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Originally Posted by Skeptic Ginger
(Post 12365887)
**By the way, I don't believe you've presented a single study that the in-person interview is required. It's a professional consensus and as such, subject to challenge. It was never determined by some RCTs or anything close. So right there you don't have supporting evidence. Did you just assume it existed?
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I do assume that the APA has good reasons to insist upon an in-person exam. And I should clarify here, again, that an "in-person exam," isn't just a brief interview, it's an ongoing assessment over time in the context of a therapeutic relationship. But even so: If it is a long-standing consensus of professionals as to the best practice, so much so that it is part of the standard of practice, then it takes more than a mere contrary opinion to challenge it. "Distant diagnosis," hasn't been subject to any scientific scrutiny at all, there isn't even a consensus about it. If they want to argue that an in-person evaluation isn't necessary or particularly reliable, fine -do that arguing in the literature where it can be peer-reviewed and validated.
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On to the rest of your post. You don't practice medicine by looking up some study about every possible presentation a patient might arrive with.
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You most certainly do if the presentation is one you aren't familiar with; you don't just wing it because you're smart. Every doctor I've ever worked for or interacted with has a shelf of reference material. They attend hours of CME every year.
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Yes, I might have an evidence based protocol for a patient presenting with abdominal pain. But if a patient presents with an arm bent in the middle where it shouldn't be, I'm not going to find a study that says said patient needs a splint and an X-ray.
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In the case of a broken bone, there are still evidence-based treatment options based on the exact type of fracture. IOW, doctors don't just say, "Yup that's broken. Set it and cast it." The diagnosis of the type of fracture is important to determining the best course of action.
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And suppose the patient with abdominal pain then tells me they think they swallowed a chicken bone. Is there a study for that? Of course not. :rolleyes:
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Uh, there are
plenty of studies for the diagnosis and
management of swallowed objects. Like I said, every thing practitioners do is guided by peer-reviewed research, case studies, etc. That forms the basis of guidelines. Their residencies, practicums, etc help them internalize those guidelines.
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You have to put a lot of pieces together.
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Yes! And in the case of mental health, you don't get all those pieces by watching someone on TV and reading their tweets.
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Say this is a little kid and the mom thinks s/he swallowed something. I do have a protocol for a young child with abdominal pain. Guess what is on it? Don't rule out something in the chest.
I have no doubt there is one or more study that says how many small kids with an abdominal complaint actually have a problem in the chest. How many doctors do you suppose go looking that up when they see a kid with a 'tummy ache'?
None! You know that because you learned that is something to consider. Know where I learned it? In my clinical in a children's hospital ED when I was in nursing school, long before I ever became a nurse practitioner.
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And you learned it because medical research figured that out. Someone didn't just make that up one day; that guideline came about because of observation, studies, etc that were published in the literature.
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There is no study that tells you what to do if you are following your algorithm and there is no step for what you find next. You just can't write an algorithm for any and every thing you are going to see. If you could then one wouldn't need a practitioner, you could use a computer.
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When your algorithm isn't working, you find another way. Sometimes, that means reading books, looking up research, consulting specialists, etc. It almost never means, "come up with your own ideas and implement them." That only happens in the areas where medicine doesn't have good answers yet and the resulting findings
end up being peer-reviewed and published in journals to further medical knowledge.
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Trump's symptoms are not hard to recognize, the diagnosis in his case is not complicated despite posts in this thread claiming it is. When you read that crap on the internet that a narcissistic personality disorder is hard to diagnose, it says that to prevent every Tom, Dick and Harriet from diagnosing every conceited person with narcissism.
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This is an assertion. Where are the citations for professionals saying, in effect, "This stuff is really obvious; you don't even need to get to know the person." I can find every medical guideline and study ever written on the internet. I can find the full text of the DSM-V. What I can't find is any support at all for diagnosing mental health conditions without ever interacting with a patient. If you can, I'm all ears.
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It boggles my mind that anyone would question Trump's problem is pathologic. OMG, look at yesterday! Putin may very well have the pee tape and all kinds of incriminating financial records, but overlying that is the blatant inability of Trump to consider for even a fraction of a second that he didn't win fair and square. That eats at him.
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This is just your interpretation of the events. You can't know what's in his head; you aren't a mind reader. In any case, pathology is irrelevant. We don't need to know that he is mentally ill in order to see what a **** show that "summit," was. Plenty of bi-partisan non-professionals have commented on just how bad that was. What are you gaining by slapping an irrelevant label on it?
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The two things he repeats more than anything is 'no collusion' (because that would mean he didn't win fairly) and it didn't affect the outcome.
Blatantly obvious pathologic narcissism, and if you weren't going by some rule you read on the internet, you would admit it.
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First off, that's begging the question in the form of, "when did you stop beating your wife." Has it been established that there was collusion and that Trump was involved in it? Has it been established that Russian interference was responsible for Trump's win?
Nope. As such, it remains possible that he is simply covering his butt, he is manipulating the public, he didn't collude/doesn't believe the Russians actually influenced anything despite their interference, etc. None of that has "mental illness" as a prerequisite. Even if he did collude to get the Russians to give him a win, what do politicians do when confronted with accusations of bad/illegal/immoral behavior? Most of them lie, obfuscate and deny. They don't have to be mentally ill to do so.
But more importantly, you continue to fundamentally misunderstand (or misrepresent) and minimize the situation. The Goldwater rule isn't just some "rule . . . on the internet." It is a part of the actual ethics code of the mental health profession and has been debated and reaffirmed. As such, the assertions of a handful of professionals are not persuasive to me. In effect, you are arguing that ethics codes don't mean much, that they are rules professionals can pick and choose from. But that ain't the way it works. If they are going to break ethics they better have a good reason that is supported by science or, at the very least, a consensus of the experts responsible for guiding the profession.
