Why did they put agoraphobia without panic disorder in my record?

[seminoles]

My psychiatrist of 10 years transferred last December, I have been waiting to be seen by a new psychiatrist since calling in March to see someone and have my meds redone.  The mental health clinic schedule me with a pharmacist to bridge my meds, I have seen her 3 times.  She is has changed my medication every single time.  I am on xanax, ativan, etc. as well as meds for bipolar and many other sc issues. This pharmacist put in my record that I have agoraphobia without panic disorder.  I clearly have a panic disorder, I have been on anti anxiety meds for at least 10 years, is this so the VA can say it isn't related to my service connected mental health issues?  I also noticed that my future appointment with my new psychiatrist has been canceled, with no new one rescheduled!!   Is  the canceled appointment with no letter, no phone call what is happening to "cook the books" on when we are seen? 

[brokensoldier244th]

No, its more likely that your Pharmacist did not look at your whole record because pharmacists cannot diagnose, only administer. They can override a doctor on occasion because doctors aren't always up on the current medication  conflicts, but if your treatment record says agorophobia with panic then thats what you have. The pharmacist is not your treating physician. 

[seminoles]

32 minutes ago, brokensoldier244th said:

No, its more likely that your Pharmacist did not look at your whole record because pharmacists cannot diagnose, only administer. They can override a doctor on occasion because doctors aren't always up on the current medication  conflicts, but if your treatment record says agorophobia with panic then thats what you have. The pharmacist is not your treating physician. 

brokensoldier, that is what is weird, this isn't in her notes from the appointment it is where diagnosis are entered.  If you go on myhealthevet and look through your records it will say for example, bipolar on such and such date, chronic migraines on another date, among other diagnosis and she put in that list agoraphobia without panic disorder.  Should I ask that it be changed, no where in that list of diagnosis does it have panic disorder or agoraphobia in any way.  I am fine with it being there, I am going to apply for housebound and I think it will help, my concern is that it may preclude it from being part of my sc mh.  I hope that makes sense.

 

[brokensoldier244th]

I have 3-4 diagnoses over the years. VA ratings can only cover one of them for ratig purposes. I don't stress about that too much what they call it, its the effects on you and your daily living that are important. You can manifest certain conditions over time like, I started out as Major depression, Severe, and that has morphed into also autism spectrum disorder and OCD tendencies. The Depression is still there, but its all layered together. 

[Mark D Worthen PsyD]

Licensed pharmacists (PharmD degree) employed by the VA often treat psychiatric patients, although a psychiatrist is supposed to review their work, and see the patient regularly or every once in awhile - I don't know what the standard is.

But your situation does not sound right. I suggest calling the MH clinic and requesting an appt with a psychiatrist.

Also try talking with the Patient Advocate (some are really effective, others not so much from what I hear.)

If you still do not have an appointment with an MD soon, then call and write the Chief, Mental Health Services at your VAMC, with copies to the Chief of Staff and Medical Center Director.

Btw, it's not unusual for people with Panic Disorder to become less agoraphobic with treatment over time, but it is much less common for a patient to stop having frequent panic attacks but still have the agoraphobia. 

Also, note the name of the diagnosis: Agoraphobia Without History of Panic Disorder.

Also note that Agoraphobia Without History of Panic Disorder was a DSM-IV diagnosis that is not in DSM-5.

All the Best,

Mark

Edited June 21, 2016 by Mark D Worthen PsyD
correction

[seminoles]

4 minutes ago, brokensoldier244th said:

I have 3-4 diagnoses over the years. VA ratings can only cover one of them for ratig purposes. I don't stress about that too much what they call it, its the effects on you and your daily living that are important. You can manifest certain conditions over time like, I started out as Major depression, Severe, and that has morphed into also autism spectrum disorder and OCD tendencies. The Depression is still there, but its all layered together. 

Agreed broken, I am not post 9/11 therefore my husband cannot receive caregiver, housebound would nice.  He has to go pretty much everywhere with me, works at home, etc.

[seminoles]

2 minutes ago, Mark D Worthen PsyD said:

Licensed pharmacists (PharmD degree) employed by the VA often treat psychiatric patients, although a psychiatrist is supposed to review their work, and see the patient every other or every third visit. Some PharmDs are quite good.

But your situation does not sound right. I suggest calling the MH clinic and requesting an appt with a psychiatrist.

Also try talking with the Patient Advocate (some are really effective, others not so much from what I hear.)

If you still do not have an appointment with an MD soon, then call and write the Chief, Mental Health Services at your VAMC, with copies to the Chief of Staff and Medical Center Director.

Btw, it's not unusual for people with Panic Disorder to become less agoraphobic with treatment over time, but it is much less common for a patient to stop having frequent panic attacks but still have the agoraphobia. 

Also, note the name of the diagnosis: Agoraphobia Without History of Panic Disorder.

Also note that Agoraphobia Without History of Panic Disorder was a DSM-IV diagnosis that is not in DSM-5.

All the Best,

Mark

Mark,

Yes the DSM difference I think may be a problem, I am going to call tomorrow and find out why my appointment has been canceled.  I really wish my last psychiatrist hadn't transferred!