The Ten Remandments

Things that I will send right back home with you if you dare bring them to my office.

1) Excuses for smoking, drinking, or using drugs to excess.

I don’t care if you think cocaine helps you multitask, if you think four blunts a day is the only thing that mellows you out, or if your personal feeling is that cigarettes don’t really cause cancer. Don’t waste your time, or mine.

2) Lame reasons why you think you need disability.

Your homework: Watch the movie The Elephant Man. If you can honestly convince me that you’re worse off than this guy was, we’ll talk.

3) Stories about how you lost yesterday’s prescription for controlled drugs and need another one.

Listen, I’ve heard it all. Your dog ate it, it melted in the hot sun in the car, and a random steamroller crushed your Klonopin to a fine powder. No. Again, no.

4) Reasons why you are justified in beating your wife.

Are you f—–g kidding me?

5) Lame excuses for not taking responsibility for your children when you knew full well you never intended to raise them yourself anyway.

Sex is raw, messy, part of a normal adult life, and usually a lot of fun. So are children. You made a choice to enjoy the former. Now, be an adult and take care of the latter.

6) A reported pain score of 10/10 in an outpatient office.

Okay. I’ve personally had a ruptured appendix and at least six kidney stones that I know of. With the former, I begged my surgeon friend to cut me open, take every suspicious thing out, or kill me and be done with it. With the last one of the latter, I was throwing up blood into an ER waiting room trash can. You’re sitting quietly and calmly in front of me demanding narcotics for a pain score of 10/10?
Get out of my office.

7) Religious proselytizing.

You are not here to preach to me, to save me, or to recruit me for your personal projects. I respect your religious beliefs and feelings, but they are almost always not relevant to your visit to see me today. Respect our clinical time. Go see your priest.

8) Requests for a specific diagnosis that we both know you don’t have.

Anyone can read the DSM. I’m not impressed when you rattle off a list of symptoms for a disorder you’ve already decided to suffer from. Talk to me, explain your symptoms, tell me how they impair your ability to function. Together, we’ll come up with a working diagnosis and an appropriate treatment plan. Oh, and if your problem is primarily substance dependence, don’t go fishing for a bipolar diagnosis from me because it’s more socially acceptable. My job is to treat you, not to make you a member of the diagnosis of the month club.

9) Bogus requests for time off work for “bad nerves”.

We all have varying amounts of stress. We all get anxious and sad every once in a while. Work is something that, in my humble opinion, does a lot towards increasing self esteem, increasing contact with other people, giving one a sense of purpose and direction, and helping to provide a framework for an organized life.
You’re a little anxious. I get that. We’ll treat that. Now, be grateful that you have a job and go back to it, before someone else steals it right out from under you.

10) ANY form that you want me to fill out after just one thirty minute visit.

After my very first encounter with you, I cannot establish: your exact ability to function at work, your mental health prognosis for the rest of your life, your ability to safely operate a motor vehicle, or whether or not you were abducted by aliens at age five (okay, I made that last one up-I don’t think there’s really a form to report that). Please have your family doctor, who has known and treated you for the last twenty years, help you with those forms. Even the MD after my name gives little real weight to anything I could say after talking with you for just twenty minutes.

Are we clear now?

See you next time.