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Thursday, April 24, 2014
Patient Discomfort with Personal Care Physician
I`m a more or less healthy 53 year old guy, who just recently established regular health care visits with a (PCP) Personal Care Physician (previously, if I needed a doctor, I went to the ER if something was really bad, but had no regular health care). My PCP is a great doctor, but I was uncomfortable telling her that up until a year ago, I took ritalin, initially for ADHD, then I saw a neuro doc and the working diagnosis was "excessive daytime sleepiness" (had a sleep study, conformed this, but not as bad as in narcolepsy), but that was the diagnosis. I didn`t care, on ritalin, I went being an impulsive, scatterbrained idiot who could not finish anything to suddenly being a fairly good student, college grad, good marriage, etc. And I did have severe daytime sleepiness; but that was recently cured by CPAP and dramatic weight loss. So the sleep problem is gone, and I stopped the ritalin a year ago; no daytime sleep problems, but the ADD is back and making my life a trainwreck, just like before the drug. I`m uncomfortable telling my PCP about my ADD and need for medication.....my insurance lets me self-refer so I can see a psychiatrist on my own.......I don`t want to lie to my PCP, but I`m uncomfortable discussing my need for "kiddie speed"...I`m not a drug abuser.......am I nuts, and how wrong would it be just to see another doctor on the side? thanks
Thank you for your question.
The broader question is why you would feel uncomfortable disclosing this information to your PCP. Given your identification of her as a "great doctor," I am assuming that you two have a good working relationship. All physicians understand that patients can commonly feel embarrassed. However, it becomes more of a concern when the would-be embarrassment prevents patients from informing their physicians the full range of their issues.
My preference is for patients with possible Attention Deficit Disorder to undergo neuropsychological testing to establish a baseline from which any issues regarding treatment would follow.
Strictly speaking, you could refer yourself to a psychiatrist and ask for the appointment to be confidential. Nevertheless, conscientious outpatient psychiatrists would want to gather more information from a PCP. Moreover, such psychiatrists would want the PCP to know that the patient is taking such medications, given the medical implications and need for appropriate medical monitoring.
Best of luck.
Ram Chandran Kalyanam, MD
Clinical Assistant Professor of Psychiatry
College of Medicine
The Ohio State University