Discussing ADHD w/ primary care physician
I have my annual physical with my primary care physician (PCP) in a few weeks and want to discuss adult ADHD/medication with her.
The first problem is, due to the way my HMO is set up, I can't see anyone besides my PCP without a referral. My PCP is of the school of "excess medication is bad" -- which I agree with -- but ADHD has effected all aspects my life (and future) so deeply that, honestly, I don't see any alternative.
Basically, I (and my parents) have known I've had ADHD almost my entire life. I remember in elementary school, I was constantly in trouble (but not 'bad' trouble, 'worrisome' trouble). I was in the gifted program, but always did poorly on tests. I almost got held back in the 1st grade because, on the standardized state assesment, I decided it would be more fun to make a "picture" out of the scantron bubbles rather than do the test. I always had problems with finishing tests early and being distracted -- again, this was always brought up (probably only the third grader who knew the term 'underachiever') in parent-teacher conferences, but never became something that the school made my parents deal with because I never disrupted the class.
The pattern continued into middle and high school -- homework was like going through hell. I would do my homework then misplace it or lose it in between home and handing it in. I was (and still am) atrociously messy. In middle/high school, I was constantly losing things -- house keys, lunch boxes, bus tokens, etc. In middle school, I took the requisite assessment to be put in the 'accelerated' math class -- when you skipped a year. I didn't find out until late high school, but somehow I made the highest score in my grade on that exam. I continued to struggle with homework and tests, although I flourished in my science lab classes -- inspiring me to go to college as a pre-med student. I took the SAT and scored extremely well (1550, back in the day when it was out of 1600) and am currently a junior at a top-10 university.
I thought in college I'd learn how to "manage" and all of the problems I had before arose from laziness and poor study habits (this is what my parents think is wrong with me). Freshman year, I tried the hardest I ever had. To make myself concentrate, I would manually copy my textbooks, word for word, diagram for diagram. I'd allow myself twice as much time as I knew a problem set "should" take me, because I knew I'd get distracted and off track after 10 minutes. My first semester, I struggled, but I made it through. My second semester, I almost failed a class -- not because I didn't do the work, but because I misplaced the requirements sheet for the final project. Too embarrassed to ask anyone else in the class or the professor for another sheet (because that would reflect my inattentiveness and irresponsibility), I decided it would be a better idea to make up the criteria. I ended up failing the final project and barely pulling a D+ in the class.
Sophmore year was even more difficult. I took challenging classes that I truly enjoyed, but I still struggled -- again, not with concepts, but with execution. I developed a special rapport with my multivariable calc professor -- I'd do the homework set, then go over the incorrect solutions with him. I'd spend about 15 hours on a problem set that was designed to take 10 hours -- at this point, I was still copying my textbooks by hand to facilitate studying. After working with him for a few weeks, Prof. Thornton suggest I get tested for ADHD -- my math work was almost always theoretically sounds, but I'd make extensive simple errors -- like read the question wrong or copy something incorrectly, that would result in getting almost every single question wrong. Towards the end of sophomore year, the "copying the textbook" technique started to falter. I'd lock myself in the basement of the library, with no cell phone reception, no internet, no windows, just me in a cubicle with my ipod and the work I needed to get done, and I'd be able to get in 15 solid minutes of work, then I'd be totally "off in left field" -- doodling, looking up some totally unrelated proof, getting a cup of coffee even though I still had a whole one left. Normally I'd attribute these things to be unmotivated and undisciplined, but it would be like I absolutely HAD to do these things. I'd bargain with myself, I'd punish myself, I tried making checklists and everything, but nothing worked.
I ended up dropping out of the pre-med program (but not my primary major, engineering) and giving up the dream I've been chasing my entire life at the end of my sophomore year. I have one class (the easiest class) left, but I'm afraid of finishing and going to medical school -- I'm afraid my inattention and impulsivity will effect my patients in a negative way. Another reflection of impulsivity -- my friend and I joke that I've been majoring in almost every engineering discipline at some point in time (almost true) and that I've made more drastic life decisions than anyone else.
I ended up taking a very different path -- in the beginning of my junior year I (impulsively, again) decided to participate in the co-operational education program. I'm taking next semester off and working full-time as a chemical engineer and applying to an accelerated (3-2) MBA program through my university at the same time.
I'm finally seeking treatment/diagnosis because, when I take stock, ADHD has deeply effected almost every aspect of my life. I'm awful with finances (my credit score sucks, I had multiple accounts sent to collection and bailed myself out from a windfall when my grandmother died). I have given up the one thing (becoming a doctor) that I've worked for since as long as I can remember. I'm scared to all heck about the future -- I'm like a time bomb -- it's a matter of counting down until I make an inattentive or impulsive move at my job that will eliminate that as an option for me. I've reached the breaking point -- this disease has controlled my life for the last 20 years, and I'm scared of what will happen to me and where I'll end up if I let it control the next 20 years. I've tried almost every coaching tactic in the book and some of them have made a huge difference -- but it's still not enough. I've become very good at hiding my disorder -- even my close friends and family don't know how much this illness has made me give up. Don't get me wrong, I realize that on paper, I've very successful, but it's the underachiever thing coming back -- I *know* that I'm not 'living up to my potential'. I know that I could be so much more accomplished than I am, but ADHD is holding me back. I'm sick of this disorder making life decisions for me.
Now, the part where my HMO/University make it tough. My university will not administer psychological treatment for anything besides mental illnesses like depression, eating disorders, general counseling. I was told I had to go out-of-clinic to even get tested/diagnosed for ADHD, despite the mounting symptoms. My HMO will not cover psychiatric treatment in any form unless the psychiatric illness is "acute" and "has the potential to cause patient harm" -- basically, again, illnesses like depression, alcoholism and bipolar disorder are covered, but since ADHD will not lead to patient harm (suicide, cutting, etc), it's not covered. I don't know how to ask my PCP for ADHD medication without looking like a medication seeker (as in seeking medication to abuse, not for treatment) and I'm frightened as to what will happen to me if I don't get help. I can't afford to pay for psych treatment out of pocket.
If anyone's been in a similar situation or has any advice, I'd love some feedback. Right now, I'm figuring I'll go in and just point blank tell my PCP my 'story' and explain why getting a referral is useless and hope for the best.
You and your parents may have known since you were young that you have ADHD, but if it's never been diagnosed by a professional, that's the place your PCP will be starting from. So, hold off on talking meds, and try not to "sound like the doctor" (i.e. telling the doctor what's wrong with you). Talk instead about yourself and all the things that are getting in the way of your performance in daily activities, specific examples of forgetfullness, disorganization, etc... Take a listing from the World Health Org. on ADHD traits and add your own examples of your personal traits associated under each category. Then have your parents or close friend do the same--offer their observations on traits you have--and give this all to your PCP. Your PCP will either refer you to a specialist or endeavor to do the diagnosis themselves. If you would rather be referred to a specialist, say so!! Be your own advocate, and be forceful. You sound like you've already given up!! Don't!! Your insurance company may not be a strict as you believe it to be--press on and seek the relief you need in order to function effectively. Good luck and let us know how it goes.
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