Author Topic: Doctor's Note?  (Read 271 times)

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Offline Poedog

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Doctor's Note?
« on: September 22, 2017, 07:40:13 AM »
So this is not for me personally; if I was going to get a SD, the only program in the state requires medical documentation; and if I was going to do something to mitigate my disability, I would want my treatment team on board, even if they didn't technically have to be.

But I have been hearing conflicting things. I am under the impression that you need your treating doctor (medical doctor, therapist, etc.) to agree that you would benefit from a SD for your disability (whatever it may be).

When speaking to a friend, who had a program trained dog for 6 years from the age of 17 until 22 for PTSD from an emotionally abusive relationship, she said that you do not need a doctor's approval for a service dog. She did try medication and lots of therapy.

When speaking to my friend (who also said
Quote
She has all the paperwork I would just have to train her more which I may or may not do because she's already so wonderful. It just depends on what I want. I can take her anywhere right now because of her papers but I dont because it brings so much attention it makes me uncomfortable plus she def loves people too much which shes not really supposed to want to get petted but i don't want to make her anti social that's just one thing I am not sure about because I want her to love everyone which she's really not supposed to so that's my battle right now :/ but I've taken her a few places but getting stared at when I'm having a bad day doesn't help
- I spoke about her in another thread. She has told me before she does not have panic attacks or flashbacks anymore, her bad days are just being sad, but, of course, I don't know what exactly she's going through, though she's always been open with me in the past) she said, since she has her note on a prescription pad from her gynecologist (who treated her when she was having a miscarriage), her dog is a service dog. The only tasks she has that I know of are leaning against her when she has a panic attack and cuddling with her. She's 10 months old. The woman has not sought any mental health treatment and claims that she is feeling much better.

I am not judging either of this people (besides what was discussed in the other thread, but that is separate from the SD thing haha). They may very well be correct- which is why I am asking. I am fairly certain I will not get a service dog, as my therapist feels "it would not be a good idea, the dog would be a visual reminder to you that "something is wrong"". She's been in practice for a LONG time and has much more experience than I do. That said, I do plan to go into the helping field and may end up in mental health (If I can deal with my own [censored] before I graduate haha), so I want to be sure I am informed. I have read the ADA laws, etc. but if this comes up, how does one handle it? Can any doctor write the note? Do you need a note at all?

And again- I don't know what either of the people listed above have gone through because I am not them. I am not judging them or their lives- they could be correct. I am just trying to be informed on the issues, in case this was something that came up in my professional career, or just if I ended up educating someone about it one day.

sorry this was so long, y'all!

Offline Summertime.and.Azkaban

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Re: Doctor's Note?
« Reply #1 on: September 22, 2017, 08:47:23 AM »
Someone OTing their dog does not need a letter unless it is a psych dog and they are flying on an airplane, or if they need to request accommodation for housing for any type of dog.

Airlines are covered under the ACAA which lumps ESAs and PSDs together and requires a note for both.

Landlords have the right to request documentation of a disability if the disability is not readily identifiable no matter the disability. 

Someone going through a program may need whatever documentation is required by their program.

In any case, all that is needed is a letter stating that the individual is disabled by their condition. It need not even mention the dog, unless a program wants a recipient to have their doctor involved in deciding tasks. All that matters is that is is documentation of a disability, at least for SDs.

I believe ESA letters may need to contain a snip about the animal being a part of the person's treatment plan.

In all honesty, while a OB/GYN probably isn't qualified to treat mental illness, everyone involved in the gestation and birthing process of a child is educated on the signs of postpartum depression, postpartum anxiety and postpartum psychosis. The OB/GYN is not really qualified to treat the illness but they would probably be able to identify and diagnose a woman with a postpartum illness. (Loss of pregnancy counts as postpartum in all cases. It is disrespectful to treat a loss of pregnancy as anything other than a postpartum period no matter how early the pregnancy was lost. Not saying you were doing that, I'm just mentioning it).

I do however take a little issue with the fact that you are talking openly about another woman's miscarriage. Loss of pregnancy is a private, traumatizing event. I would not want others to speak freely of something that traumatized me, I think it would be more respectful if you omitted the detail that the woman lost a pregnancy and instead put the OB/GYN into context by explaining she had a traumatizing experience with her last pregnancy unless you had explicit permission to discuss this online.

We went through the same respect discussion maybe a year ago when someone was discussing an individual's ability to use a toilet as if it was not disrespectful simply because the person wasn't named and was a "low functioning" autistic.

Please refrain from discussing intimate details of other's intensely private affairs or disabilities even if they are not present or will never know of the conversation. I know that you meant no harm but it is making me quite uncomfortable speaking of a woman's loss of pregnancy so frivolously when you have not indicated you have permission to discuss this here.

That said, case law says an individual must be receiving treatment for their mental illness for it to rise to the level of disability. Treatment can mean anything from therapy, to medication to simple monitoring by a PCP.

An OB/GYN seems like an odd individual to write such a letter but they may be involved in the diagnosis of a severe postpartum illness. I could see an OB/GYN making a statement as to whether the person has a disabling postpartum illness, they are often on the front lines of postpartum illness and are some of the first ones recording PP illness in women.

The question comes in whether the OB/GYN is involved in treatment, and I'm guessing not. If doctors could write letters without truly treating a patient then the telemedicine stuff a lot of fake registries do would be legal.

It is possible that this woman is seeing her OB/GYN frequently to monitor the health and healing of her reproductive organs or to further identify infertility or medical problems that could've resulted in her loss. The GYN would likely be monitoring whatever mental health issue the patient had as a result of the loss, though one has to wonder if a mental illness that needs only monitoring by a GYN is truly disabling.

 
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Offline Poedog

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Re: Doctor's Note?
« Reply #2 on: September 22, 2017, 08:59:03 AM »
Quote
I do however take a little issue with the fact that you are talking openly about another woman's miscarriage. Loss of pregnancy is a private, traumatizing event. I would not want others to speak freely of something that traumatized me, I think it would be more respectful if you omitted the detail that the woman lost a pregnancy and instead put the OB/GYN into context by explaining she had a traumatizing experience with her last pregnancy unless you had explicit permission to discuss this online.
I apologize for that; I did not mean to offend. She posts about it regularly online, as she wants to bring awareness to the issue and is very, very open about it. If she was just open and had not shared her story online, publicly, and has spoken to me about her wish to raise awareness to it, I would not have brought it up, but I will refrain from using examples in the future (though I am always sure to change details as much as possible while keeping the gist of the story- so I did change details in that story/left a good bit out). And again, if she was just open to it but had not expressed (both to me and online) that she wanted to talk about it more, bring more awareness to it (I have literally heard her introduce herself as "hi, I'm _____ and I'm the one whose child died), have more people discuss it through her story, etc. We've had long discussions in the past about how knowing that she helps other women through them knowing her story helps heal her and keep the memory of her child alive, and have discussed that it is okay if I share it (she asked if someone in my life knew and I said I did not feel it was my place to say anything so she said "I don't mind other people telling anyone. I want people to know, I'm not ashamed of it and I want people to know about and remember ___". So it was not specifically about asking about it online, but in general. I should have asked her specifically, though) I would not have shared, but clearly I made an error in judgement and I apologize. I will be sure that it does not happen again.

Clearly I shared too much already so I won't go into detail regarding her relationship with her OBGYN, but no, she is not being treated for any mental illnesses (which is also something she discusses openly).

And as for the other friend that I discussed with a SD- everything I mentioned (her PTSD from an emotionally abusive relationship, etc.) she's made youtube videos about, so I feel comfortable sharing that information since she shares it with the internet and also is a huge advocate of mental health awareness, etc.
« Last Edit: September 22, 2017, 09:04:14 AM by Poedog »

Offline Summertime.and.Azkaban

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Re: Doctor's Note?
« Reply #3 on: September 22, 2017, 09:42:24 AM »
Oh, I'm sorry I jumped on you.  :facepalm: That is just a thing that can be touchy for some (apparently I'm part of the some).

There are two friends? I'm confused. The one who got her letter from the GYN is not the one with the 10mth old dog?

Anyway, the general consensus is that a treating doctor is the one who writes the letter, though that can get confusing at times.

One of our members, ZombieFodder, has a condition which does not require active treatment. She spent quite a while without having insurance or a PCP, she used urgent cares for other maladies. In this case she would just need a letter from a doctor who is familiar with her case (perhaps a previous doctor) to write the letter and say that her condition was and currently is disabling. She could probably find a doctor versed in her disability and get a letter from a new doctor in one appointment. Her condition is stable and receiving treatment is irrelevant because treatment would not make her disability less disabling, and her degree of disability is not likely to change. It is pretty easy to prove she has a disability and just about any doctor can attest to that.

(sorry for the refrence ZF, hope you're cool with it)

Like a person with hearing loss would just need someone to attest to the degree of their hearing loss, if it is not going to improve and there are not treatment options available.

When it comes to psych dogs it's a little different because psych conditions often require ongoing care and if the individual can function without treatment they are likely not disabled by their illness.

It all comes down to the qualifications of the individual describing and attesting to the disability.

A mental health care professional who does not have a relationship with a client can not properly assess if the illness is disabling. Case law says a person with an MI is probably only considered disabled if they are receiving treatment, if they are not receiving treatment but are functioning they likely aren't disabled by their illness. I imagine there will be some exceptions but that is probably going to be the general rule. It is going to be very hard for an individual to assess whether a client is disabled by their mental illness in one session. Thus someone who is treating them for their mental illness would be more qualified than someone who is only assessing them.

Does that make sense? I recently had a neuropsych evaluation. The person who did my neuropsych eval could probably definitively tell you I am disabled by the degree of my mental illness but my therapist is more qualified to explain the disabling aspects of my illness because he sees me weekly and is directly involved in how my mental illness affects my day-to-day life. Even though the evaluator has more education in the mental healthcare field my therapist is more educated in me and my disability, so my therapist should be the one to write the letter.

It varies by disability. The person writing your letter should be the person who is most qualified to explain how your disability impacts your life.

For some people that could be any doctor who understands their illness, as their disability is easy to identify and the way it impacts their life can be easily explained. If someone can not walk it doesn't take a rocket scientist to identify and explain why not being able to walk is disabling. There is a pretty clear and identifiable level at which difficulty walking qualifies as disabling. Most doctors know how a normal person should be able to walk and identify when an inability to walk is disabling.

A person with a more fluid or complex disability would need to rely on someone who knows their individual situation intimately. It may be more difficult to explain how a person's individual anxiety attacks are disabling because there is not a clear line where anxiety attacks are disabling. One must consider the frequency, the duration, the physiological effect and the condition it leaves the person in afterwards. Not all doctors can understand how anxiety attacks or other mental illnesses are disabling.

I'm not doing a terribly good job at explaining this.

In general, the person treating you is the best person to explain your disability. Sometimes you may not be receiving treatment because you would not benefit from treatment, and then a doctor that understands your disability pretty well and is willing to assert that your condition is disabling is the one who's most qualified to explain it.

Use common sense. Whoever is licensed to practice medicine and understands you the most thoroughly should be the one writing the letter.







 
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Offline Poedog

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Re: Doctor's Note?
« Reply #4 on: September 22, 2017, 09:59:18 AM »
No no, you're fine! You were right and I appreciate you pointing it out.


Sorry- I explained poorly.

I have one friend (apparently asymptomatic according to what she's told me, besides some depressed days, which is to be expected, of course, as she's been through a hard loss) who has the 10 month old and got the note from the gynecologist and is not receiving treatment for mental illness and has only gone to a therapist once in the past. She was under the impression that a note on a prescription pad was enough to qualify her for a SD and considers her 10 month old a SD, as she will cuddle with her when she has (had? Unclear as she's said in the past that she doesn't have them anymore, but maybe I am wrong) a panic attack, which means she can bring her with her anywhere. She has had regular training but no official SD training, as there are no SD trainers in the area and she does not have any experience in dog training.

The other friend is one who had a SD for 6 years from a program for her PTSD that she got in high school from an emotionally abusive relationship (she has videos on youtube about her PTSD and SD if anyone is interested). She said that you do not need to have a doctor's note or approval.

Both of these individuals have/had SDs for psychiatric reasons. And again, I'm not judging either of them for their need or lack thereof of a SD. It isn't my business, at the end of the day, and I have no way of knowing. Talking to both of them over the last few days about SDs made me realize that if it were to come to me, I wouldn't know and since they were the two examples that made me realize that, I used them. But I don't mean to seem judgmental or like I have any idea of what they're going through/they need, because I don't.

Thank you so much for that response! It did make sense. I apologize if any of that should have been common sense; I just wanted to be sure in case I was ever confronted with this if I do end up in the mental health field.

Thank you so much for your response!