Everything you do for your client matters. If and how you choose to diagnose your client matters a lot. Amanda B. wrote in asking if it is OK to routinely give a diagnosis of Adjustment Disorder to her clients if they do not exhibit symptoms warranting a more serious diagnosis. (She was trying to help them get reimbursed by their health insurance companies.)
The short answer is “No it’s not.” As tempting as it may be to slap an Adjustment Disorder diagnosis on to every client who is dealing with normal life transitions, it’s not wise and it’s not OK — clinically, ethically, or legally.
"Worried Woman" by HikingArtist.com / Frits Ahlefeldt-Laurvig
The clinical implication is this . . . by intentionally giving your client the wrong diagnosis, in this case a more serious diagnosis than is truly warranted, you pathologize your client. This is like going to your primary care doctor for a mosquito bite and him diagnosing you with an infection. Mosquito bites happen just like life happens. Misdiagnosing does nothing to empower your client. Nor does it inform her about the real nature of what’s going on or lead her toward useful strategies for managing the transition at hand.
Ethically you’ve failed . . . to provide honest, accurate and useful information to your client if you’ve told her she has something different than what is true. You’ve also set yourself up to provide inaccurate information to others i.e. physicians, lawyers, etch. that may gain access to your records later on.
And, legally, you’re setting yourself up for big trouble. When you choose to list an inaccurate diagnosis on health insurance claims forms and submit them, you have just committed insurance fraud. Should you choose to put the inaccurate diagnosis into your clinical record, you have falsified documents and failed to meet the professional standard of care.
If knowing all of this you are still tempted (perhaps you believe with good intentions) to misdiagnose a client, seek clinical, ethical, and legal consultation.
[Update 10 Dec. 2009 5:54 pm – Of course, mental health professionals are not the only one fudging on diagnoses. Check out The Last Psychiatrist blog post, “How Am I Going To Get Paid If It Isn’t Autism?“]
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Oh, no! I’ve been doing this . . . for a really really long time. Exactly this! Thank you for pointing this out. Now what do I need to do?
E. J., Thanks for stepping up to admit this practice.
I have a couple of suggestions. First, go over each of your current client files and revise the diagnoses to more accurately reflect your true clinical impressions based on the client’s current symptoms. You should include in your clinical notes a statement reflecting that change like “Based on a review of client’s history and current symptoms X, Y, and Z, this therapist is revising her diagnosis to more accurately reflect clinical impressions. The current diagnosis is ABC.”
Secondly, I would suggest that you contact a mental health attorney in your particular state to discuss what other steps you can take to rectify any past damage done as well as to protect yourself.
E. J., I hope you’ll drop back in often to join us here at Private Practice from the Inside Out!