drmargaret

I do evaluations on people for social security disability. It’s not the best way to evaluate people. People get very little feedback about how they are doing and they have to wait weeks for results. The outcome has substantial meaning for the people involved who believe that they require their disability checks in order to survive financially. The process is full of ambiguity and creates anxiety more than psychological testing normally does. In addition the people applying are bombarded by television commercials and advertisments in doctors’ offices from attorneys suggesting that disability evaluating doctors “aren’t on their side” so they will require legal representation in order to “get the benefits they deserve.”

I, and the other doctors in all the offices where I work, are independent contractors with the State. We have sets of questions to answer about disability applicants from the State. The State evaluates people per speciality. My speciality is psychology, so I evaluate the cognitive and emotional functioning of an individual. I also ask about their medical history in detail because it’s important to know about. If a child is applying, I ask the parent or caretaker about the birth, pregnancy and delivery and developmental milestones in addition to education. I’m not expected to provide all the information to the State. The disability analysist integrates all the information and ultimately makes a disability determination. I don’t determine whether a person is disabled or not.

After I see someone, there is a four to six week wait for a letter to arrive with a disability determination. This waiting period is filled with anxiety for many people. During that time people ruminate about the evalution process, worry about what they might have done wrong or what the doctor “really thought.” Preemptive complaints to the analyst about the doctor or evaluation are common during the waiting period and simply express anxiety.

I recently had the opportunity to take the oral examination for licensure in the state of Nevada. Any test taken with litle to no feedback where you have to wait for results is a very similar process to a social security evaluation. The difference for me was that my survival wasn’t on the line. I’m licensed in California and employed. If I didn’t pass the exam, I could take it again. Of course there was a lot of pressure from a company I work for that opened a clinic in Nevada for me to pass. They want me to work there starting yesturday.

So I took the test. I’m best in the early mornings. So being tested late in the afternoon almost evening wasn’t the best time for me. Everything in the world that could have gone wrong apart from death, fire flood, tornado and earthquake, had happened in the two weeks prior to the test. My car had started showing signs of blowing a head gasket so I sold it and got a one year old car with low mileage which immediately needed the gas tank replaced. I refinanced my home with all the resultant problems that come with that process. My husband was being evaluated for surgery. Someone brought a gun into one of the clinics. Some new staff people quit some new staff people were hired. I had my taxes to finish prior to seeing my accountant. All ordinary stuff if it was spread out over a couple of months but not in a two week time frame. The test itself didn’t worry me. The timing of it wasn’t the best.

I know every trick in the book to manage test anxiety. I used to vomit prior to exams in high school and college and read some self help books that taught me some steps to relax. When I took the oral exam in California and passed I threw up. When I took the exam for doing Worker’s Compensation and started getting anxious I just controlled the symptoms and was fine. This time I stayed in my car until 10 minutes prior to the exam time. Waiting in the building makes me more nervous. In the car I can listen to music and calm down. I can talk to myself and get myself to relax. I know how to do all that.

I talked to my Aunt prior to her disability evaluation. she was nervous and didn’t know what to expect. I told her it was a doctor’s appointment only a lot simpler. She’d had three heart attacks, a stroke, emphysema, diabetes, diabetic neuropathy, and some problems with night vision. The stroke hadn’t been well documented but everything else had. I told her to bring her reading and distance glasses and either a list of her medications or all the bottles of medications, not insulin. They would take her blood pressure, hight and weight and make her read an eye chart and ask her to fill out forms about her problems and the doctor would ask her some questions and listen to her. If she couldn’t fill out the forms someone would be able to help her. The doctor might request x-rays or, in her case, a breathing test. The doctor was attempting to agree with what she said was wrong with her. The doctor was documenting what she said as well as the opinion of the doctor. The doctor didn’t make a disability determination. The doctor wasn’t there as her doctor. They might not have the best bedside manner or establish rapport to your personal liking. They can’t diagnose, recommend or treat. Sometimes it’s hell for them not to. Sometimes they actually like the people and would really want to help. That made her less anxious. When her claim for disability got denied, she called me and asked what to do. I told her to get her medical doctor to document her stroke. With that documented, her claim was approved. She didn’t need to return to see an SSDI doctor. She just needed an MRI from her own MD.

I took my oral examination in Nevada. I can’t talk about the details of the examination. I can talk about my 4 1/2 hour car ride home. I screamed about every single detail I missed. 4.5 hours of screaming. No law enforcement officer pulled me over for screaming in my car while driving. It’s an easy thing to explain. “You have to realize officer, I knew that one, I just forgot it.” I missed information from things I do five days a week. I missed things I train people to do. Because there was no feedback or responses I wasn’t sure how some answers would be interpreted. I figured all in all I was in the borderline range. I might or might not pass. I probably passed, but there was a chance I didn’t. I’d have to wait a couple of weeks.

The people who evaluated me were nice. I perceived them as nice because I actually like the concept of regulatory agencies. I think they protect the public from unscrupulous people out to take advantage of them. But some people view them as agents of the government, similar to tax colectors and IRS agents, and are fearful. They have both roles. A psychologist was recently threatening to leave without notice as required which would have resulted in cancellations and delays for about 16 people and a wait for several more weeks. That person was threatened with being reported to the Board for unprofessional conduct. They decided to uphold their end of the contract on behalf of the public. It helps to wave the stick sometimes.

Some people perceive me as nice and helpful. Some people perceive me as evil and mean. The perception can change in the middle of a sentence. A man came in with this idea expressed very clearly: “When I first met you I thought you were a Nazi, but then you seemed caring.” I didn’t change in one hour. His anxiety lessened.

In some cases the anxiety increases. I evaluated a woman. She had problems with English and spoke some Spanish which she also had problems with. She had a history of special class placement in school. I said everything first in English. I translated every sentence then in Spanish. When she left I got a call from her mother who reported the woman said the entire evaluation was conducted in Spanish and she had understood nothing, she worried she had lied. Her anxiety had increased. I explained the bilingual presentation and reassured the mother.

I spent two weeks ruminating about how I did on the evaluation coupled with friends and my work ruminating. “Have you heard yet?” During the four to six weeks SSDI applicants have to ruminate we get complaints about doctors, the office, the office staff, and anything they might need for a “do over.” I didn’t need to complain about anyone. If I wanted a “do over” I’d ask for an earlier time next evaluation cycle. I either passed or I didn’t. It isn’t life or death. The ruminative voices in my head can shut up. Time for a good CD to listen to. No I haven’t heard yet, stop asking I’ll call you. Call the Board and ask them if they have mailed out the letters. I’m not going to call I sent an email. I can wait.

Yesturday I heard. I passed.