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Are we the ones who are crazy?


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Ernie's right: "What matters is that we have symptoms that they have not heard about in med school thus we must be making it up for some emotional reason."

I think that some doctors are functioning as if they were short-order cooks. If you have something that is not on their limited menu, they assume that you are crazy.

When I went to Mayo, one of the doctors there suggested that I might have a histrionic personality disorder, that I was just going to doctors to fulfill a pathological need for attention. I thought this was extremely illogical, because I had dropped out of all of my social and civic activities because I was sick. What kind of physically healthy person with histrionic personality disorder would do that? Just to be able to go to a doctor's appointment once every few months? Ludicrous. When I told my sister about the personality disorder diagnosis, she laughed herself silly. She told me she really liked the idea that I had a personality disorder, but that's not the one she would have picked for me. "You're the least histrionic person I know. You don't want attention. You mainly want to be left alone to read your book." Another friend of mine also thought that the suggestion of histrionic personality disorder was the stupidest thing he had ever heard. He had tried unsuccessfully to get me to audition for a role in his community theater production of HMS Pinafore. He knew that I had the voice for it. The problem was that I was too sick to sing, and too sick to stand up for long, and way too sick to sing and stand up simultaneously. Much less dance. He eventually persuaded me to fill in occasionally for the rehearsal piano player for their next production, the Mikado. That I could do sitting down, and without any Valsalva maneuver. Plus, I didn't have the pressure of being able to function in the real performances. Even so, I couldn't do two rehearsals in a row without collapsing with a debilitating migraine. This does not sound like the behavior of a physically healthy person with histrionic personality disorder. In fact, it pretty much rules it out. Both my sister and my friend (and my husband) thought that I would never have been given such a ridiculous misdiagnosis if I were male, unless perhaps I were a gay male.

My theory is that giving me a ludicrous misdiagnosis of personality disorder was an example of projection, an annoying behavior commonly exhibited by people who have genuine, DSM-IV personality disorders. They accuse you of having a defect that they actually have but you don't.

Have any of you ever encountered a physician who exhibits the following: a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. An exaggerated sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

2. Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love

3. Believes he is "special" and can only be understood by, or should associate with, other special or high-status people (or institutions)

4. Requires excessive admiration

5. Has a sense of entitlement

6. Selfishly takes advantage of others to achieve his own ends

7. Lacks empathy

8. Is often envious of others or believes that others are envious of him

9. Shows arrogant, haughty, patronizing, or contemptuous behaviors or attitudes

For example, someone with traits 1 and 2 might assume that you must be crazy if you think you are sick and he can't instantly see that you are sick. The fact that he lacks empathy (trait 7) means that he won't be able to perceive your suffering and therefore won't bother to go out of his way to seek a less than obvious diagnosis. He might fantasize that you are seeking medical care from him just to bask in his radiance. If you try to reason with this individual, you run smack into a brick wall constructed of traits 1, 4, 7, and 9. Don't waste your breath. And don't pay his bill, either. You did not receive the services you went in for.

That list is not my creation. It is the definition of narcissistic personality disorder from the American Psychiatric Association's Diagnostic and Statistical Manual, Fourth Edition (DSM-IV). I think that most of us have met men and women like this. However, most normal people are too charitable to believe, at first, that grownup people can really be this childish. They can be, and if you don't recognize it in time, you can be in for serious trouble. My preferred style of interacting with other people is to reason with them as if they were adults. This approach doesn't work with a narcissist. They are always right, by definition, and you are far too insignificant for anything you say to be of any importance. They are not conversing with you, they are granting you an audience. Perhaps they may let you kiss their ring.

I enjoy the company of genuinely brilliant people, but I really dislike dealing with people who are considerably less brilliant than they imagine themselves to be. I shun them socially, not that it makes any difference to them. Nothing I could possibly do would make the slightest difference to them anyway. The difficulty is when you have one of them for a boss or a doctor. The only solution is to change jobs or change doctors. A better solution is to avoid having one as a doctor or boss to begin with. I want a doctor who genuinely cares about his or her patients, who readily admits the limits of what he or she knows, and who isn't afraid to learn something from me.

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Doctors are not god-believe me.

They are generally overworked and go on auto pilot. When it comes to dysautonomias it is so much easier to dismiss patients as 'crazy' so they do not feel 'lazy'. Even mayo clinic, they misdiagnosed gout for a friend of ours!!!!

Complicated conditions take a lot of time and energy!!!!!!

My husband was sent to so many shrinks and given anti-depressants that made him feel worse.

Insurance companies support this behavior by not reimbursing doctors for taking the time to do the correct diagnoses on conditions.

check out the good web sites, vanderbilt university has lots of info, keep at it, eventually some things will work and make sense.

good luck and take care

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I really appreciated your post for the humor you were able to see in your situation despite the serious nature of what you were trying to get across. I just wanted to comment on that- love the list of the 9 traits to look out for :) True for most docs I've ever seen!!!!

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Guest Julia59

WELL SAID----I MUST SAY, VERY WELL SAID!

You should read my post about an experience with a local neurologist I had.

Here is the link to the posting.

http://dinet.ipbhost.com/index.php?act=ST&...st=0#entry25118

The good thing is that I stood up to him----and I wrote a letter to the president of The Medical University of Ohio----this is the hospital he works for.

The letter was a bit long winded, but I got my point across.

This man fits the profile of a narcissist exactly.

Thanks for the post---I found it to be so accurate.

Julie :0)

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WELL DONE !! this is a wonderful post echoing experiences we all share in common. Well written , amusing (to us) and frightenly accurate. You soon realise as a Patient that you HIRE them to facilitate a service for you - your treatment . That being said ; like no other "service" industry your characterisation properly implies that we expect a level of expertise commesurate with the Docs education, facility , credentials and of course FEES. We don't expect to be denied co-operative treatment ; with this I suggest that even thru the stress of diagnosis a Doctor should do there utmost with the Patient to achieve an outcome - not pass the buck as it were. The ease at which mental health issues / physciatric evaluations are bantied about for Dysautomia Patients typifies the lack of understanding in the Medical community not a disconnect. Unfortunately , they want to leave it in our hands. They require us to do the work. To bring them the Evidence as it were. The frustrations ,anger and sometimes fear are valid; It prevented Me from going to the Mayo until my family could stand it no longer. Fortunately , I've had an inspiring GP and Doc at the MAYO both of whom make all the other ones , and believe me I've encountered my share, SUPERPHLOUS . Its my opinion that the regimens are all basically the same. the appt end with the same pats on the back. Test results vary with little imperical difference. Yet, WE know symptoms can and do fluctuate beyond the pale of normalcy. Its encumbent upon us , at this time , to do all we can to YANK this profession into treating this DISEASE. Until then the most powerful treatment is getting up in the 'morrow and finding what works for you , then journaling tellin' the Docs and so on . There is no doubt that stress manifest itself in Dysautonomias , DUH !! It affects the autonomic nervous system but to assume that we are all nuts first is to discredit a REAL oppurtunity for science and research. First thing Isaid to them at the Mayo was that I was nuts and for the benfit of my wallet lets stick to Imperical testing first. Again Ithomas great post Point well taken and presentd ; probably what brought alot of us here.

MOVIN CROSS CANADA TODAY Kite 7

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Very amusing--thanks for sharing. Immediately made me think of one doctor in particular who attempted to diagnose me--with post partum depression. He was insistent that this was what was wrong with me, said he could spot depression in a patient without fail, and severely chided me for not accepting it and instead doing further research into rare conditions. To top it off, he brushed off my concern that the medication he wanted to prescribe me could not be taken while breastfeeding. He said -- "I was never breastfed," as if to say "and look at me, I turned out great."

He was the best argument FOR breastfeeding ever presented to me. :P

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I am so sorry you had to go through this, but thank you for sharing! I laughed out loud, and I really needed that! See, if there isn't an obvious diagnosis, the docs will always go for a mental one, as they need to have a dx code on a claim form in order to get paid for the service. They don't have a dx code for "the doctor just doesn't know" so they pick one in the mental health category because that is subjective, and then they get paid. Unfortunate, but true.

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i have had many good docs lately....not necessarily having answers, but open & willing...

that said, this definitely fits the bill for some...one in particular...that i have seen over the years...

it's perhaps one of those "have to laugh to keep from crying" scenarios?

:-)melissa

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Ha, ha, that was soo funny, but unfortunately true!

I heard a doctor in the hospital (talking about me) ask if another doctor had ever seen anyone with munchausens (you know the one where you make yourself sick for attention) because that was obviously what i had! they're just jealous cos i'm special!! :D

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See, if there isn't an obvious diagnosis, the docs will always go for a mental one, as they need to have a dx code on a claim form in order to get paid for the service. They don't have a dx code for "the doctor just doesn't know" so they pick one in the mental health category because that is subjective, and then they get paid. Unfortunate, but true.

I checked with two acquaintances who have practiced medicine in the United States: a gynecologist and a psychiatrist (neither of whom has ever been my doctor). To my horror, they both confirmed what you wrote. The psychiatrist said that most nonpsychiatrist physicians think that psychiatry is "easy," so they blithely make psychiatric diagnoses even if they have had no particular training in psychiatry (and sometimes even if they lack rudimentary interpersonal skills, in my experience). When I asked the psychiatrist about the prevalence of narcissistic personality disorder among physicians, he laughed and said that it probably approaches 100% in some of the academic centers. I hope he was kidding.

We have to come up with a list of suitable ICD-9 codes for POTS and other dysautonomias, so that the doctors can fill out their forms honestly.

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here's an earlier discussion that has many applicable codes listed:

http://dinet.ipbhost.com/index.php?showtopic=2386&hl=codes

it's also possible to get a book wherein all ICD codes are listed at the library, and once i found a listing online (but can't find the link on my computer now...if i do i'll post it)

:-)melissa

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Please refer to the new thread I started on ICD codes for information--there are free online libraries of all the codes, but I compiled a list of useful items.

Nina

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hi

was thinking about this post today as i made my appointment for an emg/rns---very painful. Now here I was questioning my sanity, as I payed the copay for the privilege of being repeatedly shocked and jolted for about an hour to see how the nerves and muscles are functiong. I think that if I was so totally into myself, this is about the last thing I'd do!

Ariella

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