It’s time to stop prejudging your patients


Recently I had an interaction online with a physician regarding his thoughts on ADHD treatment. (Let’s call him Dr. Stigma). This post is not about doctor-bashing but more to point out the prevalence of stigma against those with a psychiatric diagnosis even from within the medical community. Stigma, unfortunately, is so indoctrinated into our culture that sometimes people don’t recognize the pure ugliness of their words.

Dr. Stigma’s comments:

Many patients use Ritalin and other stimulants to:

  1. lose weight
  2. “study” for college exams (“cramming”)
  3. to go out and party (dance raves)

So, before you use Ritalin, get all medical records in place (“Gather all your facts before you make a decision,” as my mother used to say) including teacher, psychological and parent assessments, etc.; otherwise, you are doing a grave disservice to your patients. Do not listen to the suburban “rich parents” who want stimulants for their pre-adolescent children to make them better ballet dancers. Once you gather your facts, note all consults, and the evidence points toward ADHD, then you give the stimulant. You don’t give it just to pay your bills. You still have to sleep at night, and the priest won’t like it if he hears about it.

Let’s translate Dr. Stigma’s “medical advice” into facts he would recommend we use to diagnose ADHD:

  • Assume patients with possible ADHD symptoms are lying. They are guilty until proven innocent.
  • Assume patients with possible ADHD symptoms are drug addicts, lazy (which is why they need to cram their studies last minute) and love to party all night — especially if it’s a rave! (Seriously, are they still called raves?)
  • When parents bring their child in for an ADHD evaluation first ask if their child takes ballet. Does the parent want them to get a college scholarship for dance? If so, that is proof the parent is lying and the child does not have ADHD.
  • Ask income questions on intake forms for anyone complaining of ADHD symptoms. This way you can find out if they are rich. If they are, you know they are lying.
  • Any physician who chooses to not to criminalize their potential ADHD patients is just trying to pay their bills. These doctors are likely criminals themselves.
  • Any physician who chooses to treat their ADHD patients with respect will not sleep at night until being absolved by a priest.

Physician burnout?

I get it — some of us have been burned by patients lying to us and abusing our medicine and our trust. Physicians are humans, and patient deceit can scar us; especially when we are honestly trying to be the best doctors we can be. When this happens, physicians who don’t take care of themselves may unfairly judge an entire population of people. If we don’t take care of ourselves, we can get burned out and turn into bitter doctors who don’t have the energy to effectively deal with anyone’s needs.

It is also a fact that some people do abuse stimulant medications. It is a rampant problem on college campuses! I agree with Dr. Stigma that a thorough diagnostic assessment is essential. We don’t do anyone a favor when we inappropriately prescribe medication. But we also don’t do anyone a favor when we approach any diagnosis and its treatment with an air of skepticism, distrust and a patronizing sneer. The majority of patients taking ADHD medications are using it because they have a neurodevelopmental disorder that can be incredibly impairing. Stimulant medicines are the most effective treatments we have to treat the symptoms of ADHD.
Here are my recommendations to doctors:

We can’t all be good at seeing every type of patient. If you have a prejudice against a particular diagnosis, please do us all a favor and:

  • Pay attention to how you feel. Admit it to yourself.
  • Get help for it! Get medical education and support, so you are more comfortable and confident in your ability to appropriately treat these particular patients with respect.
  • If you are unable to let your prejudice go, don’t act like an expert in treating a diagnosis (see Dr. Stigma’s diatribe for an example of what not to do). If you feel the majority of patients coming to be assessed for a particular diagnosis are faking it, this should be a sign that you yourself need help. Kindly refer this patient to another provider.

I know stigma exists, but it especially saddens me when it is coming from within the medical community. On behalf of all physicians, I apologize to the patients out there who have experienced this type of stigma. I know this doctor’s comments only represent the tip of the iceberg for a society that has an ingrained prejudice about psychiatric illness. We, as medical providers who specifically take an oath to do no harm, can do better than this.

Melissa Welby is a psychiatrist and can be reached at her self-titled site, Melissa Welby, MD.

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