Diagnosis: Are doctors full of crap?

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I think most people really don't care whether they do a good job. They go to college to get a job (and probably party and come to class hung over the next day) then just do what they have to at work to get a paycheck. I don't think doctors are any different. You go to 3 different doctors, you're likely to be diagnosed with 3 different conditions. You have no way of knowing whether your doctor got straight A's or a D- in every class so why should they even bother studying hard in medical school since it doesn't make a difference because no one will ever know?

To be fair, I don't think Asperger's became a diagnosis in the US until 1994 so many doctors were never taught it in medical school and there's really no incentive for them to keep up with the latest information since most people have health insurance which means endless referrals especially if you're forced to use only network doctors.

If I wanted to be a doctor, I'd study hard to help my future patients even though it wouldn't help me earn more money, but I'm sure most people don't think that way.

Kanner's original criteria is really like the [possible] current criteria for Asperger's, age of onset is the defining factor (<3 years of age).

A severe lack of social contact and repetitive behavior (lining stuff up, spinning the wheel of a toy car, watching the same TV show over and over again for example) were his.

God, do I know this all too well.

I'm sorry to say I'm going through much of the same problems. Medication is a huge deal with me right now.

From a doctor's perspective, there really isn't much they can do about AS, but there is with ADHD, bipolar disorder, OCD, social-anxiety disorder and even schizophrenia, at least by writing a prescription.

Do any American health insuarance companies even cover AS?

It's the usual system's runaround, something we've all had plenty of problems with throughout our life. Of course there are those few exceptions in the case of doctors but unfortunately if insurance doesn't cover it leaves people with well to do parents to have access to this first.

Some doctor's are just as*holes as well. There are plenty who will refuse treatment or give you half assed treatment if they even suspect that you might be a drug addict. Sometimes just having a body piercing or tattoos is enough to make them think this. Although this is against medical ethics and the Hippocratic oath, it still happens.

Here's the criteria that those at Attwood's use to diagnose people (it took them several minutes to say I had AS when using this one):

According to that list, I have Asperger's. What a flipping surprise.

Colin, sometimes doctors don't know much. I've twice now done my own research and figured something out before my doctor did, and both times I was right. Fact is, the doctor's an expert on medicine, but he isn't an expert on YOU. That's the part you have to bring to the table. You can't just sit there and let the doctor do what he likes; you have to insist on participating in your own diagnosis and your own treatment; and if the doctor doesn't like it, then chances are he shouldn't be practicing medicine. A good doctor will want your perspective, your opinion, your experiences, because that's the part of the diagnosis he can never figure out for himself.

There are no medications for Asperger's, as you probably already know. Medication can be somewhat helpful for peripheral symptoms (depression, anxiety, attention-deficit issues, sleep problems, etc.), but the autism itself is not a psychological problem. It's a neurological problem that has to do with how your brain developed before you were born and in your very early infancy. The best way to deal with things of this sort is to use medication as a tool to help the core treatment--which is education and therapy. If you're an autistic person, your best bet isn't to go medication-shopping, but to go and find out where your strengths and weaknesses are, which problems you're facing, and how to find the solutions or the assistance you need. It's very much a practical process.

For example, let's say you have problems shopping because you get choice overload. Your doctor, who's in love with medicine, may want to prescribe an anti-anxiety med; but what you really need is more like an occupational therapist who can teach you how to make those choices more quickly, or how to decide in advance; or how to limit your options so that things are easier for you. There are many issues like this which respond much better to education than they ever will to medicine; but there are many doctors who, having a hammer, see only nails (a metaphor which means that since they know how to prescribe medication, they believe that most problems should be solvable by prescribing medication). Advocate for yourself; don't just let your doctor prescribe more and more medication. There's much more to autism treatment than meds.

My opinion is, that the crap factor comes in, when the specialist tells the parents, not to expect their child, to get very far, in life. That's my interpretaion, of the crap factor.

Speaking as a physician, I think it's important to note many of the presentations related to ASD's are not "medical" problems, per se. Often GPs are looking for the medical issue, and don't really see the larger issue, because they are focussed on the immediate issue.

A secondary issue is that GPs are the gatekeepers to the specialist system. GPs must exercise judgement about when a patient presents symptoms that merit the attention of a specialist, and when they should stay at the generalist level. When dealing with unfamiliar issues, GPs will sometimes get that call wrong.

We are fallible people, who are limited by our training and our experience. The best physicians know this, and bring to their work a open and curious mind. But the framework of the medicine business model doesn't encourage this and makes little allowance for it.

Yep. Once you get to the point of post-graduate stuff, there's just too much to learn for you to specialize in everything. It's simply impossible for one person to know about everything. I learned that this summer, working with grad students and post-docs in a gene therapy lab; we were all specialists in our own areas, and we had to teach each other if we wanted to learn about each others' areas. We couldn't be expected to learn all of it; there's simply not enough time in a person's life. Even the primary investigator didn't know everything... and for that matter, I brought my own specialty (image analysis) that they didn't know a whole lot about, and I'm only an undergrad. It's not that we were incapable of learning each others' subjects--just that there are too many specialties for anybody to have a prayer of learning them all.

That's another reason that most doctors can't be expected to know about autism. Yes, it's not some kind of ridiculously rare thing; but there are a so many other diseases and conditions that if your GP specializes in a handful, he'll have to do it at the expense of ignoring all the others. The only thing he can really do if you have something that isn't in his field is learn whether your symptoms are bad enough to warrant attention, and then determine which specialist to send you to.