When your patient comes to you and asks a genuine question about her medications, the correct response is not “you have ADHD or you don’t”. That’s actually incredibly insulting.
And suggesting that she get testing done for ADHD, after she talked to you, in depth, over a year ago, asking about filling her scripts because her nurse practitioner was leaving, and the therapy she’d been using for over a year for managing an incredibly late ADHD diagnosis and other things was coming to an end, well that’s just a slap in the face.
1. That medication I’m asking about, it’s a fast acting medication with an incredibly short half life. It doesn’t build up in my system over time and change my brain chemistry in such a way that I need to be weaned off of it if I need to discontinue it. When I ask about using it as a PRN because I’ve put a lot of work into managing issues without medications and continue that work every day, but sometimes it’s really helpful to be able to not space out during long meetings or losing whole minutes of time while I’m driving to Minnesota, I’m looking for a helpful answer. Not an accusation that makes me feel like a drug-seeking hypochondriac.
2. There’s no magical test for ADHD. I spent a year in therapy with someone who specializes in ADHD. I had to get records from elementary school to see my teacher comments about my classroom behavior. I read books and talked about them with both the therapist and the nurse practitioner and how I related to them. I had to have a fucking meltdown at work to even consider seeking treatment in the first place. It was long and time-consuming and expensive. It’s insulting to me, my therapist, and the nurse practitioner who used her own professional judgement when prescribing the medication in the first place to suggest that, maybe you don’t actually have this thing you’re getting treated for.
3. Also, I know you were available and weren’t with a patient that time I came to urgent care and I had to see some stranger because you didn’t want to come out of your office. I ended up having shingles. So, thanks for caring. I used to like you. A lot. I liked that you went to the office early the day after I came in with a 104F fever and personally called me to let me know that you couldn’t wait until office hours to look at my x-rays and see that I had pneumonia. I liked that you joked around and used to make it a positive thing that I had ideas about how to manage my health care. I liked that you respected me and my nursing background. I don’t know what happened or what’s going on in your life that made you lose that doctor-patient connection I liked so much, but I hope you figure that shit out.