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Originally Posted by Quixotic1
I completely agree with you. We can't change the way some neurologists make their diagnostic decisions. And the result of a lot of those decisions leave us in a wasteland. But, if we already know the pitfalls, and the way they should be analyzing the information, we are better able to fend for ourselves. We can dump the defective neuros earlier and guid the wishy-washy ones with pointed questions.
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I am not advocating changing how our docs dx us, nor am I advocating doctor shopping. I also don't think we are in a medical wasteland. However, knowledge is power and the more we know as we go through the dx process, the better we are.
We are not medical professionals. We are patients seeking help and therefore lean on the professionals to know what they are doing and how to interpret the results. Again, knowledge is power. But when we go in for the first time, scared and not knowing what's going on, we have no knowledge.
Doctor shopping is sometimes difficult depending on where you live...even some have mentioned that they cannot switch docs within the same practice.
We are there to be helped, not to guide. There comes a time when we should work
with the doc, but to start right out in the beginning with an "in your face" attitude does not lend itself to a good doctor/patient relationship.
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As to whether these Criteria are hard and fast, you will get varying answers to this. It is stornger than a Guideline, but weaker than a Federal Law.  Generally Criteria are more to be followed than not. Neuros with less confidence and skill will be "safe" if they follow them rigidly. They will be able to defend their decisions if challenged. Truly smart, skilled and confident doctors know when they can see a wider picture and diagnose outside the Criteria.
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Guidelines are guidelines and should be used as such. I agree that some docs probably follow these Criteria, but I am willing to bet that if you were to do a survey, not very many keep a copy of the MC on their desk or in the exam room to refer to when examining a patient.
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The "problems" of diagnosing outside the Criteria are 1) a weaker defense if challenged, 2) some patients won't qualify for certain studies, 3) certain meds may not be approved, and 4) potential problems with insurance.
Someone said recently that Neurologists are often linear, mechanical thinkers. A person may qualify for diagnosis until the MRI is atypical. Then, that supercedes the earlier information. We should attempt and look for the non-linear thinker who can think and evaluate laterally - seeing a global picture that shows the diagnosis, despite varying from the Criteria.
The upshot is that we can't know when we have been snookered without good information. I do believe there is no such thing as too much information.
Quix
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I don't believe that dx'ing outside the MC is critical for insurance purposes. I also don't believe that my insurance company asked my neurologist when I was dx'd "was she dx'd using the MC" and if so which box did she fall under.
The MC is just that, a guideline that they use, not a rule that
must be followed. It gives the docs a starting place. They have to have one otherwise where would WE be?
I also don't think there as many people who get snookered or there are as many bad doctors as you are alluding to. That's just my opinion based on my association with the organizations I belong to and the background I come from....FWIW...
