Dr. Jain, please explain why you disputed another Dr.'s diagnosis of ADHD

[caper]

“Dr. Jain does not believe that Dr. Blouin established a proper A.D.H.D. diagnosis or indeed, any other diagnosis”

When I was reading this I felt shocked, confused, disgust, and a bit angry. It seems in this case Dr. Jain is fighting AGAINST someone with ADHD. He refers to impulsiveness as a separate diagnosis from ADHD, yet on totallyadd.com he’s mentioned nothing of the sort.

read from [22] on

http://www.canlii.org/en/on/onlshp/doc/2011/2011onlshp34/2011onlshp34.html

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[caper]

Adding to what I’ve already said, Dr. Jain’s insists that an ADHD diagnosis (in an adult) must use the DSM 4 criteria (which includes hyperactivity).

Dr. Barkley unequivocally states that hyperactivity is “of no diagnostic value”.

http://www.youtube.com/watch?v=Q6jeWwRQRaE

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[Wgreen]

Well, under normal circumstances, I would imagine patient-doctor confidentiality rules might preclude Dr. Jain from answering a question like this. But he testified in open court (which would seem to waive confidentiality.) Still, I’m not sure it’s pukkah for a psychiatrist publicly to discuss, much less defend, any individual diagnosis. But, of course, I’m speaking out of school.

Having said that, this case you dredged up certainly illustrates one thing: that “expert” opinion is just that—opinion. Nothing more. Here we have two credentialed doctors examining the same evidence, then reaching two completely different conclusions.

After the lively debate on “ADD: gift or curse” we just had on a different string, I went back to read David H. Freedman’s book, “Wrong: Why Experts Keep Failing Us — And How to Know When Not to Trust Them.” The book had its genesis in a conversation the author had in a Boston coffee shop with John Ioannidis, a doctor, researcher, and expert statistician whose specialty is calculating the chances that scientific studies’ results are false. (He does a lot of work for drug companies and the National Institutes of Health.) His work has revealed that most (2 out of 3) scholarly studies come to erroneous conclusions. By extension, he posits that most “experts” are simply… wrong. http://www.nytimes.com/2010/06/11/books/excerpt-wrong.html?adxnnl=1&adxnnlx=1313877335-dI7Hhu9eoXGpnPpZQq5hrQ&pagewanted=1

From the book’s introduction:

“The facts suggest that for many, if not the majority, of fields, the majority of published studies are likely to be wrong,” [Ioannidis] says. Probably, he adds, “the vast majority.”

Medical and other scientific expertise aren’t exactly the bottom of the barrel when it comes to expert wisdom. Yes, much-heralded drugs get yanked off the market, we get conflicting advice about what to eat, and toxic chemicals make their way into our homes. But you don’t have to dig far in pretty much any other field to see similar, or worse, arrays of screwups. I could fill this entire book, and several more, with examples of expertise gone wrong — not only in medicine but in physics, finance, child raising, the government, sports, entertainment, and on and on. […] The fact is, expert wisdom usually turns out to be at best highly contested and ephemeral, and at worst flat-out wrong.

Of course, compiling anecdotes and quoting experts about expertise doesn’t prove that experts usually mislead us. Actually, proving expert wrongness isn’t really the point of this book. I’ve found that most people don’t need much convincing that experts are usually wrong. How could we not suspect that to be the case? We constantly hear experts contradict one another and even themselves on a vast range of issues, whether they’re spouting off on diets, hurricane preparedness, the secrets to being a great manager, the stock market, cholesterol-lowering drugs, getting kids to sleep through the night, the inevitability of presidential candidates, the direction of home values, the key to strong marriages, vitamins, the benefits of alcohol or aspirin or fish, the existence of weapons of mass destruction, and so on.”

So. There we have it. When it comes to coping with our problems, it appears we’re basically on our own. That should brighten up our day! I think I’m going to go lose my keys, lose my temper, and bump into a wall…

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[Anonymous]

Yes, agreed……..doesn’t this lead right back to the Barkley “Gift / Curse” discussion……..very nicely.

I am as always, convinced, we, each of us, is ‘the” expert…….on our selves, regardless of what else is said or printed, statistically, scientifically or otherwise. We also differ as much as we are similar……we keep attempting to discuss commonality, or, differences where there is so much uncommon data (via human chemistry & experience)……we might be better using shoe size as a starting point?????

But…….I enjoy the conversation, camaraderie and debate……so I ain’t goin’ nowhere.

toofat

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[Wgreen]

@Toofat—yes it does dovetail nicely into the gift/curse debate. But it has much broader ramifications, don’t you think? It means “new science” may have the same materiality as, say, astrology. Most people long ago dismissed astrology as myth. (Increasingly, theology is being relegated to the same category.) Educated people are taught they should put their “faith” in science. Ioannidis is saying most new science is a myth, too. So where does this leave us?

And why should we then care what ANY “expert” has to say about ADD/ADHD? After all, they’re apparently more likely to be wrong than right. So we’re left with only our own experience and intuition—which may be entirely different from the next guy’s. Maybe you’re okay with that. I was really hoping I could find some objective answers. If Ioannidis (who btw was a math prodigy) is right, and his analysis correct, we’d all be better served by flipping a coin when we want to know something about ADD. That way, we’d have a 50/50 chance of arriving at a correct answer. That’s better than the 33% chance we’d have by asking an academic or clinician.

And I guess we should all stop listening to global-warming researchers, economists, social scientists, and…well, you name it. It sounds like we’re left with absurdism or nihilism. Take your pick.

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[Tiddler]

This sums it up for me:

Dr. Jain wanted clarity. He was initially distressed that Dr. Blouin appeared to be refusing to produce testing that would have provided more clarity, until he found out that it was Mr. Lyle’s lawyer who had called a halt to the additional testing – not Dr. Blouin…Dr. Jain’s concern is that an early diagnosis has merely been carried forward to adulthood, without the proper adult evaluation having been made.

I disagree that Dr J is fighting against someone with ADHD. Instead, he’s fighting against a situation that could be causing harm to a person with some symptoms of a problem that haven’t been looked into properly because a lawyer has stepped in to prevent further testing taking place.

Number 35 was also important:

None of those treating or diagnosing Mr. Lyle followed the DSM 4 categories of diagnosis recognized as being authoritative. Everyone just assumed that an earlier A.D.H.D. diagnosis was correct. They assumed that because of his conduct, he must have A.D.H.D. …To definitively diagnose A.D.H.D. one must apply the DSM 4 criteria. Dr. Blouin did not do this. As a result, there could be any number of other diagnoses that are more appropriate.

The original adult diagnosis was not really a diagnosis. It sounds like it was assumption based due to conduct. What if there’s another issue going on that is not being resolved because he’s being treated for the wrong thing?

And if there are incorrect assumptions being made, I want doctors to be able to stand up and question them. I know from personal experience how damaging incorrect diagnoses can be and how medical staff can close ranks and refuse to allow patients to challenge problems. (For example, crucial records ‘disappearing’ that drag out medical negligence cases.) So I’m heartened by this example of sensible questions being asked by another doctor to ensure that appropriate care is given to patients and to ensure that lawyers don’t get to make medical decisions.

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[Tiddler]

Okay, that helped me avoid the pile of washing up for an hour! Thanks for that!

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[Anonymous]

Interesting Wg……I think you already understand where I come from on “Experts”……..but, I’m not hard on all experts, that’s for sure.

Soft sciences are just that, they are soft, and involve as much art, as science, and maybe more actually. The Psychology community is desperate to be acknowledged by the “hard science people” and are trying to distance themselves from the soft side of psychology, to chemistry, hence all the new latest human chemistry studies…..but so far,to date, a Chemist would likely refer to a Psychologist or Psychiatrist as a voodoo doctor, not a person of science..(maybe a little harsh, but not much).

Example……the brain is a vast unknown, while dissecting a rock and knowing “exactly what it is made of” is considerably more concrete (no pun). Now consider the variables that affect us, and our development. These variables start generations and generations before we are borne…..how does one measure that, or factor it in??? That does not include the stimulus, once we are borne……jeez, the permutations and combinations are staggering. If one ever did capture that criteria how would you ever establish it’s impact on the brain, give it credible weighting????? ART????? Science???

Science likes to tell us they are close to replicating a brain, or at least artificial intelligence….sure……ready to do a transplant!!!! My gawd think about it. Science hasn’t scratched the surface of the human brain, or human make-up.

My thoughts have always been you wanna know what’s going on in there, get a guide be prepared to spend years and years working on yourself….maybe if we are diligent and perSEVER……..we, as individuals can understand who we are and who we aren’t as individuals maybe even change somethings we never were, and become content with ourselves and live out our short time with no regrets?????

Oh by the way, climate change…..I can tell when my popsicle is melting….don’t need an expert to confirm that observation.

toofat

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[caper]

“I am as always, convinced, we, each of us, is ‘the” expert…….on our selves”

So what is your solution for the courts, schools, etc. where someone of “authority” evaluates us?

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[caper]

Wgreen: I would add emphasis to NEW in “new science”.

Much of basic chemistry (atoms, molecules, chemical reactions) is now in the realm of undisputed fact.

Much of astronomy (earth revolves around the sun which is in the milky way galaxy, etc) is also undisputed fact.

New science like cosmology (dark energy, multi-verses, etc.) is likely to be proven wrong in the next 50 years.

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[caper]

Tiddler: Dr. Jain was disagreeing with the diagnosis of ADHD. The patient was content with that diagnosis. Dr. Jain instead was suggesting a diagnosis of “impulsivity”. Impulsivity is one of the 3 DSM criteria for a diagnosis of ADHD, and as I pointed out the hyperactivity component is of no diagnostic value in adults.

Dr. Jain knows that impulsivity is a key component of ADHD (in my case I feel it is the most negative aspect of ADHD), yet he lied and said the impulsivity suggests something other than ADHD. I think he did that because he was paid to dispute the ADHD diagnosis.

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[Anonymous]

Before we jump to conclusions, let’s give Dr. Jain the benefit of the doubt. This was a lawyers disciplinary hearing, I used to work for a disciplinary board in law school, and I can tell you that, at least in NY, many of the facts are either omitted or coaxed in the formal, public document. More importantly, we’re talking about lawyers writing about ADHD, not doctors. They’re liable to missinterpret some nuances in the discussion.

We don’t know the full facts, but it seems that Dr. Jain was called in to give a second opinion and simply wanted more clarity.

This isn’t about someone getting meds or something, but blaming their ADHD for unprofessional conduct. That should be a higher standard.

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[Anonymous]

Ok??? Somebody reel me back in, please….ADHA…… Dr. Jain….testifying…..court….unprofessional conduct??? I musta just fallen off the cabbage truck, where did this come from????

duh……….

toofat

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[Geoduck]

Okay, so we’re all ADD here, so did anyone read the WHOLE thing? And you probably won’t read all of this post, either. LOL!

I ended up reading the whole thing (last bit of meds working in me…or I’m perseverating…like how I linked that in?). Taking any of this out of context is dangerous, as far as comprehending the situation goes.

First to address something previously posted: Just because someone is paid by a lawyer to testify, does not mean that person is immune to being charged with perjury, which in costs, would really not be worth the effort here. Actually, my husband was just called on to testify in a case involving the weather. Hubby DISAGREED with the lawyer’s argument, and was still paid. You get paid whether or not you even testify, let alone whether or not you agree with the lawyer. At least that’s how it works here. Admittedly, I don’t know much about the Canadian justice system.

Now to the subject of the thread: If you look earlier, you see that this guy stopped the testing, so it’s clear why Jain couldn’t agree on the diagnosis. You can’t agree on something, at least in an official setting, unless you have some sort of set criteria. This is what the gist is of what Dr. Jain said (from different sections):

“He says that Dr. Blouin’s diagnosis may be wrong, and if so, the treatment may also be wrong. The cause of Mr. Lyle’s behaviour may be some other undiagnosed condition that may raise its head in the future and result in a repeat of similar, unacceptable behaviour that will get Mr. Lyle in more trouble than he is in now, as a repeat offender.”

Unless you interviewed the guy, you don’t know if he had ADD. Really, all you would have to go in is the records of the physician who did interview him, but never finished the testing process.

The following regards his own physician, Dr. Blouin: “Dr. Blouin was very candid in his recognition that not all the symptoms exhibited by Mr. Lyle were consistent with A.D.H.D. in adults.”

Further in the same section (note the word “probable”):

“Moreover, some of the symptoms were consistent with post traumatic stress disorder, but not all. The diagnosis of adult

A.D.H.D. was difficult to make because not all symptoms were consistent with it, but when Dr. Blouin factored in all of the symptoms exhibited and as detailed in the Agreed Statement of Facts, he was satisfied that the probable and most descriptive diagnosis was

A.D.H.D.”

Here’s the kicker: “He also acknowledged that he had not used the diagnostic criteria for Attention-Deficit / Hyperactivity Disorder (Exhibit 4), in DSM 4, which was the authoritative diagnostic yardstick for A.D.H.D.”

Impulsiveness just does not equal ADD. One symptom does not a diagnosis make. The guy also was exhausted and overwhelmed, drank heavily, and supposedly also had PTSD, which both (well, if you’re an angry drunk) can induce symptoms of anger and acting out in the manner described in the document.

Of Course, Dr. Jain is human and could have screwed up, but looking at the link you posted, it looks like he made the right testimony given the evidence available. I sure as hell wouldn’t hire this guy for my lawyer until he got a proper diagnosis.

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[Geoduck]

OMG, I’ve wasted an hour. Damn. I gotta stop posting in these forums. This is more distracting than facebook!

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