I overthink a lot of events.

It’s part of what this blog is about – the inner working mind of an autistic clinician (aspiring, was practicing, failed to continue because a school lied and her ethics were stronger than her ability to continue to ask for an exception). And I wanted to make a post about my dilemma with insurance companies and diagnostic departments.

Because often most of my distress with mental health agencies, work, and management harkens to (boils down into) insurance companies and diagnostics.

My first job was a diagnostician.

I failed epically.

Not necessarily since I was giving wrong diagnoses. It was quite the opposite. I was giving highly accurate, overly specific diagnostic markers to hone in on the real mental health criteria met by the clients in the addictions center. I did not realize (until about three jobs later) that I failed epically because I essentially was saying “TF you doing” to a bunch of pyschiatrists and medical staff who were giving generalized diagnostics and treatments.

No one meant “You don’t have enough experience” in the sense of “You are bad at this, you are failing the clients”. They actually meant “You don’t understand that your ability to help these clients is admirable and very ethical, and also against the values and practices of management, who are more concerned with processing insurance reimbursements”.

Because my heart is in addictions treatment.

I can talk for hours about how much addiction is my passion diagnosis to work with.

This little bubbly kindergarden teacher of a human is really good with addicts.

It’s the duality of woman, I suppose.

Addictions treatment centers, as I frequently found, are managed by people with no experience in clinical mental health or even healthcare. One was managed by a woman who was a CFO of a bank prior to opening a residential facility. One was managed by a man who was in techology sales for decades before seing the grant money out there.

I cannot, and am not, claiming that people in healthcare are after the money (because utlimately, if they were, I have some bold questions on it). But some people who are in business see that there’s a market opening. They misunderstand that being able to hire people to work in a facility is not adequate to knowing how to run or manage one.

Healthcare is not a corporate office, or even like a business.

Management cannot expect their faults to be magically absorbed by the clients or employees. It results in so many issues. Living through poorly managed companies and adequately managed ones is such a game changer. It shows the dilemma of healthcare.

I’ve seen the multiple ways poor management pans out and fails the clients.

Sometimes it means not knowing how to train staff. This is the most common error I’ll come across. This shows up in hiring staff at low pay grades. This results in having people who are disinterested in training, as they are simply not paid enough. The staff need also be briefed on how to train and give proper instructions to a variety of people.

Other times it simply is just bad management practices. Like when management offers no solutions to the “bad work” just that “it’s being done wrong”. This results in high turnover rates and disallows treatment to succeed. Because one of the hallmarks of treatment working is the ability for a client to build a therapeutic relationship with the clinician.

And sometimes, poor management is also shady hiring practices. Such as assuming clinical staff don’t need benefits, or fair pay. It can be thinking that clinical staff don’t need supervision or other stated contingencies of hire. Shady hiring practices harm the clients because these often involve bullying and toxic management practices that harm all.

I don’t like any of these.

Good people in bad management stand up for themselves.

The first company who told me my diagnostics were too specific and on the nose was providing me an insight into my calling as a clinician. They told me I could work for them as a BHT at my same rate, which was funny, because if they really didn’t trust I was qualified to make the diagnostics in the first place, they wouldn’t try to keep me on.

So the second company I worked for, in the interview, I was upfront.

I told them that I listen to symptoms clients tell me and I like to validate their experiences and treat them for what they tell me is their issue. I explained that my passion is to work with addictions and trauma, and that dissociative disorders are there, too. I expressed my passion for more accurate diagnostics without slamming anyone in my past companies.

The HR manager (lord bless this woman) hired me at an amazing rate.

Many colleagues in the company were much older. They saw this quirky girl who was maybe half their age, making connections with clients who were maybe given to her out of spite or whatever – I’ll never know why people were shocked my clients liked me.

All I know is the job was to make clients feel heard and seen.

My main issues with clinical work were communication based.

The struggles of being an autistic clinician are often that the working environment makes us look so aloof or out of it. I did telehealth, and because I cannot keep eye contact, just took the damn progress note during session. But the response I gave was seemingly something clients didn’t take issue with. I got feedback that my style was quirky.

One guy (silly human) says one time, “I notice you often look away and stare at your screen while I’m talking. But then you come back and have a great response. So I really don’t mind.” I almost lost my cool. I just smiled and laughed softly, because it was fun.

And maybe that was the joy of being my client.

People would call me out for being different and I would just brush it off and think it was some of the silliest, but most delightful feedback in the world. I did realize that I said “You can give me feedback whenever you want to,” and I also didn’t realize that my communication methods were so atypical of a therapist that these clients were noticing.

I loved it though.

Because the only reason they ever were comfortable enough having that freedom to speak their mind was because I knew how diagnostics worked. I knew that the client’s story was so much bigger than the diagnosis we could give them on a piece of paper.

I knew sometimes the diagnosis wasn’t even from us.

Maybe I was not the ideal diagnostician. Perhaps I was too autistically inclined. Maybe the criteria were all too factual and informational to me.

And maybe it was also because I knew the people using it were going to be clinicans who expected the diagnosis to mean something.

In clinical programs, often we are taught how to treat people based on a presenting diagnosis or a symptom presentation. By being a diagnostician, I assumed the goal was to provide the clinical staff the accurate diagnosis to treat their clients with. In fact, when I was a diagnostician, my clinical team was in love with my assessments and clinical summary statements, because I actually gave real treatment ideas and diagnostics.

I understand the practical aspect of diagnostics needing to be generalized.

Insurance companies are rude about a lot of it.

Taking a diagnosis off of a chart is so hard, believe me. Getting a new assessment to validate a misdiagnosis of an earlier testing is really complicated and takes years. That’s really why we try to provide general diagnostics for insurance companies.

However, if my clinical impression is different, that matters.

My human heart understands that insurance companies have a lot of power and sway to take away, restrict, and deny coverages based on diagnoses. And my clinician heart screams for the clients who have been fighting to get their story validated so they can gain access to the treatment only accessible with a diagnosis on paper.

It works both ways.

I’ve seen how it works both ways.

I’ve experienced a misdiagnosis causing a lot of issues. I’ve experienced a proper diagnosis opening up a world of treatment possibilities and remedies that have made my life less stressful and also brought joy back into who I am.

The diagnosis is really important.

It’s not just for insurance companies.

It’s a person’s life and medical treatment you are dictating.

And we need to do better.

As clinicians and mental health professionals, we must do better.

XOXO,

Dorothy B.