perplexed...my neuropsychologist testing

[DammitJanet]

I have finished my neuropsychologist testing and just have to wait for the result appointment.

I am a bit perplexed however, about the way that this neuropsychologist reacted, or maybe I should say treated, me after we were done with the testing and I asked for the names of the tests that had been administered. Actually over the days that I was being tested I had asked about the tests or made comments about the tests...things such as "Oh I have heard of the MMPI recently on a message board I post on." or after doing a computerized test for what I assumed to be attention issues...I asked if it was the computerized test that they used for ADD because I had heard of that test being used with kids. Oh and there was one test she used that was a much harder and longer version on paper of that colored block test that is out on the internet where you have to match the color of the word that is written in one color ink (say red) but it spells blue. I told her I had done that test online and it was hard.

She got kind of irritated with me and asked me how I knew so much about the tests. I told her for one thing I had been dealing with mental health and psychology with my kids for nearly half my life plus I read a great deal about these subjects.

So then after all the testing was done I asked about getting a list of all the tests...she tells me that there will be a list along with the scoring on the final report but that neuropsychs dont like to give these test names out because they like to keep them secret so people cant just go and learn about the tests. Ok????? What does it matter after I take the test? I am wanting to find out what the tests test!

Then she really ticked me off....she said she really felt she might not ought to give me a report with all the details because I would just use that report to nit pick the report to death and come up with all kinds of awful things. She thinks that I will just use it to make myself feel worse. Uhhhh no...that isnt me. I do want everything I can get because knowing things gives me a better handle on where I am and what I can do but I use that knowledge as a platform.

This woman doesnt really know me from Adam's house cat. She doesnt believe I have borderline PD at all. Trust me if I say I do. I may not have all the symptoms at this time but I have enough of them...and I had many more when I was younger. Heck...I dont have ALL the symptoms of bipolar on any given day of the week! If she had just met me when I was fully medicated she probably wouldnt have given me any diagnosis...but she saw my medication profile and it scared the bejeebers out of her. She had never seen anyone on such high dosages of medications as I was on while in rehab and they hadnt even actually increased me to my full pre-hospital admit levels...lol.

I just find this whole thing kind of wacky. Why be so secretive? Why act like I am some loony person who cant be trusted with information about my own health care? She even said I shouldnt be given my own forms with my AXIS lists on them! If I wasnt given that info, I wouldnt be working with that agency. Noone better try to keep me out of my treatment team. It just doesnt happen. In fact, that is one of the most important key things to know about me IN my Person Centered Plan...lol.

Right in the Support section of my PCP it is written:

Janet likes to know all the facts about her treatment and will research medications and treatments to help herself and others stay informed about new and effective treatments to help meet her needs.
It is important to Janet that she is fully included in treatment planning and informed by all professionals. (she likes to have all the facts)

This neuropsychologist committed the cardinal sin of talking down to me. I would never go back to her again even if I felt I needed more testing.

 

[klmno]

Geez- I am aware that they like to keep the test names out of public knowledge- part of it for the reason she gave you and part of it because they are just plain arrogant, in my humble opinion. But the part about not wanting to give you- AN ADULT- a copy of your own report would royally tic me off. I hope you make sure she gives you a copy of it- and I think I'd ask for a copy of everything, just for the point of it. I think she's required by law to give it to you upon request.

My guess is that she's leary about the accuracy of the tests you took now that she knows you've check some of them out. But the secrecey thing drives me up the wall- another reason I don't want any court getting involved in any therapy of mine- they get like that- they demand they treat you but don't want to tell you what they are treating you for. LOL!

 

[Lothlorien]

Lawsuits...they are simply afraid that if they say something that you are offended by, you will sue them.

 

[klmno]

Another thought- if you aren't satisfied with her diagnosis or recommendations, you could take the test results to someone else and get their opinion. The actual results should be ok- her synopsis and diagnosis might be biased at this point.

 

[Hound dog]

Janet

You have a legal right to all test and results of those test. She can't keep them from you. If she tries, get a court order. Those results belong to YOU, not her. A patient has a legal right to access all medical records. Period.

Gawd! I hate it when docs cop an attitude. Makes your wonder what they're up to. Or at least it does me. lol

I've had a few attempt this with me. It doesn't work. I don't back down because I know my rights. Makes them furious with me. Oh, well.

Of course you want to know about the testing and results. sheesh How else are you going to know where you are now, and how much work it will take to get stuff back? What an idiot. Obviously this person has never delt with such a life altering thing before, she doesn't have a clue........doctor or not. humph!

Hugs

 

[DammitJanet]

Oh one more thing.

She said I shouldnt use "diagnostic" words for things that were wrong such as cognitive impairments or executive functioning problems. I should just describe symptoms. I used the word aphasia because I couldnt think of how else to describe what I wanted to say BECAUSE of my word retrieval problems and she jumped all over me on that one...lol. She said I dont have true aphasia so I should just say I have trouble getting my words out. Well...I have trouble getting my words from my brain to my mouth and sometimes what I am trying to think of doesnt come clearly and at that particular moment aphasia was what came to me. Im real sorry if I happen to know some medical terms!

I should say that I have problems thinking clearly, problems with remembering things instead of memory impairment I guess, and I have no idea what would be executive function problems would be. I guess just whatever those individual problems are. Things like I cant sequence things or whatever.

It really makes me wonder why there is this big no no on terminology. Its not like I dont know what things are. I have no doubt that I have some cognitive impairment from both the medications I take and the meningitis. Not to mention the fibro which has its own set of symptoms. I didnt even go there with her.

 

[klmno]

Ok, with that one, I can see her point a little. I see where you are coming from, too. difficult child's psychiatrist used to have to tell me (many times) to tell him exactly what I'm seeing in difficult child and not come in there saying he's showing a lot of depression or I think he's hypomanic. I found this very difficult at times because not only was it frustrating to have to go over difficult child's typical list of symptoms but I had to do it right in front of difficult child. difficult child is very sensitive to this stuff and to have to sit and tell psychiatrist that difficult child is crying at the drop of a hat while difficult child is sitting there- well, you can see where that goes.

Anyway, I found that writing the individual sppecifics down when I saw symptoms come out at home helped a lot. Then, I just took a list to psychiatrist and told him that when I say difficult child is depressed, this is a list of things I'm seeing. And here's the list of what I see when I say he's hypomanic. In hindsight, I can see where psychiatrist needed those specifics. For one, it would have been me diagnosis'ing difficult child otherwise and for another, sometimes the treatment approach is different depending on specific symptoms- especially when it's psychiatrist and different medications help more with different symptoms.

 

[Josie]

I just had a neuropsychologist evaluation. done on difficult child 2 and at the end of the report, it listed all of the tests with the scores. I tried to look them up online and couldn't find out much about them anyway.

Since she said the report would list all of the tests and the scores, I would expect that yours will, too. If she does omit this in your report, then you could go back and demand it. It might be easier to get your therapist to request it and then get a copy from her. It is annoying to have to do it that way but it might save you some stress.

 

[DammitJanet]

FOP...I have a feeling I wont be able to find out much either but her evasiveness makes me curious. I dont like it one bit...lol. See...I know what depression is and I know what hypomania is in me. If they want the specifics they can ask me. My regular doctors are fine with this. I know enough to go into unknown docs and attempt to explain this to them but this woman didnt seem to want to listen to me. Her attitude was one of "you couldnt possibly know all about psychology because you havent graduated with a masters"...argh. Well...I have had been inundated with psychology for at least the last 18 years of my life so I might just have half a clue.

 

[Fran]

Janet, diagnosing is the sacred cow of MD's and PhD's. No one can diagnose but those professionals. If you think of how insurance is paid and services are doled out, it is all based on a diagnosis given from the DSM IV(I think that is the recent one) Only doctors. can give that label so that insurance pays and services given. You must meet the criteria for the professionals to give us what we need.

I never, ever go in to a new professional with my diagnosis. I simply speak of symptoms regardless of what I know it to be. If I already think I have the diagnosis then why do I care what they think? Because I can't get services without they professional signature and they want to analyze the symptoms and come with the diagnosis on their own. I don't want to set up a defensiveness with someone who I need for treatment and services. Once you have a working relationship it's a little different.

Janet, you have every right to lead your treatment plan team regardless of how annoying this person is.

 

[Marguerite]

Janet, I've had to deal with psychologists and psychiatrists from a health professional point of view, as well as occasionally from a client point of view. And I share with you my findings...

1) With very few exceptions, psychologists are nuts. Paranoid, extremely. If they feel you're questioning them or challenging them, you get a reaction of, "What do you mean by that?" and you get slapped down. husband has actually studied psychology and commented that the lecturers were even more nuts, sort of along the lines of, "Those who can, do. Those who can't, teach."
I realise there are psychologisgts who are NOT nuts, please don't flame me for saying this. My observations are that increasingly, clinical psychologists (especially the younger ones) are much saner, much more compassionate and much more balanced. Especially this last. But older psychologists, especially those who are removing themselves from face-to-face treatment, are often the most paranoid.
Think of it in terms of medical practice - the doctors who have the worst bedside manner and the worst arrogance but who want to become specialists, become the sort of specialist who doens't have to ever TALK to patients. Either they are orthopedic surgeons, or anaesthetists (although generally, anaesthetists are in the business of trying to remove pain, which often means they really care about their patients) or the ultimate - they specialise in pathology. And from what I can work out, neuropsychology is as close as a psychologist can come, to being a pathologist.

2) A psychologist might start out sane and sensible, but over time and practice become more strange. Again, I've seen this in friends (mostly former friends these days) who I diverged from at uni when I studied more of the pure sciences while they went down the psychology path. It's as if the profession has, at least in the recent past, had a deleterious effect on the practitioners. They start out sane and slowly go nuts from the pressure of the job. All except the most balanced ones.

3) You then come to the group who studied psychology in order to better understand themselves. They are comparable to those who become priests because they want to strengthen their faith - and often end up with more questions about God than they ever thought existed. Studying psychology in personal self-awareness search is asking for trouble, because of all professions this one (as husband has observed) risks teaching paranoia, to people who may not have been so stable to begin with (ie the group who are aware they're not as balanced as they want people to think, and who are wanting to study psychology so they can learn how to fool more people, more of the time).

4) Older psychologists I have known, whose paranoia has been most obvious to me, have tended to react the most when they feel under personal attack. The sort of questions that would make them feel personally attacked:

"What do you do for a living?"
"Tell me more about yourself."
"I want you to explain this facet of your work, in detail, because I want to copy all your ideas and make money for myself from them."
This last is what I beelive they are terrified they will one day hear, and as a result they hear this often, even when it is not uttered.

One final really important point - the more you apply psychometric testing, the more suspect and unreliable are the results. Someone whose job it is to do these tests - they make their money from doing the tests but always have to guard against over-testing. This is a contradictory position, which of itself can send a sane person nuts and make them paranoid. But I digress - those who do the tests really do worry at the effect caused by too much knowledge in the test subject. If they suspect you have acquired that knowledge through being over-tested, then it means their efforts are a waste of time. And even if you yourself weren't being tested, if you were sitting in on your child being tested then you will have been exposed to the test, which makes you think about the test questions so when YOU get tested, you've been pre-warned, so to speak. You've had time for the answers to be found by your brain, either because you remembered to look a word up in a dictionary, or when you next came across a word you took extra note of it and so found an answer which otherwise you wouldn't have found.

Psychometric testing is NOT exact. I do strongly feel that often there is far too much made of it. However, it IS very much of value, if applied correctly.

You need to stop and consider how these tests were developed, underwhat conditions, using what subjects, and for what purpose. The uses these tests are put to these days often stretch these boundaries to beyond breaking point. This leads to conclusions being drawn which can be leading you down the wrong garden path.

Example - people describe certain conditions such as Downs Syndrome, as being characterised by having an IQ in the mild to moderate mental retardation range - IQ 30 to 60, according to one website I just found. Now, my recollections have mild mental retardation (ancient and now outdated term) as being about IQ 80 (upper range). Average IQ is supposed to be 100. It's called Intelligence Quotient because it represents mental age divided by calender age, multiplied by 100. Purely by definition, average will be 100 (mental age = chronological age). Knowing this, a series of questions was devised and then applied, to a large number of children. But which children? Which people were tested? Since these tests were developed at a very different time socially (a time when children with even high-functioning autism would not have been in the tet group, certainly not in the numbers we have now; and at a time when most children with various disabilities, including Downs, would have been in institutions) then how valid are the tests applied to them?

It was AFTER the tests had been allpied to so-called "normal" kids, that it was then taken into the institutions and applied to kids living there. But think about life in an institution in the 30s, 40s and 50s - what sort of access to education has there been? WHat about mentla stimulation? WHat about traumatisation? Institutionalisation? How valid is it to say, "Children with this or that condition are generally in the moderate mental retardation range"?
Children with cerebral palsy were also often placed in institutions. These children may have been severely physically handicapped, unable to speak and in the past were not given access to education. How, then, can you apply tests to these children? Once people began waking up to themselves, they went in and changed the way things were done, and found that contrary to previous opinion children with cerebral palsy were NOT automatically "mentally retarded" but were often, in fact, perfectly capable intellectually. At least, as capable as the next person.

Psychology as a profession is still dragging itself out of these dark ages. There is a sense of collective guilt adding to the paranoia, at least in some older representatives of the profession who still have their influence on the game because many of them now teach the courses.

This is going to sound like I'm bagging psychology as a profession - I don't mean to, I'm only reporting what I have observed. Until I worked out what was going on, it was really bizarre at times, some of the people I had to deal with and work with. So often I would be coping with a work colleague behaving very strangely towwrds me, being paranoid if I offered to help with anything (including making acup of tea) and once I realised the person was a trained psychologist, it all made sense.

As I said, maybe this is changing now because younger psychologists I've had dealings with, have certainly seemed much more 'normal' and I've not noticed any paranoia lately, except in the occasional older psychologist.

But I'm an older person myself - people I know socially include qualified psychologists. And of those my age - only one or two aren't a bit 'odd' in their reactions to people, and when it comes to reliability - downright bizarre.

So my advice - if you have questions about the test process along the lines of, "Can we take a break so I can get acup of coffee?" then there should be no problem. But if you ask, "How do you spell the name of this test so I can go buy myself an illicit copy so I can study it in detail and fudge all future results and thereby get into the record books as having an IQ of 7000" then expect a VERY explosive paranoid reaction.

Marg

 

[DammitJanet]

Number one I have never self diagnosed. Even with all my physical problems I have been extremely careful not to go into doctors and tell them what I think I have. I will go in and tell them symptoms and ask them if they think I need a test for something and if they think it is possible that I have XXX but I dont come out and say I am sure I have it. I also dont go in and list the mental health things like I am reading from the diagnostic criteria for some diagnosis. I dont go down and say I have grandiose ideas, racing thoughts, pressured speech, etc. That just sounds like I am reading a list. I let my therapist get to know me and she can see that I have these problems. After a time it is obvious.

 

[WhymeMom?]

I don't have much experience with neuropsychs, but from what you posted here it sounds like she is suspicious that because you are so familiar with "terms" she thinks the tests could be skewed, so all the time you/she have taken could have been wasted and the results may not give a true diagnosis. Since the diagnosis is based on conclusions of how you performed on tests it would greatly reflect on her if she doesn't have valuable information from those tests. Because you knew about the color test you knew what to look for when taking that test.

This is just my opinion, but I can see her not wanting to tell you the test information until the results are complete...... just in case you needed to retake anything....... If the tests are not listed when you get results, then I would take it to the wall........ I do think she doesn't know you, so there is no trust built into your relationship with her.......

 

[DammitJanet]

True Whymemom. I did tell her before we started that color test that I had seen it before....and where. So she did have the option of not giving that test to me. I didnt hide anything from her. With any of the tests, if I even suspected I had seen the tests given even with my kids, I told her.

 

[DaisyFace]

Janet--

I think your doctor is just afraid that you are going to "look behind the curtain"...

The answers to your questions reveal her own feelings of in-adequacy....a low sense of self-worth.

Not your problem....you still have the right to your own medical records.

However, if you value the feelings of your doctor, perhaps next time you see her you could "butter her up" with a few compliments about her wisdom and professionalism?

--DaisyF

 

[klmno]

Janet, I don't think you are diagnosis'ing yourself. I just think she needs some specific symptoms to write down to justify a diagnosis. I know they should be able to see them, but when it's not something that gets revealed in a written test, I don't think they all are as smart as we hope sometimes.

 

[timer lady]

Janet, I had a neuro psychiatric at my recent hospitalization. I couldn't believe what that woman who had no clue of who I am or how I operate diagnosis'd me.

The neuro doctor who ordered this had no clue who I am, neither did any of the treating doctors.

Having said that, my therapist, my neurologist, my GP, my rheumatologist basically blew this woman out of the water with her diagnosis & her prognosis. My therapist called her & read her the riot act.

It doesn't bode well for my application with SS if they get hold of this report. Unfortunately, SS is asking for all the reports of recent clinics, hospitals, & doctors I've had contact with over the last 3 years. Her report is included. I fear SS will naysay Mayo Clinic's diagnosis & listen to this newly graduated neuropsychologist.

You have my most sincere empathy, dear.

 

[Marguerite]

The answers to your questions reveal her own feelings of in-adequacy....a low sense of self-worth.

Yep. Paranoid psychologist. That's my diagnosis.

Janet, sometimes we feel there's nothing we can do or say that doesn't antagonise some people. It took me a long time to realise, it wasn't my fault. There are people in the world who I DO get on with well, so anyone who is prickly, defensive or touchy - I shrug my shoulders and move on. If I need them in my life, I try to avoid antagonising them. If I can't, I simeply reduce contact time where I can so I don't have as much chance to upset them.

What else can we do?

Marg

 

[Hound dog]

Marj

Your observations are some of the same ones I've had over the years. I worked a psychiatric unit for 2 yrs before husband and I were married....and of course all the experience with family members and my own difficult children gave me even more exposure.

Travis' first neuropsychologist was a nut job from the get go. Even his neuro was upset at the report. So we got a 2nd opinion from a (in my opinion and neuro's opinion) much more objective neuropsychologist and got a more accurate report.

I've gotten so I can peg them pretty quickly. And I've also noticed the younger ones aren't quite as bad as the older ones. But you get a few bad apples in every bunch.

While working psychiatric I had one psychiatrist who used to get so frustrated at his colleages. He warned me way back then to always be wary of psychiatrists and psychologist because 3/4 of them were bonkers. lol

Janet, I think Marj is right. This lady is just more than a wee bit paranoid. My worry with this would be that with her reaction and attitude........how accurate will her testing actuallly be.

Hugs

 

[Marguerite]

Lisa, I've had even the wacko psychologists do decent reports, so there needn't be a problem there. Where I've had problems with their reports, is when they insist on sticking to the rules at all costs and not be even a little bit flexible. For example, difficult child 1's first assessment was done by the school counsellor (without my knowledge or consent). I got told about it in a meeting a few hours later, the school counsellor told me how anxious and increasingly fidgetty difficult child 1 had been (he was 6 years old) and that he eventually was fo fidgetty that she couldn't continue with the test. However, she still scored the test as if he had completed it.

Now, the way the scoring is supposed to work, is the subject has a time limit (in some of the sub-tests) and the subject works fairly solidly during this time, thinking and answering, until the time is up. In my opinion a tester should make a note of it and take it into account, if the subject simply chooses to not comply, or ceases to participate. The time at which participation stops should be noted and scored accordingly. At the very least, that particular sub-test should be considered invalid, rather than scored as if the subject was working solidly and diligently the whole time.

In difficult child 1's case, the school counsellor's testing process and her entire approach was so off-putting and intimidating for difficult child 3, that he was unable to properly be tested. But her report failed to mention this at all - I only knew that he had failed to comply because she told me verbally. Any attempt I made to suggest this however, was met with extreme hostility.

Also something we've had in our system until VERY recently - psychologists would send reports, but never send or include the individual sub-test results. They could justify this on the grounds that the specific sub-test results were NOT the property of the subject, but of the tester. Like medical records, you may be entitled to a summary of your health records but the doctor owns the detailed notes and can keep them from you if he chooses.

We got around the problem of the sub-test scores not being released to "lay people" (again, pure paranoia in my opinion, translated into industry standards across the profession which allowed the paranoia to proliferate and perpetuate) by cultivating a tame professional (in our case, difficult child 1's current psychiatrist/psychiatrist/pediatrician) who requested a copy of the detailed results for his own use, then photocopied them for us. Those particular results were a difficult child 1 test result from high school, when he was 15.

So don't immediately dismiss the anticipated report from this person, she may actually do a good job. She may simply be being thorough and concerned that your knowledge indicates possible over-testing with subsequent invalidation of certain tests; or the possibility that in the future, too much knowledge gained through her, could invalidate future tests. She may just be being a tad over-zealous in trying to protect her profession and others who practice it. Again - paranoia fodder.

Don't sweat it too much - the trouble with letting it all get to you, is you risk becomeing as paranoid and introspective about it as she is, and therein lies the danger of going round in ever-diminishing circles until you disappear up your own fundamental orifice. As she and so many others of her profession seem in danger of doing!

Marg