Many of us with mental health conditions know that the same symptoms can be interpreted differently from one doctor to the next.
Practically, this creates obstacles for ADHDers seeking treatment. It might mean that you have to see multiple doctors before you get the right diagnosis.
It also makes having to switch doctors potentially a big deal. If you move to a new city, or (in the US) get a new job with new health insurance, that can raise questions about how your new doctor will continue your treatment. The more you have a documented history of successful treatment for a mental health condition, the better your chances of being able to continue that treatment with a new doctor, but it’s not a given.
Inconsistency in how diagnosis is handled across doctors is a real issue for ADHDers, which is why I was happy to come across a recently published study titled Variation in Rate of Attention-Deficit/Hyperactivity Disorder Management by Primary Care Providers.
As the title suggests, the study looked specifically at rates of ADHD diagnosis by primary care providers, who are often the first medical professional that potential ADHD symptoms get raised with. The study also focused on patients between the ages of 4 and 17. However, based on my experiences, I would bet good money that the issues brought up in the study are also relevant to adult patients and medical professionals who specialize in mental health treatment, such as psychiatrists.
In the study, researchers at Stanford University School of Medicine tracked over 40,000 patients who saw their doctors at least twice over the course of two years. In total, about 5 percent of those patients were diagnosed with ADHD, and a little over half of diagnosed ADHDers were on meds.
However, rates of ADHD treatment varied considerably from one doctor to the next. While the average doctor was involved in managing ADHD symptoms for 3 percent of patients, that figure was anywhere between 0 percent and 8.3 percent for any given doctor out of the 73 who were included in the study.
It’s worth noting that those numbers are for ADHD symptom management, not diagnosis per se. So, to be fair to the doctor who was treating not a single patient for ADHD, it’s possible that doctor did have some patients diagnosed with ADHD and just wasn’t treating any of them!
Obviously, though, these numbers point to a lot of variation in how different doctors interpret and treat potential symptoms of ADHD. In fact, the researchers estimated that characteristics of individual doctors explained 28 percent of the variation in which patients were being treated for ADHD. And keep in mind that this study looked at one health network in one place, so if you zoom out across health networks and locations, there’s quite possibly more variation between individual doctors.
This study highlights why you can’t make generalizations about ADHD being overdiagnosed or underdiagnosed. Realistically, ADHD is probably underdiagnosed by some doctors and overdiagnosed by others – although the authors of this study suggest that underdiagnosis is more common than overdiagnosis.
You can add to that the fact, separate from this study, that ADHD may also be underdiagnosed in certain types of patients and overdiagnosed in other types. Put all this together, and you have to seriously entertain the possibility that the biggest problem is not underdiagnosis or overdiagnosis per se, but inconsistency in how ADHD is diagnosed.
I’d say that the results of this study are discouraging, but to me they aren’t because they shine a light on something I already suspected to be the case. Actually, this study is encouraging because it suggests researchers are starting to pay more attention to the problem of wide doctor-to-doctor variation that has tangible effects for ADHDers.
I’m not sure what the best solution to this problem is, although more research on ADHD diagnostic practices and training for doctors in this area can’t hurt.
In the meantime, those of us with ADHD have to navigate an imperfect healthcare system. On our side of the equation, the biggest takeaway here is probably that doctors aren’t all the same, and that a statement made by a doctor is not necessarily objective truth.
We have to keep in mind that, when seeking treatment for the first time or switching doctors, sometimes it’s necessary to get a second opinion. Sometimes it takes time-consuming research, or trial-and-error, to choose the right doctor. That can be a major inconvenience, but it’s worth it to find a doctor who is able to adequately address your symptoms.