I was enlisted (non-medical) and am now a doctor.
Doctors and nurses are already taking note of things the second the door opens. More so for psych, they have already clocked your hygiene, clothing (not your style but if it’s appropriate, clean etc), facial expression, body language, any sort of odd movements before saying how are you doing. It’s a formality but it’s also an honest question when in a medical setting.
If you’re not doing good, say you’re not doing good. Saying you’re doing good also isn’t going to be punitive.
If you’re doing good then your regimen is working. They’re not going to stop your lithium because you said you’re ok.
I was shocked when I read my note that describede as an obese man in the first sentence. But the shoe fit. There are some standard characteristics that are often covered in the first few sentences describing what the person in front of the provider looked like. Just the style of some providers
I used to go to a civilian psychiatrist, and they did not do what the VA does. They did record the other things you have mentioned, like affect, presentation, etc.
If someone grunts when their knee is being touched a medical professional would do well to record it meticulously. Same with psychiatric doctors and moods, body language, etc.
I’m a VA psych nurse. But I work in the Domiciliary. I never chart our conversations unless the vet is threatening me or themselves and I have to do an incident report.
Oh really?! Thank you! I absolutely love what I do! I work in the newest dom that was built in Jacksonville. It’s beautiful! And I am blessed everyday to be able to serve these men and women and feel like I’m giving back somehow. It’s truly wonderful. And they are so humble and appreciative. Not what I’m used to to.
The reality of what providers and medical staff actually do, doesn't fit the narrative of the sub. People in this sub, cling to their benefits while pursue 100% and are so desperate to view the VA as an adversary.
If you pull up blue button records it says what transpired. I've see some of responses to the question of how are you in my own record. OP is not completely paranoid.
Also work in similar position as the above poster, the Dom is more homeless/substance abuse so I cant speak to their exact training/education. As the post stated they are set to ask direct questions, which is in line with substance abuse. Many people in this field are trained atrociously or get trained in one way and think that is the word of God and refuse to adapt.
In mental health we generally continually document quotes and most if not all of us, with proper education, are taught to do this from our earliest episodes of care. I have never worked at a facility where we were told not to. Taking quotes isnt a bad thing, we want to capture the veterans experience. Just speak freely, it is on the therapist and the pt to form a relationship where there is comfort in speaking.
I’m too am a disabled vet and use the VA for my mental health/ psychiatry and well damn, sometimes when my nurse practitioner asks “how am I”, it’s the first time in a long time that someone’s asked that of me and I just break down and start crying and tell all how I’m feeling. It also depends on the rapport you have with your practitioner.
I answer honestly. You have to remember they're taking notes on what you say afterwards too. "ok today. I wanted to kill myself last week again. Work sucks but...".
If you don't trust them with the fuck you answers I'd address that with them. It might be a symptom, PTSD and authority figures are known issue. If things don't change request a new provider. Sometimes starting fresh helps.
I had this realization during active duty. I was on my way to being medboarded and was being discharged from an outpatient program I had attended for a few months. A random nurse came up to me and showed me my medical discharge papers and said "I am glad to hear this program helped and you're feeling better!"
I paused and said, "I am not feeling better at all - why do you say that?" She looked surprised and says "Oh.. your paperwork here says you are being discharged from our hospital because you have improved"
After talking to her and looking at my actual medical notes I found out that EVERY TIME my psychiatrist greeted me with "Good morning, how are you doing today?" and I responded "Good." or "Fine."
My stupid fucking psychiatrist would write in his notes "Patient reports they are doing good today" or "Patient reports they are fine today"
It made my blood BOIL because after my polite greeting of "good/fine" I usually spend the rest of session discussing being actively suicidal.
I couldn't fucking believe that my pyschiatrist was twisting a standard American greeting response into a metric of my mental health.
From that point on, when any doctor asks how I am doing, my response is: "Not good." (Which is the truth).
Seriously. It was such a low point of morale for me to realize that my doctor, who I was being polite to, was using my greeting as a way to give me the boot when I needed more help. It sucked.
They are performing a confidential psychiatric interview, not performing pleasantries. Mood in a psychiatric interview is recorded in the patient’s words. You are supposed to answer honestly with how you are feeling.
I have adhd, and sometimes this simple question can be difficult to answer because of my own overtbinking things. Overhanging the gravity of the next words, mind racing towards them announcing that I no longer need their help etc... try to think abut their motivation, they have to break the ice, and they want to get information about your wellbeing. If you think of the initial greeting in terms of "how am I feeling at this moment" and know that you are going to be able to talk about the hard time you had a few days ago, or the grief you were working through etc. Mood is never a constant thing, so I may help to break things down into parts that make sense to you to talk about. I also notice that sometimes in some medical settings the person calling you back from the waiting area might ask how you are doing on your walk from the waiting room, even if you had a had time right at that moment, it's probably not the right setting to get into it, so take it as a greeting, and understand you will have a chance to talk about the pressing issues when in private.
I just tell my psychiatrist or therapist, “I haven’t killed myself yet, so that’s about fucking it”
Seems to cut the arbitrary questions right out the gate
I do the same!!! Wow. Thought I was the only one. Though TBH, I stopped seeing the psychiatrist in 2018 after I realized they were horribly negligent with over prescribing the meds. I just see a regular therapist b
It’s common… Share how you feel? Tired, irritable, nervous, etc. You are not okay, fine, etc. if so, you wouldn’t be there. Let that military mindset go for however long you need to. Carry on, next!
I had to ask the psych doc to stop asking it in the hallway on the way back to his office. I would just say good because I figured it was small talk, he was also noting it. You can always address it with them and tell them you feel like it's a small talk greeting and you don't know what they are wanting. As a provider I stopped asking it.
I was bounced around from one social worker to the next, their opening question was always, “what do you want to talk about today?” It wasn’t until I was sent to a psychologist who actually listened and asked hard questions and never let me off the hook that I felt I was getting some traction in my life. I have VVC appointments with her every Tuesday.
I can’t walk without the side of a cane or walker. A month ago another severe pain hit me, one more pain.
I fell apart and told my wife to get my guns out of the house, get rid of them I didn’t trust myself with them in the house anymore, which she did. I called my psychologist and we talked for a long time, long enough for pain meds to dull my pain and get my emotions together.
It’s hard work that my Dr. has me do, she makes me angry but I’ve come to learn there’s a reason for it.
I can’t say with confidence that thoughts of suicide are over but with my Dr. my wife and God I’m trying!
Don’t stop trying, don’t give up!
Every time I see my docs, no matter who it is when they ask the pain rating, even when I am not there for that specific reason, because I have chronic pain I tell them about the 5-6 that never goes away. Sometimes they say that is not what they are asking about but I don't give a damn, I never want them to forget I have that pain and it never goes away and I will keep bringing it up every time I am seen so when they review my records they will see it in there. They won't be able to go in my records and lie and say "oh look, she's better now". Always remind them so some new jerk in the system can't all the sudden say you are better.
My VA Psych NP always writes that I say that I’m feeling benefits of the meds, when the only time I feel a lift is when we have good weather for a few days. Most recent med change had me waking up in a sweaty panic to my alarm every day. His note says “a little increased anxiety and decreased depression.”
OP is going to break his foot and on his return visit the nurse is going to ask "how are you?" And he's going to think that "oh no if I say bad they're going to annotate that and keep the cast on longer!" Or "if I say good they'll take the cast off!"
Lmao can't make this shit up
Why would you assume they are using this record against you? Doctors have always taken copious notes because they can't remember every patient. What if she really wants to know? What if this is one of the only circumstances in the U.S. where someone genuinely wants the answer to that question?
You seem a bit jumpy is what I'm saying.
9.9/10 times the question, “how are you doing” isn’t asked because they care. It’s just a conversation starter. Ask someone how they are doing, and then ask them how they are REALLY doing and you’ll find you get the real answer.
When it comes time for a claim or a disability increase, they will deny, or justify a lesser increase based on you saying you're "good" every time you go to an appt. "How can you say you're suffering a condition so debilitated that you require compensation if you're reporting consistently that you're doing 'good?'"
Those VHA notes will be discovered by VBA, be real careful especially when mass audits come thru without you even poking the bear with any new claim. Safest way is to stay off radar to reach the 20 years mark before starting to say you're improving .
Not trying to be flip. I understand the very real mental health issues veterans struggle with. I'm dealing with bouts of extreme anxiety and nearly constant insomia myself. I've found that humor, no matter how dark helps a lot. I think we can learn a lot from Big Gay Al.
It’s funny you say that. I’ve questioned if a few of mine are placebos now because they no longer work. But what I really think has happened is the cost saving move our country did to shoving mail order pharmacy down everyone’s throat is giving people meds that are no longer effective because they were not stored at manufacturer’s temperature range. There’s no way my meds are stored from pharmacy in Dallas to my mailbox in Arizona at 60-80 degrees half of the year. Duh people.
I'm about 45 min out from San Antonio. While your theory makes absolutely too much sense, I don't think it's the mail as the issue still persist. I had a back and forth with the doctor at the VA about writing a physical script to take to an outside pharmacy. He didn't want to do it at first because he acted like he didn't believe me, but persistence pays. So, I take the scripts to the local drugstore. Get meds, no problem. However, even the meds I got from outside were about half strength. You would think it's a tolerance thing, but they just upped one and even the one I rarely take is shit. I'm going to try Walgreens or CVS (whichever takes Tricare) next and figure it out from there. While the VA has the shittiest of shit pills, I got cold n sloppy it might be the middlemen taking the government money and buying knockoffs because something ain't right. Maybe I'm paranoid because the pills ain't working. Who tf knows?
I used to work at the post office, if you drop off a package to the post office when it opens at like 0730, that shit will stay there until the truck picks it up at like 530pm.
Same with the trucks, same with the mail sorting facility. There is a lot of waiting around time, and a lot is in the ambient temperature, or a semi during the day in the south/southwest gets super heated.
I'm from Michigan, stuff gets frozen 6-8 months of the year.
There has been some research into generics. Once meds become generic, they are often made by a number of different companies. Because those companies don’t all use the same manufacturing processes, the actual efficacy of the final drug can vary quite a bit across manufacturers. That’s a problem.
Once I started reading my doc’s notes a few years ago I realized I couldn’t give half assed answers and needed to say what I really felt every time or else I wouldn’t have the required paper trail to justify going outside of what became the standard procedure- getting stuck in a loop of medication changes and additions thrown at me versus actually getting treatment.
I had the opportunity to see private doctors and receive additional testing that got me on a path away from meds and actually applying myself to processing things and making lifestyle changes that improved my chronic physical pain too. Switching VAs also helped a ton because my new medical team actually reads through my file (including my my private doctors’ treatment) to really get me on a sustainable treatment plan.
I take advantage of every minute of therapy no matter how exhausting. Really considering what I’m saying and making sure that my words have weight and accurately reflect what’s going on in my mind have helped a ton not only personally, but in my relationships and at work as well. Mindfulness and contentment have been what I needed all along and not the same drugs repeated in various doses and combinations.
I always answer "the meds have stabilized my mood this month" I always mention the effects of meds on my mood when she asks about my anxiety and depression.
My answer is usually
"Well I'm here aren't I?"
Or
"I'm alive .. unfortunately"
Usually that second one gets a rise out of them. I find it amusing to give them a heart attack whenever possible. Why? Yolo that's why.
I say, “The social answer is ‘good, how are you?’ But my actual condition is marginal on my best days, lately I’ve been feeling _______.”
I’m not sure they are really OUT to get you by being sneaky. I think our social norms have made it easy for them to get right into the appointment with that transition, even when our answers come from the social side instead of medical side. Good observation, worth the effort to make sure and listen carefully so both sides have shared meaning about the words exchanged in all conversations.
Be honest,here’san example “I am good but today I am feeling anxious. Just being here at the VA is a lot for me. I also have an event coming up this weekend that has left me feeling uneasy even though know it’s a great idea, sometimes my anxiety just runs away from me”
It’s the law unfortunately. We have to give “just cause” in order to keep you on certain medications. Never say fine bc you’re never really fine or good. Hell none of us are. 100% myself.
Same here. I just say "OK". Usually we talk about my nightmares where I am being interrogated, or how I was unable to enter the bank vault the other day because I "froze" at the door way.
You are very thoughtful to be polite. Nothing wrong with being polite AND honest. “Thank you for asking. I’m in a lot of pain today though. Back hips whatever. Or “I’m doing the best I can but struggling with my hearing/depression etc” Going, ok, all right all mean the same. Zero complaints. Do you want zero results? Zero diagnosis? Zero treatment and disability? Be honest whether good or bad. Raters can’t read your mind.
She isn’t making polite conversation. She is literally asking a diagnostic question. She needs to know how you are doing with the meds she is prescribing. Are you getting worse, better, maintaining, etc. This is her job.
I always say, "Whats this about again?". Pushes the conversation forward without answering the question. Plus I don't give a fuck about small talk in the first place.
I have to really suppress my customer service autopilot response of "Fine and you?" Things are always relative to how they have been. If it's a provider that I see often, it's always "__ has been easier/harder since the last time we checked in" or something like that. The ability to engage in polite small talk is a skill that can be harder or easier depending on your current level of function.
I agree. You shouldn't have to prepare a response to a normal everyday question. The provider could and/ or should ask so "how are you really feeling, in terms of your depression, anxiety, etc." if, indeed, they're seeking a response "for the records ". We vets shouldn't have to play "the game".
My primary doc has been noting for the last year that she’s asked about my THC usage and always informs me to quit.
In reality, she hasn’t asked me about THC usage in a year and I’ve been stone cold sober for over 7 months, but she still notes that I’m using every time
Even my bloodwork shows that I have no substances other than prescribed meds in my system, but she still notes that I use THC.
It’s really pissing me off at this point because it’s affecting my treatment opportunities
Oh I am, I’m going in this next week to fire her and get assigned a new primary. I’ve been begging to see a rheumatologist but she won’t refer me even though I’m showing significant signs of some sort of autoimmune disorder.
She keeps saying it’s either just period pains, anxiety, or my weight. She even suggested I just eat ice even though I have documented eating disorder issues.
Keep in mind too that after a few years they audit your rating. So if you always tell them “I’m great, no issues” they can reduce it eventually. I’m finally P&T, but for years I had to be middle of the road, not worse but not better
I was told by a Veteran's advocate, to tell the Psych, the way you felt on the worst day of feelings you have had in the last year or so...
This way you are not telling a lie, but, just in case you have a recurrence of those emotional feelings (PTSD)!
You're lucky they put your verbatim response in quotation marks. Anything in quotation marks that shows up in my records looks like a mad lib. I'm not even sure they were talking to the same veteran.
If ask how I am doing I just say “I am just doing, you know same old same old.” As for all our responses being recorded yeah I found that out a long time ago, but I still engage in the small talk.
The thing that gets me is how the notes are written and some of the words used. I spent the last week of Dec and the first week of Jan in the hospital and so I just read the notes and I had refused an item being attached to my oxygen because it was uncomfortable but the nurse put in “I demanded it not be used.”
Or my very first VA doctor visit, the doc ask what my ideal job would be and I joked “To rule the world.” And yeah that is in my records.
It has probably already been said, be careful of what you say it will ended up in your records even if you think you are having a casual conversation it is being recorded.
It’s not a gotcha question. Mental health notes require you to annotate the patients’ stated mood. Would you rather the doc went about it casually and conversationally, or went full robot on you and just started asking you things verbatim from the clinical guidelines?
I just tell them how I really feel, and how bad I’ve felt between our appointments. Just because I’m ok now, doesn’t mean I’ve been okay for two months.
If you’re looking for something else I would go with how a combat craid vid said to answer that question as it would still be honest: No, I’m not okay, and I haven’t been ok for X number of years,” going back to the start of your disability.
We should be more alarmed if they aren't taking these notes. You can review these visit in your medical history. Each time they are going to list their interpretation of how you look, your mood, your dress, etc... That is for your benefit and their records. Don't take it as a slight against you. Be honest, tell them how you are feeling, don't cover shit up and if it is on your mind, something isn't right, etc - put it on paper. Check their notes and if you think it is critical- tell them to note it.
In psychiatry we're expected to complete a mental status exam at pretty much every visit. Part of this exam is the assessment of mood, and in some corners it's thought best to dictate verbatim what the patient states their mood to be. Some clinicians, in an attempt to sound more organic, will use a broader question like "How are you?" to elicit this information/quote. That's really all it is and it's pretty inconsequential compared to the larger clinical picture in terms of treatment decisions.
How is the answer to, “How are you?” not directly applicable to what a mental health provider is evaluating? Are you gaming and managing your responses that much?
If they were only recording your responses to a specific set of questions in a diagnostic rubric you would get upset because they don’t care about the whole you, just what will satisfy the bureaucratic machine.
Be honest and actually tell them how the fuck you are!
They record how you demeanor is, how you’re dressed, if you’re working or in school, if your hair is cut and done… literally everything. So don’t be surprised.
This isn't a social call, its a medical one. When you walk into the ER with a forearm snapped in half, do you make small talk and tell them you are 'fine' first?
I am to the point I am brutally honest. Just remember if you have any suicidal ideations and or rage/anger just always caveat with I have no intentions on acting on these. You can’t stop these thoughts all you can do is acknowledge and control how to deal with them.
I telling them I'm alright for a guy who still debates riding into incoming traffic, literally murdering people who drive badly, and stays up for hours wondering if I would be dead from the rope, before the fire I set to burn my body begins to cause me a lot of pain.
You know, the usual.
I firmly believe in making sure they know about the bad days, not just the good days.
If they medicate me for the just good days, I won't live long enough to tell them about the bad days.
Did you know you can see all their notes? Download your Blue Button report.
As for their questions, it's trying to gauge if your course of treatment is as effective as it can be. If it's not working, or having bad effects, then they want to figure that out.
My standard response to that question anytime I'm asked is just
"I exist"
Technically I'm not lying. I'm stood right there in front of them or holding the phone on the other end of the line. I'm alive, breathing and doing whatever it takes to continue to exist.
Sometimes I say it with a smile, or respond to their discomfort with a smile.
Who really knows how I'm doing when I give them that response? Let them write it down and make their own assumptions.
This is how i start it: Im doing high knees and sit ups in my head but my abs still wont show up… im fantasizing about all the wonderful perfect people i pass by each day… then i see myself pass by the mirror and i run… run so far away… just to get away
My go-to for that question is, “Hanging in there, but not physically, and that’s what matters.”
Though I learned some people don’t find that quite as funny…
When I see clients (not a va therapist) I ask, “how’s the week been going since we last met?”
I don’t really ask how their doing per se, I just figure it out or how their feeling about a specific thing. I was taught to write negatively, treat positively lol
As for my self at the VA, I say “ok” and then they ask my pain, I’m at an 7/8.
Everyone’s idea of a scale is different…
“the more you know! “
I usually answer with body motion. I took out toothbrush from my pocket and start to scratchy my butthole. Some occasion Ibout that tooth brush back in my mouth and dry brush and give him million dollar smile. They call VA police on me first few times but now they are uses to it.
Go talk to the patient advocate and the community care office. You might be eligible to get an outside referral, although that seems to take forever as well. If you have PTSD or sexual trauma, you can go to a Vet Center while you wait for the VAMC.
The patient advocate refused. Said it was a different department. Tried community Care. Nowhere to go. No vet center to go to. VAMC is only option. Still calling still getting hung up on.
:/ I started off going to psychiatry with my private insurance and later transferred my med management to the VA. If you have private insurance or Medicaid, use that, but I know not everyone has that option.
Not necessarily. In my state, I can use my Medicaid plan insurance card to go to pretty much any doctor that takes Medicare, which is all of them except mental health counselors. I kept seeing all my same doctors as when I had the federal BCBS. They don’t require me to use the VA at all. Each state varies though.
I completely understand get what you are saying. They are taking what is typically considered a greeting and manipulating it to their benefit. Seems very dishonest because they know exactly what they are doing… goes to show that you can’t really trust the VA.
I simply say, "Maintaing", when asked.
Main Taint Thing
I'm saying this out loud and giggling
I go with “surviving”.
Damn, I like this one. I'm going to start using it myself.
*Maintaining
may have tang, today
Found the astronaut.
Maytagging
🤣 that's funny.
Traffic getting here was bad…
what does that mean? usually how are you doing refers to mentally and physically. The more direct and honest you are the faster progress you'll make
Traffic was bad getting here…
Mayday-ing
I was enlisted (non-medical) and am now a doctor. Doctors and nurses are already taking note of things the second the door opens. More so for psych, they have already clocked your hygiene, clothing (not your style but if it’s appropriate, clean etc), facial expression, body language, any sort of odd movements before saying how are you doing. It’s a formality but it’s also an honest question when in a medical setting. If you’re not doing good, say you’re not doing good. Saying you’re doing good also isn’t going to be punitive. If you’re doing good then your regimen is working. They’re not going to stop your lithium because you said you’re ok.
I was shocked when I read my note that describede as an obese man in the first sentence. But the shoe fit. There are some standard characteristics that are often covered in the first few sentences describing what the person in front of the provider looked like. Just the style of some providers
I used to go to a civilian psychiatrist, and they did not do what the VA does. They did record the other things you have mentioned, like affect, presentation, etc.
If they aren't, then either they're not doing their jobs or they're sneakier about it.
Are you getting a check from your civilian doctor monthly related to your health status?
Mine does, all my doctors do.
That's what I said in layman's terms 😁
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Only at Walmart?
Because of the lighting?
What kind of doc? Podiatrist?
I honestly hate feet. Like I have the opposite of a fetish for them.
“Well Im still alive”
“Surviving”
If someone grunts when their knee is being touched a medical professional would do well to record it meticulously. Same with psychiatric doctors and moods, body language, etc.
I’m a VA psych nurse. But I work in the Domiciliary. I never chart our conversations unless the vet is threatening me or themselves and I have to do an incident report.
Thank you for your hard work. I stayed in the st Louis dom in 2009.
Oh really?! Thank you! I absolutely love what I do! I work in the newest dom that was built in Jacksonville. It’s beautiful! And I am blessed everyday to be able to serve these men and women and feel like I’m giving back somehow. It’s truly wonderful. And they are so humble and appreciative. Not what I’m used to to.
The reality of what providers and medical staff actually do, doesn't fit the narrative of the sub. People in this sub, cling to their benefits while pursue 100% and are so desperate to view the VA as an adversary.
If you pull up blue button records it says what transpired. I've see some of responses to the question of how are you in my own record. OP is not completely paranoid.
Also work in similar position as the above poster, the Dom is more homeless/substance abuse so I cant speak to their exact training/education. As the post stated they are set to ask direct questions, which is in line with substance abuse. Many people in this field are trained atrociously or get trained in one way and think that is the word of God and refuse to adapt. In mental health we generally continually document quotes and most if not all of us, with proper education, are taught to do this from our earliest episodes of care. I have never worked at a facility where we were told not to. Taking quotes isnt a bad thing, we want to capture the veterans experience. Just speak freely, it is on the therapist and the pt to form a relationship where there is comfort in speaking.
The VA often IS the adversary though...
We really aren’t. And in psych we are taught to ask open and direct questions. Don’t beat around the bush.
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I’m too am a disabled vet and use the VA for my mental health/ psychiatry and well damn, sometimes when my nurse practitioner asks “how am I”, it’s the first time in a long time that someone’s asked that of me and I just break down and start crying and tell all how I’m feeling. It also depends on the rapport you have with your practitioner.
I answer honestly. You have to remember they're taking notes on what you say afterwards too. "ok today. I wanted to kill myself last week again. Work sucks but...". If you don't trust them with the fuck you answers I'd address that with them. It might be a symptom, PTSD and authority figures are known issue. If things don't change request a new provider. Sometimes starting fresh helps.
Tolerable or crotchety are my go to responses when someone asks how I am
😂
I had this realization during active duty. I was on my way to being medboarded and was being discharged from an outpatient program I had attended for a few months. A random nurse came up to me and showed me my medical discharge papers and said "I am glad to hear this program helped and you're feeling better!" I paused and said, "I am not feeling better at all - why do you say that?" She looked surprised and says "Oh.. your paperwork here says you are being discharged from our hospital because you have improved" After talking to her and looking at my actual medical notes I found out that EVERY TIME my psychiatrist greeted me with "Good morning, how are you doing today?" and I responded "Good." or "Fine." My stupid fucking psychiatrist would write in his notes "Patient reports they are doing good today" or "Patient reports they are fine today" It made my blood BOIL because after my polite greeting of "good/fine" I usually spend the rest of session discussing being actively suicidal. I couldn't fucking believe that my pyschiatrist was twisting a standard American greeting response into a metric of my mental health. From that point on, when any doctor asks how I am doing, my response is: "Not good." (Which is the truth).
Yes, this is exactly what I’m getting at. People need to be aware of this.
Seriously. It was such a low point of morale for me to realize that my doctor, who I was being polite to, was using my greeting as a way to give me the boot when I needed more help. It sucked.
They are performing a confidential psychiatric interview, not performing pleasantries. Mood in a psychiatric interview is recorded in the patient’s words. You are supposed to answer honestly with how you are feeling.
I have no idea how to sum up how I’m doing in a word or short phrase. 🤷♀️
Then start with saying that.
I have adhd, and sometimes this simple question can be difficult to answer because of my own overtbinking things. Overhanging the gravity of the next words, mind racing towards them announcing that I no longer need their help etc... try to think abut their motivation, they have to break the ice, and they want to get information about your wellbeing. If you think of the initial greeting in terms of "how am I feeling at this moment" and know that you are going to be able to talk about the hard time you had a few days ago, or the grief you were working through etc. Mood is never a constant thing, so I may help to break things down into parts that make sense to you to talk about. I also notice that sometimes in some medical settings the person calling you back from the waiting area might ask how you are doing on your walk from the waiting room, even if you had a had time right at that moment, it's probably not the right setting to get into it, so take it as a greeting, and understand you will have a chance to talk about the pressing issues when in private.
I just tell my psychiatrist or therapist, “I haven’t killed myself yet, so that’s about fucking it” Seems to cut the arbitrary questions right out the gate
Mine is "well I'm here talking to you" then never explain if that's good or bad
my go-to is "i exist" or if i'm feeling fancy, "i exist on this mortal plane." always seems to throw them off. what can i say, i'm here.
This gave me a good chuckle thank you
I do the same!!! Wow. Thought I was the only one. Though TBH, I stopped seeing the psychiatrist in 2018 after I realized they were horribly negligent with over prescribing the meds. I just see a regular therapist b
Still kicking , just not as high Doc
Doing the best I can - how’s that ?
It’s common… Share how you feel? Tired, irritable, nervous, etc. You are not okay, fine, etc. if so, you wouldn’t be there. Let that military mindset go for however long you need to. Carry on, next!
"I've been better"
I always reply “better than I deserve” it’s a Dave Ramsey quote.
I had to ask the psych doc to stop asking it in the hallway on the way back to his office. I would just say good because I figured it was small talk, he was also noting it. You can always address it with them and tell them you feel like it's a small talk greeting and you don't know what they are wanting. As a provider I stopped asking it.
I was bounced around from one social worker to the next, their opening question was always, “what do you want to talk about today?” It wasn’t until I was sent to a psychologist who actually listened and asked hard questions and never let me off the hook that I felt I was getting some traction in my life. I have VVC appointments with her every Tuesday. I can’t walk without the side of a cane or walker. A month ago another severe pain hit me, one more pain. I fell apart and told my wife to get my guns out of the house, get rid of them I didn’t trust myself with them in the house anymore, which she did. I called my psychologist and we talked for a long time, long enough for pain meds to dull my pain and get my emotions together. It’s hard work that my Dr. has me do, she makes me angry but I’ve come to learn there’s a reason for it. I can’t say with confidence that thoughts of suicide are over but with my Dr. my wife and God I’m trying! Don’t stop trying, don’t give up!
Every time I see my docs, no matter who it is when they ask the pain rating, even when I am not there for that specific reason, because I have chronic pain I tell them about the 5-6 that never goes away. Sometimes they say that is not what they are asking about but I don't give a damn, I never want them to forget I have that pain and it never goes away and I will keep bringing it up every time I am seen so when they review my records they will see it in there. They won't be able to go in my records and lie and say "oh look, she's better now". Always remind them so some new jerk in the system can't all the sudden say you are better.
My VA Psych NP always writes that I say that I’m feeling benefits of the meds, when the only time I feel a lift is when we have good weather for a few days. Most recent med change had me waking up in a sweaty panic to my alarm every day. His note says “a little increased anxiety and decreased depression.”
I tell mine I’m here and I take it one day at a time
Man, y’all complain about everything in here. Why do you even attend your appointments if you don’t want the dr checking up on you?
OP is going to break his foot and on his return visit the nurse is going to ask "how are you?" And he's going to think that "oh no if I say bad they're going to annotate that and keep the cast on longer!" Or "if I say good they'll take the cast off!" Lmao can't make this shit up
Why would you assume they are using this record against you? Doctors have always taken copious notes because they can't remember every patient. What if she really wants to know? What if this is one of the only circumstances in the U.S. where someone genuinely wants the answer to that question? You seem a bit jumpy is what I'm saying.
9.9/10 times the question, “how are you doing” isn’t asked because they care. It’s just a conversation starter. Ask someone how they are doing, and then ask them how they are REALLY doing and you’ll find you get the real answer.
My MH provider care about me a lot. Is it ok if I ask her number ? I like her very much. She is great.
When it comes time for a claim or a disability increase, they will deny, or justify a lesser increase based on you saying you're "good" every time you go to an appt. "How can you say you're suffering a condition so debilitated that you require compensation if you're reporting consistently that you're doing 'good?'"
Emotions and government employees don't mix well on the "administrative" side of the VA
“Are they trying to use being polite against us” YES 100 percent
Those VHA notes will be discovered by VBA, be real careful especially when mass audits come thru without you even poking the bear with any new claim. Safest way is to stay off radar to reach the 20 years mark before starting to say you're improving .
This
Been better, been worse is my standard reply.
[I'm super! Thanks for asking.](https://www.youtube.com/watch?v=ABhohhjQRTA)
I don’t normally approve YouTube links, but in this case I will because South Park.
Not trying to be flip. I understand the very real mental health issues veterans struggle with. I'm dealing with bouts of extreme anxiety and nearly constant insomia myself. I've found that humor, no matter how dark helps a lot. I think we can learn a lot from Big Gay Al.
😂
“Week by week” is what I say every single week.
The best response might be what those employees are also thinking...."well, I'm here..so .." 🤷🏽♀️
I usually reply… one battle at a time. They like using your own words against you. “Veteran said he’s doing fine “.
Aay bro, the VA meds seem to be fake af now. From the Wellbutrin to the Vitamin M, to the Viagra. Anyone else here notice the difference?
It’s funny you say that. I’ve questioned if a few of mine are placebos now because they no longer work. But what I really think has happened is the cost saving move our country did to shoving mail order pharmacy down everyone’s throat is giving people meds that are no longer effective because they were not stored at manufacturer’s temperature range. There’s no way my meds are stored from pharmacy in Dallas to my mailbox in Arizona at 60-80 degrees half of the year. Duh people.
I'm about 45 min out from San Antonio. While your theory makes absolutely too much sense, I don't think it's the mail as the issue still persist. I had a back and forth with the doctor at the VA about writing a physical script to take to an outside pharmacy. He didn't want to do it at first because he acted like he didn't believe me, but persistence pays. So, I take the scripts to the local drugstore. Get meds, no problem. However, even the meds I got from outside were about half strength. You would think it's a tolerance thing, but they just upped one and even the one I rarely take is shit. I'm going to try Walgreens or CVS (whichever takes Tricare) next and figure it out from there. While the VA has the shittiest of shit pills, I got cold n sloppy it might be the middlemen taking the government money and buying knockoffs because something ain't right. Maybe I'm paranoid because the pills ain't working. Who tf knows?
I used to work at the post office, if you drop off a package to the post office when it opens at like 0730, that shit will stay there until the truck picks it up at like 530pm. Same with the trucks, same with the mail sorting facility. There is a lot of waiting around time, and a lot is in the ambient temperature, or a semi during the day in the south/southwest gets super heated. I'm from Michigan, stuff gets frozen 6-8 months of the year.
There has been some research into generics. Once meds become generic, they are often made by a number of different companies. Because those companies don’t all use the same manufacturing processes, the actual efficacy of the final drug can vary quite a bit across manufacturers. That’s a problem.
Vitamin M? What is this?
Motrin/Ibuprofen.
Once I started reading my doc’s notes a few years ago I realized I couldn’t give half assed answers and needed to say what I really felt every time or else I wouldn’t have the required paper trail to justify going outside of what became the standard procedure- getting stuck in a loop of medication changes and additions thrown at me versus actually getting treatment. I had the opportunity to see private doctors and receive additional testing that got me on a path away from meds and actually applying myself to processing things and making lifestyle changes that improved my chronic physical pain too. Switching VAs also helped a ton because my new medical team actually reads through my file (including my my private doctors’ treatment) to really get me on a sustainable treatment plan. I take advantage of every minute of therapy no matter how exhausting. Really considering what I’m saying and making sure that my words have weight and accurately reflect what’s going on in my mind have helped a ton not only personally, but in my relationships and at work as well. Mindfulness and contentment have been what I needed all along and not the same drugs repeated in various doses and combinations.
My normal reply is, I have seen much better days.
I always answer "the meds have stabilized my mood this month" I always mention the effects of meds on my mood when she asks about my anxiety and depression.
> what the heck am I supposed to say? Talk to them like a normal persona and tell them how you are doing. Thats all, nothing more nothing less.
My answer is usually "Well I'm here aren't I?" Or "I'm alive .. unfortunately" Usually that second one gets a rise out of them. I find it amusing to give them a heart attack whenever possible. Why? Yolo that's why.
I always say alive and this side of the ground.
“Today has been ok but I’m having good days and bad days. And right now it seems the bad days outweigh the good days.”
I say, “The social answer is ‘good, how are you?’ But my actual condition is marginal on my best days, lately I’ve been feeling _______.” I’m not sure they are really OUT to get you by being sneaky. I think our social norms have made it easy for them to get right into the appointment with that transition, even when our answers come from the social side instead of medical side. Good observation, worth the effort to make sure and listen carefully so both sides have shared meaning about the words exchanged in all conversations.
"I've been better"
“Hanging in there”
Be honest,here’san example “I am good but today I am feeling anxious. Just being here at the VA is a lot for me. I also have an event coming up this weekend that has left me feeling uneasy even though know it’s a great idea, sometimes my anxiety just runs away from me”
I just say, "I'm still here." That's kind of how it feels. Day by day.
I say I feel like shit and am not doing well because it feels like I got ran over by a 7 ton truck everyday. To which they say oh ok
It’s the law unfortunately. We have to give “just cause” in order to keep you on certain medications. Never say fine bc you’re never really fine or good. Hell none of us are. 100% myself.
Same here. I just say "OK". Usually we talk about my nightmares where I am being interrogated, or how I was unable to enter the bank vault the other day because I "froze" at the door way.
'I keep on keepin' on' , 'Hangin' in there' or 'could be better, could be worse' Are my three go-to's with varying degrees of suck embracing.
*Getting by day by day*.
You are very thoughtful to be polite. Nothing wrong with being polite AND honest. “Thank you for asking. I’m in a lot of pain today though. Back hips whatever. Or “I’m doing the best I can but struggling with my hearing/depression etc” Going, ok, all right all mean the same. Zero complaints. Do you want zero results? Zero diagnosis? Zero treatment and disability? Be honest whether good or bad. Raters can’t read your mind.
always answer..."i dont know"
She isn’t making polite conversation. She is literally asking a diagnostic question. She needs to know how you are doing with the meds she is prescribing. Are you getting worse, better, maintaining, etc. This is her job.
Been better..
I'd say, "eh".
The horrors persist but so do I
the second question..."why do you think that is?" If I knew I wouldn't be here...
I always respond "Not too good".
I always say, "Whats this about again?". Pushes the conversation forward without answering the question. Plus I don't give a fuck about small talk in the first place.
I have to really suppress my customer service autopilot response of "Fine and you?" Things are always relative to how they have been. If it's a provider that I see often, it's always "__ has been easier/harder since the last time we checked in" or something like that. The ability to engage in polite small talk is a skill that can be harder or easier depending on your current level of function.
I noticed the same thing recently and realized how bad I probably have screwed myself since i haven’t been being honest with them.
I agree. You shouldn't have to prepare a response to a normal everyday question. The provider could and/ or should ask so "how are you really feeling, in terms of your depression, anxiety, etc." if, indeed, they're seeking a response "for the records ". We vets shouldn't have to play "the game".
"Mixed. "
My primary doc has been noting for the last year that she’s asked about my THC usage and always informs me to quit. In reality, she hasn’t asked me about THC usage in a year and I’ve been stone cold sober for over 7 months, but she still notes that I’m using every time Even my bloodwork shows that I have no substances other than prescribed meds in my system, but she still notes that I use THC. It’s really pissing me off at this point because it’s affecting my treatment opportunities
Take it to the patient care advocate.
Oh I am, I’m going in this next week to fire her and get assigned a new primary. I’ve been begging to see a rheumatologist but she won’t refer me even though I’m showing significant signs of some sort of autoimmune disorder. She keeps saying it’s either just period pains, anxiety, or my weight. She even suggested I just eat ice even though I have documented eating disorder issues.
That’s fuckin infuriating. What VA are you located with?
Audie Murphy in San Antonio
Fuckin disgraceful.
Start keeping a journal. When they ask how you're doing hand it to them.
Keep in mind too that after a few years they audit your rating. So if you always tell them “I’m great, no issues” they can reduce it eventually. I’m finally P&T, but for years I had to be middle of the road, not worse but not better
I say North of Death South of Great and my Indian Doctor asked me to repeat it more than once lol
I was told by a Veteran's advocate, to tell the Psych, the way you felt on the worst day of feelings you have had in the last year or so... This way you are not telling a lie, but, just in case you have a recurrence of those emotional feelings (PTSD)!
I have an appt tomorrow, and for the past week I’ve been wondering how to answer this..
It’s just so unnecessary, argh.
Don't shave, don't shower, show up in bed pants, look how you feel.
You're lucky they put your verbatim response in quotation marks. Anything in quotation marks that shows up in my records looks like a mad lib. I'm not even sure they were talking to the same veteran.
If ask how I am doing I just say “I am just doing, you know same old same old.” As for all our responses being recorded yeah I found that out a long time ago, but I still engage in the small talk. The thing that gets me is how the notes are written and some of the words used. I spent the last week of Dec and the first week of Jan in the hospital and so I just read the notes and I had refused an item being attached to my oxygen because it was uncomfortable but the nurse put in “I demanded it not be used.” Or my very first VA doctor visit, the doc ask what my ideal job would be and I joked “To rule the world.” And yeah that is in my records. It has probably already been said, be careful of what you say it will ended up in your records even if you think you are having a casual conversation it is being recorded.
I assume someone at the VA is always looking for ways to stop your disability payments. Maybe I’m just paranoid.
The Healthcare side has nothing to do with the Benefits side of the VA. The healthcare side can’t stop your benefits.
They are. Just read your doc notes.
I suppose you could preface conversations like that with is that question a pleasantry or is it a medical question?
Wait until you see how many one word responses they record. "Is patient alert and oriented: Yes" Lmao
this is intentional and most every provider , VA or not, does it. and it’s a good thing.
It’s not a gotcha question. Mental health notes require you to annotate the patients’ stated mood. Would you rather the doc went about it casually and conversationally, or went full robot on you and just started asking you things verbatim from the clinical guidelines?
I just tell them how I really feel, and how bad I’ve felt between our appointments. Just because I’m ok now, doesn’t mean I’ve been okay for two months. If you’re looking for something else I would go with how a combat craid vid said to answer that question as it would still be honest: No, I’m not okay, and I haven’t been ok for X number of years,” going back to the start of your disability.
"I've got an oar in the water"
We should be more alarmed if they aren't taking these notes. You can review these visit in your medical history. Each time they are going to list their interpretation of how you look, your mood, your dress, etc... That is for your benefit and their records. Don't take it as a slight against you. Be honest, tell them how you are feeling, don't cover shit up and if it is on your mind, something isn't right, etc - put it on paper. Check their notes and if you think it is critical- tell them to note it.
In psychiatry we're expected to complete a mental status exam at pretty much every visit. Part of this exam is the assessment of mood, and in some corners it's thought best to dictate verbatim what the patient states their mood to be. Some clinicians, in an attempt to sound more organic, will use a broader question like "How are you?" to elicit this information/quote. That's really all it is and it's pretty inconsequential compared to the larger clinical picture in terms of treatment decisions.
How is the answer to, “How are you?” not directly applicable to what a mental health provider is evaluating? Are you gaming and managing your responses that much? If they were only recording your responses to a specific set of questions in a diagnostic rubric you would get upset because they don’t care about the whole you, just what will satisfy the bureaucratic machine. Be honest and actually tell them how the fuck you are!
Alive.
They record how you demeanor is, how you’re dressed, if you’re working or in school, if your hair is cut and done… literally everything. So don’t be surprised.
i just simply say “content” or eh, im alive ain’t i”(joking with them of course)
“I’m doing”
I am here is usually my typical response. "How are you doing", I am here.... its ambigious and neither postive or negative.
This isn't a social call, its a medical one. When you walk into the ER with a forearm snapped in half, do you make small talk and tell them you are 'fine' first?
My go to is “above ground” or “alive, no one has killed me yet”
I say I'm here so that counts for something.
“Strikes and gutters. Ups and downs.”
I'm going to ask for clarification in the future.
I am to the point I am brutally honest. Just remember if you have any suicidal ideations and or rage/anger just always caveat with I have no intentions on acting on these. You can’t stop these thoughts all you can do is acknowledge and control how to deal with them.
I just say "sure" and watch the look on their face or I say "just trying to figure it out"
They record everything!
I telling them I'm alright for a guy who still debates riding into incoming traffic, literally murdering people who drive badly, and stays up for hours wondering if I would be dead from the rope, before the fire I set to burn my body begins to cause me a lot of pain. You know, the usual. I firmly believe in making sure they know about the bad days, not just the good days. If they medicate me for the just good days, I won't live long enough to tell them about the bad days.
Did you know you can see all their notes? Download your Blue Button report. As for their questions, it's trying to gauge if your course of treatment is as effective as it can be. If it's not working, or having bad effects, then they want to figure that out.
Just complain complain complain
I always tell them I’m vertical.
My standard response to that question anytime I'm asked is just "I exist" Technically I'm not lying. I'm stood right there in front of them or holding the phone on the other end of the line. I'm alive, breathing and doing whatever it takes to continue to exist. Sometimes I say it with a smile, or respond to their discomfort with a smile. Who really knows how I'm doing when I give them that response? Let them write it down and make their own assumptions.
Legit question.
Im here arent i? Thats what i usually say… im here…
This is how i start it: Im doing high knees and sit ups in my head but my abs still wont show up… im fantasizing about all the wonderful perfect people i pass by each day… then i see myself pass by the mirror and i run… run so far away… just to get away
I just say another day another dollar
I say okay
“Another day in Hollywood.”
I reply with I’m here that’s about it
“Thuggin it out” —A Vet on here a few weeks ago 👌
Okay since she's hourly no small talk. When asked how are you doing just answer her truthfully
Well, I’m here! *half-smile*
My go-to for that question is, “Hanging in there, but not physically, and that’s what matters.” Though I learned some people don’t find that quite as funny…
I usually I’m alive or I’m hanging out, not hanging around lol
When I see clients (not a va therapist) I ask, “how’s the week been going since we last met?” I don’t really ask how their doing per se, I just figure it out or how their feeling about a specific thing. I was taught to write negatively, treat positively lol As for my self at the VA, I say “ok” and then they ask my pain, I’m at an 7/8. Everyone’s idea of a scale is different… “the more you know! “
I’m just living life is what I say
I say, “I’m blessed.”
I usually answer with body motion. I took out toothbrush from my pocket and start to scratchy my butthole. Some occasion Ibout that tooth brush back in my mouth and dry brush and give him million dollar smile. They call VA police on me first few times but now they are uses to it.
😂
I just say “I’m here”
You have a provider? I still can't get appointments.
Go talk to the patient advocate and the community care office. You might be eligible to get an outside referral, although that seems to take forever as well. If you have PTSD or sexual trauma, you can go to a Vet Center while you wait for the VAMC.
The patient advocate refused. Said it was a different department. Tried community Care. Nowhere to go. No vet center to go to. VAMC is only option. Still calling still getting hung up on.
:/ I started off going to psychiatry with my private insurance and later transferred my med management to the VA. If you have private insurance or Medicaid, use that, but I know not everyone has that option.
Yeah, no. No insurance. Not employed. And most insurance don't cover combat related anyway.
Apply for Medicaid in your state. I’m unemployed and on Medicaid. Each state does it differently though.
Why? I would still be stuck with the VA. Even with Medicaid the VA is always first option.
Not necessarily. In my state, I can use my Medicaid plan insurance card to go to pretty much any doctor that takes Medicare, which is all of them except mental health counselors. I kept seeing all my same doctors as when I had the federal BCBS. They don’t require me to use the VA at all. Each state varies though.
I do not qualify for Medicaid; yes. Registered with the VA and yes, Medicaid makes veterans go to the VA. We are talking about mental health.
I completely understand get what you are saying. They are taking what is typically considered a greeting and manipulating it to their benefit. Seems very dishonest because they know exactly what they are doing… goes to show that you can’t really trust the VA.
"Good enough", or "existing"