[AE.Personal, AE.ADHD] My path to a prescription.
So yesterday I told you that today I'd say more about how I got here. I'm glad that I started writing about that yesterday because early this afternoon I was struck by a migraine, which is another of the things that the pills can't solve for me. If anything, they may be changing what triggers them; I'm beginning to track to see if there's anything there.
Anyway, this may be shorter than it would have been otherwise, though I'm not sure that's a bad thing.
How I got here:
For years I've been told by friends with ADHD diagnoses that I probably had it myself, but I also was for much of that time either uninsured or badly underinsured, and I had also heard that many doctors are skeptical of adult ADHD and reluctant or even hostile to the notion of diagnosing it in anybody who did not have a diagnosis as a child.
But recently someone in my life who had a childhood diagnosis resumed medication as an adult and likely as a result of talking about that started getting targeted advertising for ADHD-related services, including innumerable services that made entirely superfluous offers to diagnose them with ADHD and provide medication.
But while they did not have need of such services, they mentioned their existence to me. I was a little dubious... ADHD meds are generally scheduled substances and, again, what I had always heard from people who had navigated the medical bureaucracy to get medication was that you needed to be prepared to advocate for yourself, finesse a little, and explain how you made it through childhood without receiving a diagnosis.
But I searched using some of the key terms from the ads – various combinations of "online", "adhd", "relief", "treatment", and "prescription" – and I found that there really are a ton of what look like tech startups that exist specifically to connect adults seeking ADHD relief with doctors who are willing to diagnose and prescribe over the internet.
I did some research and passed over some services that had negative reviews in favor of one that had recent good ones. I have chosen not name the specific service I am using out of a combination of personal privacy concerns and an unwillingness to endorse one of these services over another.
I signed up and was contacted via an internal messaging system accessed through my account on their website, where after an intake questionnaire I was given an appointment to speak to a doctor over a teleconference interface that was again accessed through my account on their website. I had the doctor's name, which I could Google to see their credentials and reviews.
The service contacted me via email and text message multiple times and in multiple formulations to remind me of my impending appointment, which is really handy for an ADHD patient.
On the day of the appointment I joined the call ahead of time in accordance with the instructions, which I suspected might have been copied and pasted from a pre-covid world where it referred to showing up ahead of time for an in-person appointment for signing in at reception and filling out forms, but which gave me time to run through the "test call" function and be sitting there centered on camera and present when my time arrived and so did the doctor.
We spoke. She asked me about what had brought me and how I had been coping with the symptoms (my answer was long but can be summed up as "exhaustively, in every sense of that word, and yet badly"), along with some questions about my medical history. My general level of un-doctor'dness had worried me going in but did not prove an obstacle; she requested that I get a blood pressure cuff and make sure it wasn't dangerously high before starting my medication, and to keep tracking it as I titrated up to find my dose, but she did not make me wait for her to submit the prescription until I had done so.
She also mentioned that generally she would also be suggesting what I think she described as therapeutic measures, meaning structured behavioral solutions, before or alongside any medication, but that it sounded like I had been doing enough of that on my own that she trusted me to keep it up.
She prescribed me about 30 days' worth of pills, with a little overage because I was taking a fraction of a dose for the first week and a half or so, and scheduled a follow-up appointment for a month later to see how it was going and if I had any concerns or needed to change prescriptions, letting me know that if I had concerns that couldn't wait I could send a message through the service.
And about a month later, we had that follow-up. She answered a few questions I had and listened to me go through my well-documented experience with side effects (manageable and managed, by that point) and benefits (many and magical), and then issued a new prescription with pills at my dosage level instead of in fractions of it to last 30 days until the next follow-up.
I can only vouch for my chosen service in terms of the surface-level facts that they took my information, connected me to a doctor who did a teleconference appointment with me, and prescribed me meds that arrived two days later via FedEx. The doctor definitely exists. The pills are real. I have not been charged anything I was not told about (the appointment was not covered by insurance but the pills were, with a co-pay).
But I don't actually know anything about their actual internal business model or philosophy. I don't know if they function as a prescription mill and only contract with doctors who will talk to a customer for an hour to assuage the law and then write a prescription, or if the doctor really did trust me when I described my symptoms and the lengths I'd gone to, trying to manage them.
I don't say this to try to scare anyone off. I love my service and I have no reason to doubt my doctor's sincere commitment and I love that these services exist and I think it's good -- or at least lucky for me -- that a need that was not being met by the existing infrastructure of the US medical system has options. It would be a better thing if it didn't require a webcam, microphone, internet connection, and out-of-pocket expenses for appointments that must be repeated.
The availability of this kind of service and what kind of requirements are put on it and what delivery methods are available for the pills are going to vary from place to place. I know that not everybody who can afford the option will have it available, and vice-versa.
But I want to make sure that anybody who might be able to use a service like this knows that they exist, because if you don't even know it's a possibility to check, it doesn't really matter.
To make a long story short (TOO LATE!), I hope some of this information is helpful or useful to someone, whether they're using a similar service or going through an existing medical professional contact or shopping for a doctor or clinic who can help.