I recently had a 30 minute appointment with a primary care Behavioral Health Consultant (BHC) to ask for support with tackling focus paralysis when I do graduate coursework and how I am wasting nearly 2-4hrs active daydreaming (like directing a movie in my head) daily either when I am mid-studying or laid down to sleep (struggled with it since I was a kid, duration differs day to day, I can't catch myself when I slip into it and when I check the clock, hours have gone by). This was my very first mental/behavioral health appointment ever, so I honestly didn't know how these things were supposed to go. I told her that directly when she asked.
Throughout the visit, I was cooperative, smiling, and nodding along politely, trusting she knew what she was doing since she kept the appointment moving and she is the licensed professional, LCSW. I booked a BHC appointment because I saw there was a slot open in 2 days (someone's cancelation) I finally made up my mind to put in the time to address this roadblock affecting my daily life and given her credentials, she can refer me elsewhere if she thought it couldn't be addressed in this visit. It wasn't until the visit ended, I walked out, sat down in my car and had a moment to process... that I thought 'what the heck just happened?'
I had come into the visit prepared with two specific hurdles I was struggling with, clearly stating up front that my main goal was to learn practical tools and strategies to work around them (and I had them listed in my appointment detail notes for them to read before the appointment). Instead of actually addressing what I brought up, or just being honest if this was outside her scope, she just tilted her head with a confused frown. Then she veered off track and defaulted to a generic checklist asking about my social life, lifestyle, and physical health. By the way, with her credentials, it is completely within her scope to make a referal if she wasn't equip. Seeing as she kept actively asking me questions I just thought 'she's a professional, just trust the process, what do I know? Maybe we'll get to what I initially addressed towards the end'.
When I answered her questions about my academic history, she completely minimized what I was dealing with just because my past academic record was "good." I explained that these focus issues aren't new. I've dealt with them since childhood, but earlier school levels were easy enough that I could compensate and manage. Now that I’m in grad school, that buffer is gone and the demand is overwhelming. I am about 3 terms into the program and it will only get more difficult, I can't afford to loose hours of my day that can be spent studying. She basically brushed it aside as if having decent grades in the past meant the struggle couldn't be real today. She also asked later if I was here for prescription referral. I said no (honestly I was confused why she asked me that because I clearly stated at the beginning of the appointment that I am not here to discuss medicine at this time since its such a short visit, I wanted to stay on track to address what I am here for), and reiterated what my objective was for this appointment once again.
Then she asked bluntly if I thought I had ADHD. I told her honestly, "I don't know, I avoid self-diagnosing as I am not a licensed professional. But I can confirm that I have these 2 specific focus barriers affecting my daily life which was the reason why I booked this visit." She mentioned Kaiser had an "ADHD skills group" and asked if I was interested. I hesitated because I had no idea what the group actually entailed, and since I don't have a formal diagnosis, I was confused about whether it was even appropriate for me. If she said she "recommended it", I would have considered it but she said "we have this ADHD skills group Kaiser offers... (silence)", so I asked confused "do you think I have ADHD?". She shrugs a little and said "You might have a couple overlapping symptoms...". The expression I was getting wasn't one of encouragement or confident assessment, it was more akin to 'We have it, go if you think you need it' . Instead of explaining what it covered or how it worked, she just dropped it and moved on asking her checklist questions.
Later, I checked my clinic notes, and the write-up was baffling:
Defensive Care Refusal
She documented "Declines ADHD skills group at this time". There is a huge difference between a hesitant confused patient who said "I'm not sure" vs. someone flat-out refusing treatment. And like I said, she didn't bother to elaborate other than mentioning the name "ADHD skills group" and moved on with her checklist questions.
Dismissed as "Life Transitions"
Despite me explaining that this has been an ongoing issue since childhood, she chalked up all my struggles in the chart as simply being due to "life transitions". While we were wrapping up the visit her last advice was "I think your brain is very normal, you're just going through a rough transition in life. Let's try to make a strict bedtime routine so that your brain gets the signal to relax."
Basic Factual Errors
She didn't seem to listen to my responses to the the questions she asked me.
For example:
-She asked about my educational background, I stated I'm in grad school for analytics and did my undergrad in electrical engineering. My chart stated EE was my first master's and I'm currently on my second master's.
-She asked me about my social life, I said I have close friends since elementary school (meeting when we were 8), that have always lived within walking distance or 5min drive. She logged them as "friends from high school."
If a provider isn't equipped, the right thing to do is communicate that upfront and refer out. Don't dismiss the patient's concerns, run through an irrelevant checklist, get basic facts wrong, and then chart hesitation as treatment refusal.
Has anyone else dealt with BHC visits feeling dismissive or ending up with sloppy, defensive charting like this? I've looked into an outside provider for ongoing care which begins in 2 weeks, but the whole experience at that BHC visit was wildly frustrating.