10 Questions to Ask to find a GRRRRreat! ADD Doc
Friday, March 25, 2011 14 Comments
ADD* & Looking for a Doctor?
by Madelyn Griffith-Haynie, CTP, CMC, ACT, MCC, SCAC
Ten great questions to ask in the initial interview
Most of us are desperate for help by the time we look for it.
ADD affect combined with a shortage of time and money means we often approach the process as beggars at a banquet, accepting a crust of bread as eagerly as a balanced meal.
If you don’t want to have to “Return to GO” when you find out later that things aren’t working (leaving your $200 on the table with the first doctor!), take some time to think first about what you need, and to find out whether your needs will be met by the care provider you are considering.
SEE: ADD: What’s in a Name? for why I don’t use the “H” – even though you ADHD-ers are definitely included in the articles you will find here.
© Updated 2011, Madelyn Griffith-Haynie,CTP, CMC, MCC, SCAC-orig. on ADDCoach.com – 07/05/95
Keep an Open Mind
Don’t automatically exclude General Practitioners or therapists in your search for a qualified ADD doc, by the way. I’ve run into a few “ADD specialists” I would never recommend, as well as more than a few GPs and talk therapists whose ADD knowledge base was impressive. They often have referral relationships with some of the most knowledgeable and effective ADD specialists, and many have what it takes to make an accurate ADD diagnosis. Nurse Practitioners can be amazing, and in many states they can also write prescriptions – so include them in your search too.
Do some preliminary research
Remember that you can do preliminary screening by telephone for free. Ask the receptionist; you will rarely be able to speak directly with the doctor before you make an appointment.
- First, if you can’t afford the doctors fees, if your insurance covers visits of this type and this office doesn’t work with your provider, if you don’t have the time to reach the top of a long waiting list, etc. move on.
- Second, ask if the office works with a coach or patient advocate you can speak with before you book an appointment. Ask if the office can send you written material about working with this particular doctor, or if they have a website for patients where you can find out more. Maybe they run a lower-cost support group where you can get to know them first.
- Once you book an initial appointment, review the questions below to develop, in your own words, a list of the ones you need to ask. The detail here is for your benefit before you get to the office. A printout of this article will be way too long to be useful during your office visit.
What to Listen For
When asking the following questions it is important to remember this: you don’t care about the specifics of the answers as much as you care about the doctor’s level of comfort with providing information in response to direct questioning.
You are listening for an indication of a willingness to take the time to establish a relationship with you. You want someone who will take your questions seriously, who is ready, willing and able to provide complete and thoughtful answers — whether “live and in person” or through systems designed to allow the doctor to leverage time.
You want to find a doctor with broad-based knowledge from which to draw. You are looking for someone well-versed in current information in the ADD field, along with an above-average knowledge of a range of comorbid disorders that may turn out to be part of your puzzle or a set of “imposter symptoms” that are part of your particular flavor of ADD (like anxiety, depression, OCD, and a host of others). A good initial doctor needs to have enough experience to make an accurate diagnosis in a field where a lot of different problems look surprisingly similar at the behavioral level.
The best ADD Docs know that there are a lot of different presentations (the way that ADD shows up), and have learned that no two patients fit neatly into the same treatment box. The following questions will help you find one of these guys.
Speaking of Great ADD Docs:
Check out my article on Brain-based coaching on Dr. Charles Parker’s CorePsych blog
Coaching, out where the ADHD rubber meets the road of reality
On to those questions:
1. HOW LONG HAVE YOU BEEN WORKING WITH ADD?
- Most doctors who have been practicing for decades have a depth of knowledge you can’t expect to find in a doctor right out of school — but you might want to keep looking if their information base is also decades old or their treatment approach includes a rigid adherence to how ADD used to be treated.
- Some doctors fresh out of med school are up to the minute and have a great deal of information, if not a depth of experience just yet — and some know little more about ADD than was presented in their school’s curriculum (not even an entire day in most cases, by the way)
Regardless of the answer to this question, you are listening for confidence without arrogance, along with a comment or two designed to make you comfortable with the length of time, whatever it is. The rest of the questions below will help you find out more.
2. WHAT PERCENTAGE OF YOUR PRACTICE HAS ADD;
What areas of focus make up the rest of your practice??
What they’re used to seeing will tell you a lot about some of the “filters” through which they see the world. Those filters may provide some additional expertise in distinguishing ADD, but they also may increase the likelihood of a misdiagnosis.
- A doctor who deals with both clinical depression and ADD would probably be pretty good at distinguishing a depressed ADDer from a clinially depressed non-ADDer, for example.
- A doctor who sees a high number of BiPolar patients and few ADDers may collapse ADD affect with hypomania, or mistake ADD mood swings for rapid cycling.
3. HOW FAMILIAR ARE YOU with the minute-to-minute, season-to-season functioning of ADD?
Do you have ADD? Does someone you live with? A close friend or relative? What made you target ADD as a practice focus -or- why do you include ADDers in your general practice?
Those are the kinds of questions that will allow you to figure out how much they understand about ADD beyond what they read in the textbooks, which will give you additional information about how likely you are to get a good differential diagnosis from them. You also want to work with a doctor who understands and likes ADDers, right?
4. HOW MUCH KNOWLEDGE DO YOU HAVE ABOUT ADD IN ADULTS?
What is the percentage of adults to children in your practice? How long have you been working with adults? How many adults have you treated? What are some of the differences in the way you work with ADDults and children with ADD?
Its not unusual for highly knowledgeable ADD doctors who began their practices working with ADD children to have less experience with adults. If they’ve worked with a large number of children, that simply tells you that they have become known as being a great doctor for kids.
An answer like, “To tell the truth, most of my ADDers are children, but I’m eager to work with the adult population because I think I can help.” would be a doctor I’d recommend in a heartbeat.
5. HOW FAMILIAR ARE YOU WITH MY KIND OF ADD?
(i.e., hypo-active ADD, ADD/dyslexia, late-life ADD diagnoses, ADDers who are recovering alcoholics, etc.)
You are listening for an awareness that there are a lot of different ways that ADD can show up, more than specific familiarity with any one of them.
There is always a “first patient who…” for every doctor and it’s ok to be that first patient if the doctor is open to new presentations. The doctor to be wary of is the one who thinks in terms of always and never, full of “shoulds” or fixed ideas about ADD.
6. WHAT IS YOUR TREATMENT PHILOSOPHY?
What is your attitude toward medication, diet, nutrition, self-care, education, non-traditional approaches?
Beware of the doctor with a formula approach, but all good ADD doctors have some basic approaches they believe in. Above all, your doctor should be comfortable working with the kinds of treatments you believe in. Its ok if they are skeptical about a particular treatment or two, as long as it is mixed with the attitude that there are a lot of ways to make a difference with ADD — and that medication alone is not some magic bullet that will make a difference all by itself.
(Remember, even if we give a child “glasses” we still have to “teach her to read.”
The glasses just help her to focus so that she can learn!)
7. HOW WILLING ARE YOU TO PARTNER WITH ME IN MY CARE?
How accessible are you? What forms of patient feedback have you implemented? As I learn more about ADD and my ADD in particular, would you be willing to try new approaches with me?
There is very little “start with/stay with” in the ADD universe. Expect to have to do some tweaking.
You’re trying to weed out the doctor for whom adequate functioning is “good enough.” Optimal functioning is your birthright.
8. HOW DO YOU DETERMINE AN ADD DIAGNOSIS?
There is currently NO test for ADD.
- Right now, bona-fide ADDers score all over the map on the tests that are available, and
- there are far too many exceptions to consider the tests themselves diagnostic.
- Until we have a test where a high percentage of individuals with ADD fall within a unique statistical sampling (and a significant percentage of non-ADDers fall outside it), we don’t have a test for ADD.
All good ADD doctors use a patient history as a large part of their diagnostic procedure, sometimes (but not always!) with reporting from teachers, parents and significant others as well. Understanding what’s been going on in your life is the single best way to know what’s going on with YOU.
Some doctors do use tests for the knowledge they provide about your functioning, for baselines to help measure improvement, and to rule out some other possible diagnoses. That’s fine, as long you can afford the tests.
However, if testing is presented to you in a way that sounds like the results of the testing are going to give you an ADD diagnosis (or rule it out), you are speaking with someone who is not ADD-knowledgeable. Keep looking.
9. HOW WILL WE WORK TOGETHER IF WE DECIDE TO CONTINUE?
- Is this doctor a psychopharmacologist or does s/he include talk therapy as part of your treatment plan?
- Does s/he do the therapy, will you be provided referrals to therapists, or are you expected to locate one yourself?
- Is being in therapy a pre-requisite for medication?
- How often will you see each other?
- What is the procedure for reaching your doctor for questions between appointments?
- How much will it cost?
The kind of guidance you receive as an answer to this question will let you know a lot about how much guidance you can expect as you work together.
A cursory, “Let’s just see what the tests say first,” is not very nurturing and a good indication that your working relationship will be equally dismissive.
Unless you are equally pressed for time and unusually knowledgeable about ADD yourself, you’d probably be wise to interview another doctor.
If you charge for missed appointments, what appointment reminder systems are in place?
Questions of this type help you to listen for ADD-friendly procedures as well as a clear understanding of the procedures in place in any particular doctor’s office.
We know that ADDers struggle with follow-through, for example. The last question would be a good litmus test to let you know how well the doctor’s understanding of ADD symptoms dovetail with an understanding of the implications of the symptoms.
That doctor’s standard email reminder, as an example, may or may not work for you, but at least you will know that the doctor has thought about the need for appointment reminders.
If I miss an appointment, how will I get my new prescription?
For those of you likely to say yes to meds, if this doctor will hold the key to your medication you need to know that you are not going to be punished unfairly for a predictable ADD lapse in memory, especially in ways that will negatively effect your ability to function.
- Many ADD medications, by law in most states, require a new monthly prescription (and no more often); no automatic refills, call in or faxed ‘scripts allowed.
- You can’t afford to set it up to run out of meds as the result of an ADD-oops.
If the back-up procedure is to mail your prescription, will that work for you? Even if you can arrange to pick it up with a receptionist instead, do you have access to transportation on demand? Can you get the time off from work?
If you must schedule a make-up appointment first, will the office procedures work with your situation?
- Can you get a make-up appointment before you run out of meds?
- If you have to pay for the missed appointment before you are eligible for a new appointment, will your budget accommodate a double payment?
- Can you work out terms if the answer is no?
Don’t automatically rule out a doctor whose systems won’t work for you. NO doctor can set things up in advance to cover all situations, and most will be willing to work with reasonable requests, respectfully presented, to design a work-around for any patient for whom exception management is the exception not the rule!
If they won’t, can’t, or don’t understand why it might be necessary, they will not be good doctors for YOU.
10. HOW UP-TO-DATE IS YOUR KNOWLEDGE BASE?
— The ADD world changes rapidly and you want your doctor to be one who stays current.
While you can’t ask the “knowledge-base” question directly and expect to get an answer that will be useful, you can find out by asking questions like the following:
- Do you speak to ADD groups? Which ones? On what topics?
- Are you a member of any client-based ADD organizations? CH.A.D.D.? ADDA? Others?
- Do you attend ADD conferences? Which ones? How often? How recently?
- Do you have a website? Are you “web-published?” Do you participate in any of the ADD newsgroup discussions or ADD Physician email lists?
A response like, “I wish I had the time to be more involved. The demands of being a practicing ADD Doctor don’t leave me a lot of time to do extra work in the ADD community,” would lead me to believe that I’m probably dealing with a caring professional who spends a lot of time with patients. If his or her information base is current, you will probably be thrilled with that doctor.
Can you give me a referral to an ADD Coach?
- It’s ok if they can’t — ADD coaches are still a bit scarce and not all doctors have referral relationships with coaches.
But if they don’t know what an ADD Coach IS, or don’t understand how an ADD Coach might be useful, you know they are more than a decade behind the times.
Dr.s Edward Hallowell & John Ratey have been extolling the value of coaching for ADDers since their book Driven to Distraction was published in 1994. Most of the books and ADD web centers since then make some mention of coaching.
- You can also say, “Would you be willing to speak to my coach?” to elicit the same information – which will also help you find out how comfortable the doctor will be working as a member of your team.
The doctor to avoid is the one who wants to call ALL the shots. It’s YOUR life – stand up for your right to be the decision-maker!
Remember, there are no “right” answers to any of these questions
Listen for the care and involvement behind the answers.
- You’re screening for a doctor who is straightforward, has a consistent theory about ADD s/he is comfortable with but not attached to, and
- for a doctor who will take the time to listen to you and answer your questions.
- With that kind of doctor you will have the relationship you need to work out any details of your care as you proceed.
Nobody really “knows” exactly what’s going on with ADD at this time. No two ADDers have identical presentations or respond to exactly the same treatment approaches.
No matter how knowledgeable a doctor seems on interview, or how successful his or her approach seems to be with whatever percentage of his or her practice, ANY doctor will be learning as s/he treats YOU.
You want to make sure that your doctor is open to the learning, and that the learning that goes on will be inter-developmental.
Make sure you bullet-point your questions, even if you have to read them from a list — no doctor has the time to listen to rambling. Make sure you don’t collapse a request to get to the bottom line with lack of interest in your question or a reticence to provide an answer.
And make sure your attitude is one of charge-neutral information gathering. A tone of voice that makes it sound like you are on a quest to prove that doctors are inadequate won’t get you what you want to know, even from the best doctors in the universe!
This article, blog-updated from the one originally written for the curriculum manual of OFI’s ADDCoach Training, is an updated reposting of an similar article from addcoach.com. All three are covered by copyright
©Madelyn Griffith-Haynie, all rights reserved.
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Articles in the ADD Overview series:
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Articles in the ADD Concepts series:
- ADD: What’s in a Name
- If the Shoe Doesn’t Fit, Don’t Blame the Foot!
- Why Tips and Tricks Fail
- Distinguishing Can’t from Won’t
- Shifting Your Come-from
- Naming the Game
- Avoiding the Holes in the Road
- Senior Moments? — The Heartbreak Of CRS