Incredibly Rude Psychiatrist

[Shalia]

I have an IU claim in. I'm currently rated at 70% for bipolar (and have a few other SC issues) and they sent me to a psych. to reevaluate. The guy was a JERK. He started out the visit with telling me off because I prefer to see female APRN's (abuse issues in my past, what can I say?) and then got mad at me when I referred to the woman I see as my doctor. (Force of habit, and besides, she has a Ph.D. so it's not entirely inaccurate.)

I tried to tell him why I couldn't work right now, and he kept telling me things like "all I hear is you are making a willful decision to quit working" and telling me I have no valid excuse for not working. When I mentioned things like I have difficulty with concentration and memory he said I was lying because I can go to school. Well, school lets me have double time on tests, has other people take notes for me, AND lets me record all my classes onto tapes so I can listen to them again if I forgot stuff. Work doesn't let you do that stuff. And with all my accomidations I'm barely passing.

But he told me "there's a time for you to be talking and a time for me to be writing, and right now I'm writing so you need to stop talking". He was so dismissive and rude I can't imagine how I'm going to get a fair write up from him when he decided before he even talked to me that I was just "willfully deciding to give up a good job I've had for years". Can I get another doctor? Or am I screwed? Do I take notes in case I need an appeal? He was the rudest doctor I've had the misfortune of seeing in my life, and I feel like I won't get a fair shake from him.

I'm so frustrated. I'm almost afraid my percentage will go DOWN now, not up like I was praying for, because of this jerk. I'm *not* OK, and he made it sound like I was just being lazy. I'm so frustrated. I want to scream or throw something.

What do I do?

Shalia

[Guest jangrin]

hi there,

IMO- Independent Medical Opinion-when a doctor takes all the medical records and treatment records and reviews them and then renders an OPINION based on reviewing the records only.

IME- Independent Medical Exam- Independent doctor does a physical examination and reviews all the records and treatment and then renders an opinion based on his own exam findings in combination with his reviewing the records of the other doctors or providers records.

Jangrin

[Hoppy]

Shalia,

I would get those doctors reports from the records people if at the VA or get their notes. They might have put in the file why they thought you needed tdiu. Were these records reviewed by the doctors who did your tdiu exam. Treating doctors have a better insight into your abilities especially if they have treated you for multiple visits. You might have had a good day the day you went to the tdiu exam and thus the tdiu examiners over rated your abilities. The treating doctors exams should be given a higher relevence than the tdiu examiners if in nfact they disagree. If they disagree and the tdiu examiners did not review the treating doctors notes I would tell them to reschedule the tdiu exam. No matter what get another exam from the treating doctor and have them explain why they told you to apply for tdiu and send those notes to the VA.

The schedular ratings are based on gaf scores. hadit has a reference to the rating schedule for psychiatric conditions on their informatiuon page. I am not sure how tdiu is determined. It might also be on the hadit info page or somebody might post it. If you have trouble finding or understanding the ratings. Let us know.

[Patrick428]

I would caution anyone that depending on a GAF score for rating purposes is not something one wants to depend on. Having once performed many C and Ps, a GAF score is only a measure of the individual's level of functioning at the time of an exam. GAF scores are fluid and tend to shift and move up and down during the day. One can be at a GAF of 40 in the morning and be functioning at 60 in the afternoon.

If a person has a long history of mental health treatment there will be a history of GAF scores as well. Meaning that if someone suggests that pairing up differing GAF scores by various doctors in an attempt to nullify them will not work. The history of a GAF shows a longitudinal picture of one's functioning over time. If a person is having a C and P it is likely they at least have a GAF score history somewhere that can be viewed. I personally use the GARF (Global Assessment of Relational Functioning) along with the GAF score to measure the overall picture of current functioning.

Finally C and Ps are very intense especially in the write up phase. A GAF score is just one minimal part of the entire process. Histories such as developmental history, current history, treatments, medications, mental status exams, medical history, family history, military history (if needed), evaluation of testing (if needed), and diagnosis are all part of the main body of a C and P. Then the particular questions raised by the rater must be answered to complete the report.

As for a rude or bad doctor as stated you can go to the Chief Medical Officer of the VAMC or to the Patient Advocate and complain. However, medical staff like police departments tend to have their own code which generally translates into "we see, hear, nor speak no evil." However, one thing the VA nor anybody else can overcome (if the situation warrants) is a complaint to the specific specialty board (medical, psychology, social worker) in the state where the doctor or clinician practices. The VA has no power over any state licensing board and sometimes a complaint to a board may get better results than trying to do through the VAMC. All doctors, clinicians, nurses, and other practitioners have to be licensed in the state they are practicing in to work for the VA. So if your complaint goes unheeded, file a complaint with the State Board, and I guarantee you will be getting phone calls from the VA wanting to solve the issue.

Patrick

Edited August 10, 2006 by Patrick428

[Shalia]

My GAF for the last year has fallen between a 40 & 45 on all my exams. My low was a 20. (I'm neurotic about keeping my medical records.) I don't have anything higher than that for the last year.

Where does that fall on the IU scale?

Shalia

[Patrick428]

Shaila,

If you had a GAF of 20 suggests to me you were hospitalized until your moods improved. With GAF of 40 to 50 the relationship to IU is relatively inconsequential. It says on your profile that you have 80% SC with the VA. If one of your disabilities is at least 40% and combined to 80% then you would be eligible for IU. However, to be eligible for IU, you cannot be working. The test of IU is whether you can particiapte in substantial gainfrul employment. If you can show that you are unable to work because of SC conditions, then you should be granted IU. As to whether it will be P and T, or with future exams will be decided by the rating team at your VARO.

Patrick

Edited August 14, 2006 by Patrick428

[Hoppy]

Patrick428.

Your recommendation to complain to licensing boards should be put in the hadit reference pages.

If you know where the schedule for rating psychiatric disabilities can be found it might be helpful to post it. I have seen it several times. However, I can't find it anymore.

Shalia mentioned that doctors recommended that she apply for tdiu. I recommended that if those reports were not used during her tdiu exam she get the notes from those doctors or see them again and get a current report as to why they suggested to her to apply for TDIU. It is best to know what is being reviewed during the process rather than waiting on the SOC to find thew flaws in the evidence. Getting the right evidence to adjudication before a decision will make the process go much faster.

The variability of the GAF score is why I suggest that an individual get treatment and submit the GAF scores along with any other comments the treating physician might have about employability. The more visits to the treating physician the better. Then Have the C&P examiner review the treating physicians notes. Relying on C&P examiners who see you only once does not even make sense to me. Yet if you do not seek treatment the VA can schedule a single C&P exam.

Additionally, the GAF is often based on the patient’s subjective recollection of their history. The VA does not accept diagnoses and symptoms based on subjective recollections of prior treatments. The examiner must review the prior reports. It is amazing how many BVA decisions throw out psych. reports based on subjective recollection. According to my SO, who was a rating specialist for 20 years, this is one of many advantage to getting your treatment at a VA hospital. Relying on doctors who are not familiar with the VA system can cause problems when submitting their reports for adjudication.