in our area, but we were limited to 2 visits each. my son had only 1 visit, and my SO's 3 visits were billed as 1 visit as it was ongoing diagnostic testing.

I doubt if my internist would be any better. Even if he was more informed than your doctors, which is doubtful, there is no way that he could give a useful diagnosis in the five minutes I get per visit. Besides, the techniques that he uses to try to motivate me to take better care of myself show that his knowledge of basic psychology is seriously lacking.

This is all quite depressing. If I was capable of maneuvering through all of the hoops and hurdles, I wouldn't need a diagnosis.