Psych asks, why did they send you?
 

If ever anyone needed proof that Canada's doctors are living in the dark ages, well I have a story for you. I just got home and want to tell you this while its fresh and before my memory loses it all.

Was referred to a psychiatrist. Of course in the interest of time and expense, I was referred to the local psychiatrist. Yes, I live in a city with ONE of those for the entire population. Welcome to Saskatchewan. My city's population is 15,000 so for many of you this would compare to a small town.

He began by asking why I was referred. I explained for post concussion syndrome. He asked, "but why?" I said, "I don't know. They said I needed a psychiatrist."

He says, "who's they?" I said "the doctor and WCB". He says "to be honest I have no experience at all with post concussion syndrome. I've heard of it but I've never dealt with it."

Instant sinking feeling in my gut that once again I'll end up without help.

He said also, "I hate WCB cases I refuse to deal with them. I has accepted your case before they told me it was WCB so it was too late. I will send a report but they will ignore it anyway. WCB are professional bullies who dictate what they want no matter what I recommend." (I couldn't believe he said that!)

He went through asking the usual questions to determine if I'm suffering depression. Then said, "what you need is a neurologist, not me, and that's what I'll write in the report. But WCB will likely not listen. Which is unfortunate because they could have you seeing a neurologist next week in a neighbouring city for the right money, and they do that all the time, they coerce doctors to see patients by paying them huge dollars. That's what you need to happen here."

"Your GP knows a little about everything but not a lot about anything, that's why they are called general practitioners. They send you to us because they don't know what to do with you. But I don't deal with this... What do you call it? Post concussion syndrome. You know more about your condition than I do."

He said I have symptoms that mimic depression but cannot be determined to be depression. Therefore no meds. No therapy plan. No progress yet.

Story of my life!

Symptoms today: head and neck pain, confusion, stuttering, feeling fullness in head and ears.

Exacerbated by ineptitude of medical professionals. But hey at least this guy was honest. That was refreshing despite the outcome! I prefer cold hard truth to pandering any day.

That sucks. If you were having problems with depression or anxiety then that's where he could have helped you by prescribing meds. I thought you were having some of these problems? Are they gone now and if so that's great!

Who you really need to see to help you through this is a neuro psychologist and maybe a speech therapist? A neurologist will be very little help unless they are in a concussion clinic or something. They are only good if there's structural damage to the brain or if you need surgery or meds. Wouldn't hurt to see one but probably won't help either.

No matter what its just going to be time.

Sorry you didn't get any answers or help from him. I'm actually glad I'm dealing with private long term disability and not workers comp. They sound horrible! Keep in mind though they're still being fair and haven't cut you off. That's a good thing!

I hope your day gets better.

CC

Good question...
 

About anxiety or depression. I have my bouts with both but in this guy's opinion it's "situational" and does not require medication I guess.

Which is fine I guess? I don't know. I'm at the mercy of whatever is recommended. I guess we all are. :)

I don't have a big beef with WCB as much as he does, clearly. I'm not sure what happened in the past to sour him this way but I kind of found it amusing! He has been a psychiatrist for 30 years he said, and has only taken WCB cases a handful of times.

In 30 years you'd think he'd have run into PCS more than once but... Nope.

That is HORRIBLE!!!I agree with cycle he should of tried to help with the anxiety and depression part....My theory today is people SUCK anywhere!Do they have malpractice in Canada by chance?Just curious?You will get some help from a neuropsych! Do not give up!You are a fighter and you are in my prayers.:grouphug:You should of dropped rosemary oil threw his office while talking to this clown!

I wasn't at the appointment so I could be wrong here but.... I don't think think this doctor did anything wrong or is a bad doctor. Psyciatrists up here pretty much won't see you unless you are suicidal or need to be followed on meds. You have to see a psychologist or counsellor for lessor issues. Which of course is expensive!

I think, but could be wrong, that if msrrio had told him she was crying every day or suffering panic attacks or anxiety constantly he would have talked to her and seen her again PCS or no PCS. Because she didn't even feel she needed to be there he didn't feel she needed to be there either!

There is such a thing as a neuro psyciatrist but seems to only be in big cities. I'm surprised with only 15000 people you actually had a Psyciatrist!

I think he could of at least listened to you about how you were feeling and then break it down to you to find a support group or something in a nice way. I had to go through a psychologist when I was diagnosised with perpherial nueropathy (8 years ago), and she listened to my fears and concerns. She said the best thing to me, "it's alright to share with others what is happening (my fears)" because I was trying to "be strong" and hold in all my fears and not share with my loved ones because I didn't want to burden them.
Good luck and take care of yourself and stay positive. Keep your eyes on all the blessings in your life and just take care of yourself (health wise). :hug:

He actually wasn't a bad doctor, just really uninterested in taking my case. He seemed decent enough but seemed very frustrated with the system, with having to see me, with me being referred to him by a GP while in his opinion I need a neurologist and not psychiatry. He admits he knows NOTHING about PCS.

I thought people might find that interesting.

He doesn't live here, he practices here as a "locum" doctor. His practice is in a bigger city.

I did cry in the appointment but I find with PCS confusion I'm very subdued in person. On here where I can type out thoughts I'm more animated.

Just to clarify I didn't decide I didn't need to be there. I just can't always answer when doctors ask 'why are you here' my brain just automatically says 'I don't know'. I did my best to explain and was honest about despair at times.

Again he simply said those are likely symptoms of the syndrome and not his area of expertise.

I found that interesting.

I feel so sorry for your tribulations.

It brings to mind:

- Do you have a lawyer?
- Have you asked him to give you a copy of his report?
- Have you asked him to assure some statement of his feelings about you needing a Neurologist? - even though he is of the opinion they won't listen.

- Have you discovered the name of your WCB's representative's supervisor, and fired off a letter of complaint concerning your representative's lack of listening skills and lack of concern for your problem? (and a copy to the Head of the WCB would not hurt) - also to your lawyer(if you have one).

I am a proactive person when it comes to my concerns with my mTBI - I talked to the representative with the Work Comp of the employer until they started throwing attitude at me about things - once that occurred, they got my attitude, my lawyer's attitude, and were never allowed to discuss anything with me, nor setup anything without my pre-approval and acceptance of arrangements from that point forward.

This may prolong things, but its on my terms, as I am the victim of the injury, not them - and if Im having a bad day when they call, I let them hear it, and feel it with my voice, my slowness, my sluggishness, my delayed thoughts, on speaker phone with my wife in attendance as witness. They get the full brunt of my problems............although my wife would rather prefer to just tell them to go to H*** those days, I just can't.....

Good luck to you.....Hang in there....

Thank you for the compassionate reply. Everyone is so supportive here. I'm glad we help one another.

To answer. I do not have a lawyer. I debated going the legal route earlier in my journey but put it on back burner as I don't really feel capable of all the work they require. In my experience with lawyers unless you do most of the work you will not get anywhere. So in my injured state I can't even remember to eat, dead serious. I have reminders for everything. And still my husband has to text me to ask if I've eaten or drank anything in the daytime while alone.

The thought of having to advocate for myself and do more paperwork is just impossible to imagine. So I do my best but like I said I'm very subdued in person. I don't like to talk much because of how I sound, plus my thoughts are difficult to organize aloud. Paperwork makes my head spin so I avoid all those stressors.

It sounds a bit melancholy but the truth is I have only enough fight left in me to cope with my every day survival. Adding any expectations from more 'professionals' is just not an option yet.

More answers: I didn't even think to ask for a copy of his report. Didn't occur to me. I wish it had!

As for the WCB case worker, besides one bad altercation in December she has eased up somewhat... Well, it's not like she's pleasant but not adversarial at least.

I admire your strength in dealing with difficult situations. I'm kind of a mouse sometimes... I get confused enough that I don't even know how to defend myself. Can't think fast enough to keep up. I'm so much smarter in the written word. It's crazy how that works.

Verbally I'm just not with it, at all.

Thanks for the tips and inspiration though. I will think on it.

I do not know if the law is the same in Canada or not but I would call his office and ask for a copy of his notes and findings. BTW a psychiatrist is able to prescribe meds for anxiety and depression where a therapists and psychologist are not able to. This guy is in the dark ages!! Your GP maybe able to if you trust him?her and he/she is willing. The emotional component in PCS can be a bear.

Use the notes to show you are seeking help and co-operating fully. Keep demanding the care you know you need. All to frequently it is the squeaky wheel that gets the grease. I know it is not fair or right. With WCB you have to be your best advocate!!

rmschaver wrote: "I would call his office and ask for a copy of his notes and findings.

Yes, please do.
(If it is same in Canada as here in USA, you will likely have to sign a "Release of Information" form to get a copy.)

I routinely now, upon completion of seeing another Dr., request a copy of the notes to be mailed to me ... and they have me then-and-there fill out/sign the Release of Information form. No problem.

Wishing you well.

MsRrio,

I think this psychiatrist di you right. he did not want to complicate your PCS with meds that would not help you. They may mask some symptoms but would not make a substantial difference. WCB would like to see you medicated into passivity so you stop complaining. WCB in Canada does not sound much different than WC here in the states.

His comment about WCB paying doctors for favorable is dead on. Although there are regulations to try to prevent such 'hired guns,' there are plenty of ways the WCB payer can get around those laws and pay for the report they want.

His comment about situation depression and anxiety was dead on. You likely have anxiety from over-stimulating a brain that has minimal tolerance for any stress at all. This results in a roller coaster of anxiety with moments of depression or simply emotional exhaustion/sadness.

Do you have any way to seek distance consults from experienced professionals in a big town? I doubt you need hands on help. Finding the right skilled professional who can help direct you over the phone may be a big help. Your challenge will be getting WCB to support such an arrangement.

I completely understand the situation you are in. You give WCB more credit than they deserve. Maybe you need to find a WCB attorney who has experience with Post Concussion. Again, you do not need to find on who is nearby. Finding good experience and knowledge is far better even if you have to do most of your communication by phone, email, and mail. Email can be a good communication system when dealing with attorneys.

btw, If the psychiatrist has no experience with PCS, I wonder how much experience your PCP has. Is he really helping or is he just taking shots in the dark? The Ontario NeuroTrauma Foundation has done some excellent work with PCS. Maybe you can find some worthwhile referrals from them. Check them out at www.onf.org

It is sad that we have to do all of this work ourselves when we are the ones who struggle to make it through a day. But, you are not alone.

As other said, ask for (demand) copies of all notes and reports. I three hole punch them and put them in a three ring binder. It helps me not lose or misfile them.

My best to you.

I respectfully disagree with Mark. Your psych sounds arrogant, condescending, and patronizing. Just being referred to him should have indicated at minimal a evaluation and recommendations that could really help. Not offhand opined remarks that do nothing to serve your health needs. As a temporary aid medication properly administered can assist in getting over the hump so to speak until you can get your issues to a more manageable level. Of course you will need a competent Dr you trust to administer. I agree with Marks comment that it is possible to over medicate here. So exercise caution.

Thanks everyone. I respect all the views on this and thank you for taking the time to post replies.

I don't think I wrote my original post very well... But it was a true account of what was said.

I'm really on the fence about whether I would have benefited from a different approach. But it's neither here nor there, I've got to move on from it anyway.

As for the question of my PCP (as you Americans call them instead of GP's... Haha) I think... frankly, they are all clueless. I've seen now a total of four different doctors in 3 months including my usual family doctor.

I think I've finally found a decent one on the fourth try but time will tell.

I'm going to heed advice on the "copy" of reports. It's not standard practice up here. Didn't even occur to me yet, in 21 years of being an adult, to ask for my records.

Also the distance consultation is something I'll look into, and distance legal representation too. Thanks Mark. Another thing I hadn't considered. I guess I better gear up for some of these difficult conversations and find my inner strength.

Had no idea I was this subdued and mousy. I used to be a force to be reckoned with, I tell ya!

Problem solving is not my forte at the moment. Lol :) help is much appreciated.

rmschaver,

I think you missed my point. If the psych had tried to do an evaluation and even prescribed medication, even as a temporary help, WCB would be able to leverage that against MsRrio. It is amazingly difficult to undo even well intentioned temporary helps. I have been through the WC system and lost miserably. I have observed this same struggle in the lives of plenty of other injured workers.

FYI, The Work Comp system was established to protect employers at the expense of the injured employee. The 'gift' to the employee is a no fault process as long as the injury took place during working hours. As WC insurance companies complained, the WC rules got rewritten to favor the employer even more. This created an entire 'industrial medicine' industry. The statutes pay the doctors based on report pages. There are industrial medicine partnerships that have databases of boilerplate reports that paramedical writers cut and paste into reports to be signed by the 'reporting doctor.'

Some doctors write their own reports but the low pay causes them to become disenchanted with the system. It becomes worse when they see the way their reports get twisted against well deserving injured workers. The system is simple, play along and the medical professions will get paid as long as the injured worker does not get everything they deserve. The attorneys and doctors with their post graduate degrees deserve their big paychecks but workers who can get injured at work are the peons who deserve the leftovers.

In a few cases, the injured workers gets a just settlement, usually when the injury is obvious, like a broken leg or amputated finger or hand. Those of us with invisible injuries are labeled as driven by the chance of a big payout. There are lawyers and claims adjusters who fill conference halls to teach how to blame the injured worker for malingering.

All we need is a medical or psych report that questions the cause of our symptoms to have our claim crash and burn. A professional who does not know how to connect our symptoms to our concussion can open that door of question. Attorney Gordon Johnson addresses the serious risk of getting such an evaluation and report. My experience confirms what he says a www.tbilaw.com and www.subtlebraininjury.com

btw, No offense taken from those who disagree with this.

My best to you all.

Update
 

Remember the time I posted about the Acquired Brain Injury coordinator coming to my house to meet with me? (At least I think I posted that story, she was the one who said I'd have therapists come right to my house and then later said, no that won't happen, the ABI team won't see concussion patients).

Anyway... She did a follow up visit today.

I told her the account of the psychiatrist and she says he did me a favour. Because, she said that in her experience, anytime WCB can pin symptoms on depression instead of the injury they will.

She said the ideal healing for head injury patients is drug free for a year if possible.

I thought some of you may find that interesting.

Glad to hear you have someone who understands the WCB system. Having confidence in what the psychiatrist said is a relief.

Absolutely true but not the whole story. There is the legal side and no doubt about it if you are brain injured as any PCS persons are. It is a fight we are not equipped to deal with. As we all know anxiety, depression, emotional lability are all emotional components of this injury. What is the best for the legal interest is not the best for the health interest nor is it the best for the employment interest.


In a perfect system there would be no conflict and no equation to solve. We get injured, we get care, period. But I do not care where in the world you are personal interest is always at play. Be it a corporate entity, a doctor, a lawyer or our loved ones. It is a fact of existing in this world/plane. The tough part is attempting to balance those interest without compromising ones self or ones health. If you are very lucky a Dr. with good ethics and morals will weigh in favor of your health interest and that makes the balancing act, Oh so much easier.