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Are doctors reluctant to fill out the ADA mental disability papers, or is it just a part of the job?

There are many doctors who flat out refuse to have anything to do with forms stating that someone is disabled - mentally or physically. I have well documented physical disabilities, and when my doctor retired, it took me almost two years to find a new Primary Care Doctor who would work with me.I had one doctor actually cancel my appointment while I was sitting in the exam room, because he read the documents I had brought and realized I would be needing disability confirmation papers. He did not even see me, just told his staff to tell me to leave.Another doctor saw me, at about the time I had my annual review. He agreed to fill out the form but made it clear that he disapproved of someone as young as me “trying to work the system” … he submitted the form without having done an evaluation of my issues, with the statement that he had advised me that I “could return to work effective immediately” — that amputation of my legs in no way prevented me from being able to carry out the functions of my job as a paralegal or as an accountant.Luckily, the insurance review board was not staffed by idiots. They knew my disability status had never been due to my amputations, and they contacted me directly and sent me a copy of what they received.I was able to get my retired PCP to submit a proper evaluation, and did not lose my disability coverage. I also filed a formal complaint against that doctor with the medical licensing board and with his hospital. He was fired by the hospital and his license to practice in Texas was suspended for 3 years. So he moved to another state.A large part of the problem is because there have been many people who have faked their need for disability, and many doctors let that slide. Often, doctors would accept a patient’s self report of inability to perform, and would sign affidavits that said the person was disabled.It did become so bad that even today, when someone says they are disabled, especially when they have an “invisible” disability, the common response is to not believe them.Why that affected the doctors is that the companies that had to pay out the medical insurance (long term disability on a private insurance claim, for example) recognized that suing the individual patients was not worth the cost. However, suing a doctor for having signed off on a fake disability .. that’s where the money could be recovered.So doctors who will do disability evaluations and certifications actually pay a higher interest on their mal-practice insurance because if someone is faking it and gets past the doctor … the doctor is the one who could be held liableSo yeah - finding a doctor willing to work with you to help confirm or document an actual disability (mental or physical) is not easy. You have to keep looking until you find one.Remember - YOU are the client. You are a critical member of the team. Do not simply accept that a doctor won’t help - find a new doctor. Use that first meeting not only for them to get to know you but for you to talk frankly with them about what you need and expect. An be prepared to decide to NOT choose a particular doctor.ONLY you can keep yourself safe. Only you know what your needs are.

Do US consulates in India unconsciously discriminate by caste?

US visas are given:When the consular officer is convinced of the purpose of giving out a particular kind of visa from a specific visa applicant, as gleaned from:body language,passport and related immigration information, andhow well the information on paper matches with the informational awareness of the visa applicant.The above are independent variables (X).It’s not only that people of oppressed groups could find it difficult to project confidence, people of un-oppressed groups could also find it difficult to project confidence, because the probability of getting the US visa is just not dependent on getting things right on paper, as is the case with most other countries. It relies a lot on discretion of the consular officer, who forms their own assessment and makes their own decision. Performance anxiety of appearing to be the deserving candidate of getting the US. visa could also drain down confidence.So, you already have a dependent variable Y (people not getting the visa due to a lacking confident body language) that’s dichotomous.A person from lower caste who is applying for a visa in a skilled category, such as F1 (graduate student) or J1 (postdoc or visiting faculty), is there asking for the visa because of certain proven achievements. S/he is not just standing there outside the visa window right after being free from shackles of oppression—they already have some human capital, and knowledge of possessing such human capital.The probability of having a lack of confident body language could emanate more from the probability of having a possible visa rejection, assessment of that factor constraining some life chances, than emanate from an awareness of a hapless status.The dependent variables are now interacting with Confounding Variables (C[math]n)[/math]of:confidence emanating from evaluation of probable consequences,confidence coming from thinking about past achievements,confidence that comes from general personality styles, as well asconfidence that comes from dressing well and “looking the part”, etc,which in turn affects the decision-making process of the consular officer.The situation is now this:Further, people also ask for the US visa on several grounds where lack of confidence from belonging to an oppressed group do not matter as much, such as:religious grounds,medical grounds,as performers,to work as domestic worker (in which case they should be accompanied by a foreign national, who then has the onus of projecting confident body language), etc.If you can’t pinpoint that low confidence levels as expressed in body language is a static feature to be present in all people coming from oppressed backgrounds or lower castes, there is no basis to believe that US visa consular officers are unconsciously discriminating on the basis of caste.However, several Indians hold the following kind of mindset, which they become comfortable in speaking from the mask of a fake profile:And when Indians do go to the US, they continue doing the same casteist shit onto their countrymen:When caste follows you overseas: Ostracism, discrimination among South Asians in USIndians have imported casteism to the US & a black journalist writes on the need to ban itA more competent person to answer this question is Annika Peacock, who has actually been an US consular officer. I’ve requested her answer on the issue.

What are anti-anxiety medications that are suitable for long-term use?

Treating anxiety has been a big challenge for medical practitioners. There are controversies about it on even the basic level, such as evaluation of disease and measurement of severity, of treatment goals, about pathophysiology, and of course the treatments themselves. Also, medications are but only one type of treatment. Non-pharmacological treatments are commonly used and have been shown to be efficacious for many patients with different types of anxiety.Among medications, besides benzodiazepines, some people are effectively treated with SSRIs, or even tricyclics, medications often referred to as anti-depressants. This does not mean that anxiety is a form of depression, only that some of the same medications can sometimes be helpful for both conditions.Buspirone is often used for the treatment of anxiety, both short term and chronic. There is not agreement on its use as a long term agent.Some beta blocker medications, such as propranolol, are commonly used to treat some forms of anxiety. They are believed to work because so many of the symptoms of anxiety are mediated by the beta receptors of the sympathetic nervous system.Antipsychotic medications are sometimes used. However, these carry risks of side effects that often lead to problems or discontinuationPlacebos have been used for ages to treat anxiety. This is tricky ground both scientifically and ethically, but it placebo treatment can be helpful and does have its advocates. I don’t think we know enough about this effect and it could use more study and research.Some anxiety has specific medical causes, such as from certain hormonal disturbances. These can be treated by medications to correct the underlying problem.Marijuana is advocated by many for its anti anxiety properties. It isn’t well studied, however (one of the unfortunate results of its legal status), and there are some serious concerns about its long term safety.Likewise, there are other psychoactive medications and hallucinogens, e.g. LSD, psilocybin, which have shown promise for anxiety. In the US these agents are illegal outside of approved research, so not commonly available, and they have generally been used as an adjunct to other forms of treatment, such as psychotherapy. Long term use is therefore not practical, and suitability is unknown.Suitable is a tricky word. Long terms studies are lacking for most of these agents, and none of them are either effective or appropriate for all patients. This is one of the reasons that there seem to be so few options for long term treatment. However, all the ones I have listed here are used by some on a long term basis..

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