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Having been at my job for thirty years (!) I’ve seen lots come and go in matters of hypothesis, diagnosis, treatments, and such. They have their time and then discarded. This isn’t a bad thing. Science and Medicine are constantly evolving, especially in my speciality.* Thanks to the internet, pop diagnosis and treatments come at fast pace compared to the 90s. I get more and more folks coming in not asking ‘what do I have’ and ‘what can I do about it’, but ‘this is what I have and this is what I need”. It makes me feel like a glorified waiter. ** A lot of my job is education, trying to convey what they do have/don’t have and what’s to be done about it. Here are few ‘diagnosis” coming in on a regular basis I thought I would write about.

“I have PTSD [post-traumatic stress disorder].” This has become a collect-all condition for anyone who has had a traumatic event. The bar seems to have lowered by society what constitutes PTSD and what causes it. I try in a nice way to educate patients having a bad break up or the loss of a loved one or a business going belly up is sad and traumatic but not necessarily ‘PTSD’. Other matters to be mindful of is the notion all trauma leads to PTSD and all cases of PTSD are permanent. Neither are true. Soon after a really bad event, I assure folks their ASD (acute stress disorder) this doesn’t mean they will have PTSD in time. When appropriate, I describe a concept nicknamed PTGO: “Post trauma growth opportunity”: you were given a nasty knock no one would wish on anybody, but choice-less you have the choice to learn something from it and grow. In the end there is some truth to the notion ‘what doesn’t kill us makes us stronger” – modified as ‘can make us stronger”.

“I have imposter syndrome.” This is an example of a lay-diagnosis I have to figure out what does the patient mean when they say they have it. They usually explain they feel a complete fraud at what they are doing and if people really knew the truth (as the see it) they would be out on their butts for the shams they know they are. There are a few dangers to this one. First, I don’t like people summing up their being by a disorder. I learned this early with AIDS. People went from ‘AIDS patient” to ‘living with AIDS” and this makes a big difference. I hear similar when a patient says ‘I am bipolar” or “I am borderline”. I try to get them to start saying ‘I am someone with bipolar type depression”. With imposter syndrome, I get them to say “At times I feel an imposter in what I am doing.’ I educate everyone feels this way to some degree (discounting narcissists and psychopaths); this is a human emotion. Emotions are not who you are, but something you experience. There is a sort of poor logic to the imposter syndrome. You doubt your abilities but you are certain your view on it is certain? I point out despite what you feel, you are surrounded by others who don’t see you as an imposter – so are they all duped dummies? Better to say I don’t feel certain what to do and that’s OK and not a summary of who I am/capable of and proceed to solve the situation showing the world and yourself what you feel isn’t what you fear you are.

“I have ADHD (attention deficit hyperactivity disorder).” Oh the pain. Many people coming in with this self-diagnosis do have some ‘wiring’ but this is never a black/white yes/no scenario. More important to ask is the question: do your ADD traits actually interfere with love/life/work? If so, then it is a disorder. This can vary in time and context. People erroneously believe if it is a neurological matter, medications are necessary. Not so. Some form of counseling A.K.A. “ADD coaching’ can do a lot as can changing the context. There is nothing wrong about a square peg until you try putting it into a round hole. Maybe the solution is the alter the hole.

“I’m an introvert.” Folks come in all the time announcing this like a horoscope or this somehow makes what the can/cannot do***. Look, no one is ‘introvert’ or ‘extrovert’. We are a mixture of both types of relationship traits, and this changes over time and to the circumstances. What I find important to ask is ‘where do you go to recharge yourself?” if the answer is ‘stay home and read a book” than do so; if you say I go out with others to a social gathering” than do so. Stop putting yourself in a box with presumed expectations how you should be.

*My best friend from medical school is an obstetrician. Birthing babies hasn’t changed with time; it is pretty much the same as thirty years ago, which she likes. We both like to say to each other I cannot imagine how you do your job.

**I have a mug with the inscription “Do not mistake your Google search for my medical expertise”

***Few if any come in announcing they are an extrovert. Thems who have predominantly introvert-like tendencies sometimes feel this is wrong, while them with extrovert seldom if ever they wish they were introspective.

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May 2022

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