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Mental Health

Patient Discomfort with Personal Care Physician

12/19/2007

Question:

I`m a more or less healthy 53 year old guy, who just recently established regular health care visits with a (PCP) Personal Care Physician (previously, if I needed a doctor, I went to the ER if something was really bad, but had no regular health care). My PCP is a great doctor, but I was uncomfortable telling her that up until a year ago, I took ritalin, initially for ADHD, then I saw a neuro doc and the working diagnosis was "excessive daytime sleepiness" (had a sleep study, conformed this, but not as bad as in narcolepsy), but that was the diagnosis. I didn`t care, on ritalin, I went being an impulsive, scatterbrained idiot who could not finish anything to suddenly being a fairly good student, college grad, good marriage, etc. And I did have severe daytime sleepiness; but that was recently cured by CPAP and dramatic weight loss. So the sleep problem is gone, and I stopped the ritalin a year ago; no daytime sleep problems, but the ADD is back and making my life a trainwreck, just like before the drug. I`m uncomfortable telling my PCP about my ADD and need for medication.....my insurance lets me self-refer so I can see a psychiatrist on my own.......I don`t want to lie to my PCP, but I`m uncomfortable discussing my need for "kiddie speed"...I`m not a drug abuser.......am I nuts, and how wrong would it be just to see another doctor on the side? thanks

Answer:

Thank you for your question.

The broader question is why you would feel uncomfortable disclosing this information to your PCP. Given your identification of her as a "great doctor," I am assuming that you two have a good working relationship. All physicians understand that patients can commonly feel embarrassed. However, it becomes more of a concern when the would-be embarrassment prevents patients from informing their physicians the full range of their issues.

My preference is for patients with possible Attention Deficit Disorder to undergo neuropsychological testing to establish a baseline from which any issues regarding treatment would follow.

Strictly speaking, you could refer yourself to a psychiatrist and ask for the appointment to be confidential. Nevertheless, conscientious outpatient psychiatrists would want to gather more information from a PCP. Moreover, such psychiatrists would want the PCP to know that the patient is taking such medications, given the medical implications and need for appropriate medical monitoring.

Best of luck.

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Response by:

Ram Chandran  Kalyanam, MD Ram Chandran Kalyanam, MD
Clinical Assistant Professor of Psychiatry
College of Medicine
The Ohio State University