Tuesday, April 2, 2013

A Diagnosis Is For The Patient, Not For The Doctor

1 Boring Old Man:
The hostility towards psychiatrists about diagnostic labeling is actually in sympathy to the mentally ill who can be actually harmed by being diagnosed – in all kinds of ways. Saying a person has a DSM diagnosis isn’t like coding appendicitis – it may make a person uninsurable or unemployable for life. That’s a big hurt. And there are other subtle consequences. These days, there’s a big suspicion that diagnostic inflation is partially motivated by people drumming up business. With the DSM-5 diagnostic inflation, that’s hard to refute.

In this reaction to the reaction Dr. Pies makes what I consider a weak point – that doctors need to make diagnoses. Of course they do, but not in the Managed Care/DSM-5 way it’s done these days. I didn’t deal with insurance companies as a practitioner and was on no panels. When patients wanted to file insurance themselves, I producing bills with the diagnosis [ICD-9-CM] and session [CPT] codes. And I often saw it important to discuss this topic with the naive, as informed consent [do no harm has lots of meanings]. Diagnosis is something one does for a patient, not to or with a patient. Our diagnoses are more in the range of opinion than anyone would like to admit, at least the ones used for outpatients.

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