Excessive number of doctors appointments

[Family Court Strategies: When Your Partner Has BPD OR NPD Traits.]

My exBP is always taking the kids to the doctor, making appointments.  I have told her several times that I do not agree.  She stated that if I didn't like it to take her to court...   I ran out of money, don't have a lawyer anymore.  I am trying to figure out the best way to express my concerns about what she is doing in writing.   Anyone have any experience with this ?

[sfbayjed]

My exBP is always taking the kids to the doctor, making appointments.  I have told her several times that I do not agree.  She stated that if I didn't like it to take her to court...   I ran out of money, don't have a lawyer anymore.  I am trying to figure out the best way to express my concerns about what she is doing in writing.   Anyone have any experience with this ?

[scraps66]

I do, sort of.  My ex wants to do all of these appts.  I've sort of given up the fight trying to make sure I'm involved in all.  But, a concern I have is when she falsifies information to shift accountability from herself, tot he child.  Our S10 for the longest time had a bowel control problem, past 8yrs old.  This all started when she took him to the pediatrician - gave me short notice, and then had the pediatrician diagnose this as a "physical" problem.  From that point on she hounded me about giving S10 his miralax and if I wasn't "you don't want S10 to get better, do you."  BUT, what she failed to explain to the pediatrician is that during the time this all started there were other factors, like, ex calling the police on Dad at any provocation, mom yelling at dad, mom interrogating dad about where he would be living after she kicked me out of the house, general toxic environment created by ex.  She obviously left this out.

My take, BP's are so loathe they try to fabricate situations where they are put in the position as caregiver.  It is an emotional need thing. 

I guess my suggestion would be to talk to the Dr's on the side so you at least look involved and you may get some insight, and document a pattern that there continues to be nothing wrong necessitating a visit.

I do think many have traits of van munchausen.

[ForeverDad]

Factitious Disorder AKA Munchausen's By Proxy.  It usually takes an extreme case, more than just frequent visits, for the authorities to see something as 'actionable'.  However, if it is causing you extra costs or your children are being excessively negatively impacted, it is something to resolve sooner rather than later.  You can speak with the pediatrician and perhaps even submit a very carefully written letter to the doctor (and for the files) expressing your concerns about whether the visits are excessive or could be triggered more by the ex's perceptions of the high conflict of the separation, divorce and/or ongoing parental conflict.  Since you can't be controlled as easily as before, this could be a way for the ex to have control over something, and to be Mother Of The Year (MOTY).

[momtara]

Are they really excessive?  After a while, a pattern would show through and could be brought to court, but it depends on if they are excessive or your wife is being on the safe side.  I think a pediatrician would start to notice wasteful appointments.  If you have rights to talk to the doc, you can call and just ask her what the latest appointments have been about.

[Matt]

I think these are both good approaches - talking to the doctors directly, and looking for objective ways to decide if the appointments are excessive (and if they are causing harm to the kids).

How old are the kids?

And what do they say about the appointments?

Do you have any objective information as to whether the concerns are based on anything, and whether the appointments have led to diagnoses?

Try your best to look at this from a distance - as if it was someone else's kids - what objective information can you get, that will either confirm that your ex's behavior is irrational and the kids are being put at risk, or that what she is doing is reasonable?

[momtara]

Oh, your original question:  You asked about expressing concerns in writing.  That might be a good way to start.  How about writing and asking her for a rundown of the appoinments, what the purpose was and what the doctor said. That way you are giving her a chance to explain (and can document it).  If she is not keeping you in the loop (and your agreement says you have joint legal), that at least would be a step toward proving there is a problem.  Or if she writes back something ridiculous or untrue, that also could help you.

[Matt]

Oh, your original question:  You asked about expressing concerns in writing.  That might be a good way to start.  How about writing and asking her for a rundown of the appoinments, what the purpose was and what the doctor said. That way you are giving her a chance to explain (and can document it).  If she is not keeping you in the loop (and your agreement says you have joint legal), that at least would be a step toward proving there is a problem.  Or if she writes back something ridiculous or untrue, that also could help you.

Great idea!

I would suggest e-mail, because it leaves a good trail.

You don't want to be confrontational - as balanced and courteous as possible.  So no answer will be a very important answer.

Let me try:

From:  Jed

To:  Ex

Re:  Doctor appointments.

I've noticed you are taking the kids to the doctor a lot.  For example, in January I think you took Child1 to the doctor three times and Child2 to the doctor twice.

Can you please fill me in as to why so many appointments are needed, and what diagnoses have been made?

Is there a way I can help?

Thanks,

Jed

If she doesn't answer after a couple of days, send it again - exactly the same - no mention of the first e-mail.  So there will be a record that you tried repeatedly, in a very courteous way, to ask for information and to offer help.  If she doesn't respond, that will show she isn't playing nice.  Or if she responds in an unhelpful way, that will be on record too.

She may answer with an explanation, and then you have to judge whether it's reasonable enough to play along a little longer, or whether it's so unreasonable that a court might agree.

I would not assume that you need a lawyer to move forward with the legal process - you don't.  If you can gather adequate evidence - through this exchange of e-mails, plus talking with the doctors directly - you can probably go to court without an attorney.  But don't do that til the evidence is very clear that there is a problem, or you wll be poking the bear.

[livednlearned]

I have a coworker who grew up with a BPD/Munchausen by proxy mother. Listening to her, I think it's really good that you're in the kids lives. You can offset a lot of the damage. It can be a problem if your ex is making them take medications they don't need. Do you think that's happening?

I imagine there are other grown adult children with BPD mothers on the Coping/Healing board who experienced the same thing. They may have some suggestions or insights into the dynamic. Because I assume it will be difficult if not costly to try and stop it through legal channels. I think there is another new term for it, "medical abuse."

Another thing you can do is to call the doctor's where the kids are going, to let them know that you feel the visits may not be warranted. It will go in the notes, probably, so be careful how you phrase things. But the notes will tip the doctors off to pay careful attention to what the kids say, what the mom says, and maybe take a little longer to try and put things together, so they don't jump to conclusions about the diagnosis.

I have a friend who has some kind of somatic disorder, always in the hospital with this or that complaint. I think the doctors know this, and seem to treat him more like a psychiatric patient than someone who needs medication, etc. In many hospitals, they even have risk assessment teams to gauge whether patients have psychiatric disorders instead of real physical symptoms, and are in hospital to get attention or drugs.

EDIT: To Matt and momtara's point -- you can also request these records directly from the doctor offices.

[Matt]

Another thing you can do is to call the doctor's where the kids are going, to let them know that you feel the visits may not be warranted. It will go in the notes, probably, so be careful how you phrase things. But the notes will tip the doctors off to pay careful attention to what the kids say, what the mom says, and maybe take a little longer to try and put things together, so they don't jump to conclusions about the diagnosis.

I would spin this a little different.

Rather than saying, "I feel that the visits may not be warranted.", I might say, ":)o you [Doctor] believe these visits are all needed?  Have you been able to diagnose any problem that I should know about?".  Or maybe, "I'm not sure if all these visits are needed, and I'm wondering if it is best for the kids to go to the doctor so often if there's not really a problem."

That is, you're asking the doctor's view, and you're expressing concern, but you're not taking a firm stand, because you don't have all the information yet.

That will put your concern on record, as LnL suggests, and it will show that you want the doctor's input.  But it won't (yet) set you up as wanting to fight over the issue, because you don't yet have all the information.  You're looking at it objectively, not as something to fight over.

[Tim300]

OP-  I agree with the other posters that this sounds like classic "Munchausen Syndrome by Proxy".  My ex and her mother (both pwBPD) definitely displayed Munchausen Syndrome.  They regularly had unnecessary trips to the ER and also a bunch of other appointments.  There are some threads on these boards about this syndrome.  Seems pretty common with BPD.  Perhaps the doctors they're attending are familiar with Munchausen Syndrome and won't be in disbelief if you bring it up.  Good luck.

[momtara]

I would not even include an accusation that she's bringing the kids a lot, or state that to any of the professionals.  Start off with an email just saying something that I know the kids have had several appointments lately, could she give you a rundown of the reasons, what doctor said, and anything else so that you are on the same page?

I give my ex very very detailed reports since he has the kids some of the time.  Your ex should give you the same.

[Matt]

I would not even include an accusation that she's bringing the kids a lot, or state that to any of the professionals.  Start off with an email just saying something that I know the kids have had several appointments lately, could she give you a rundown of the reasons, what doctor said, and anything else so that you are on the same page?

I give my ex very very detailed reports since he has the kids some of the time.  Your ex should give you the same.

Yeah, open questions showing your interest are a good way to start.  Then proceed based on her answers.

[ImaFita]

My exBP is always taking the kids to the doctor, making appointments.  I have told her several times that I do not agree.  She stated that if I didn't like it to take her to court...   I ran out of money, don't have a lawyer anymore.  I am trying to figure out the best way to express my concerns about what she is doing in writing.   Anyone have any experience with this ?

Yeah when I was organising these supervised visits I had a heap of orders that I had to go by.

I couldn't feed my son this, that, this, because he was apparently allergic to everything under the sun.

When I questioned this and asked for his doctors name, the workers tried to make out I was being controlling.

So I had to basically get diet tips of my sons Mother about what to feed him - mind you she is the size of a small house.

I sent him home with a roll once, then I got a letter sent out to me telling me to stick to his dieting plan, then I later found out that after I leave my visits, my sons gets cake and bikkies off the ladies at the centre - when his Mother picks him up.

Then every second session got cancelled because my son was apparently sick, I later found out off ppl I know he is apparently always sick.

These people actually make me sick, they are just a bunch of helicopter parents and attention seekers.

[ForeverDad]

Due to the long history of conflict - and that several months back ex got more time with the kids 'temporarily' - I don't know whether asking ex in a letter why she's taking the children to the doctor so often would be productive.  Likely she'd reply that they need to go and you're refusing to take them or something blaming like that.  At the least she's trying to be MOTY - Mother of the Year.

Do the children still have their own lawyer, Guardian ad Litem?  If they do, does the GAL know they're going to the doctor so much?  That you've inquired of the doctor and didn't get any real reason for them to be there?  What does the GAL think?  (I doubt a doctor would ever say 'don't bring the kids so often', they expect the parents or caregivers to have some judgment on needs and concerns.)  Are the extra doctor visits causing you any added financial expense?

[livednlearned]

I doubt a doctor would ever say 'don't bring the kids so often', they expect the parents or caregivers to have some judgment on needs and concerns.

I'm in a relationship with someone who practices medicine. Part of his diagnostic process is figuring out if the person is there for emotional or psychiatric reasons. Somatic disorders, factitious, Munchausen, and a whole bunch of other ones that I'd never heard of. Then there are the ones who have a legitimate illness but come in to try and get pain killers. And people who are ill but don't have family support and turn to medical staff for emotional support.

He described some of the behaviors of people who use health care to get other needs met. I think it's true that doctors expect parents/caregivers to have judgment on needs and concerns, and to err on the side of bringing them in. But if a parent is being truly excessive, there's a good chance that the staff have similar concerns. They just can't do much about it.

[momtara]

ImaFita, that's frustrating.  I hope things have gotten better.

[sfbayjed]

I have spoken to the doctor and expressed my concern. The doctor is know for being a doctor that readily will write scripts and referrals without much question. 

I attempted co-parenting with ex again and this was the issue. Ex is making appointments unilaterally, She stated in co-parenting that if I did not like it to take her to court at which point the co-parenting therapist said she was not willing to see us anymore. 

I think I do not have enough to prove that the appointments are not needed, it is something I am certain is true though because it does not feel right.  I do have plenty of proof that she is attempting to act unilaterally. I am afraid of being view as obstructive however.

I think she makes appointments to engage me, as she knows I will question the necessity of the appointments. 

It is always something.

[Matt]

What did the doctor say?

Have you written any e-mails to the doctor or to your ex about this issue?  What were their answers?

Let's brainstorm your case for a change to the court order:

* You have engaged a therapist for co-parenting, but your ex stated with the therapist present that she would not work with you on key issues and that your option was to take her to court.

* You have asked about the kids' doctor appointments but have not been given the information you asked for.

* You have expressed concern that some of the appointments may not be necessary and that it may not be best for the kids to see the doctor unnecessarily, but your ex has not responded constructively.

Is that right?

My view is that this may be enough to get a judge's attention, but it's not as strong as it could be.

I would suggest a few ways to strengthen it:

1.  Write an e-mail to the doctor asking what the kids have been diagnosed with and what treatment has been prescribed.  Make it polite, but also state that you are asking as the kids' father and you have the legal right to this information.  Consider that your e-mail will be seen by the court so make sure it has just the right tone - firm, clear, polite, moderate.

2.  Write an e-mail to your ex, as has been suggested here, asking what the kids have been diagnosed with and what appointments they have been taken to this year.  Again, remember that your e-mail will be presented to the judge, so it needs to be clear, firm, polite, and moderate.

3.  Write an e-mail to the therapist asking if she is willing to see you and your wife again, and if not why not.

These e-mails and the responses you get will document what you have told us here.

If you can find an affordable family law attorney, you may have a good case for a change to custody.  Without an attorney, you might want to file a motion anyway - it's not rocket science.  But you have a better chance with an attorney.

Figure out what change to the court order will make things better for the kids.  It's not about "winning" at your ex's expense, it's about arranging things so it will be best for the kids.

Give up on wishing that your ex would act right.  That is out of your control.  Figure out what custody arrangement will be best for the kids, and how to make that happen.

[sfbayjed]

Thank you Matt,

Those are some very good ideas.  I have given up on lawyers.  My case file is now 4 volumes and I can not afford to pay an attorney to read it. 

I am lucky that in my county all the pleading papers and court forms are on line.

I like the idea of sending out emails to the players,  I will do that and see what happens.   

[Matt]

What does your current court order say?

When was it issued?

Was there ever a third party involved, like a custody evaluator?

Does your ex have a lawyer?

And can your co-parenting therapist be subpoenaed to testify?

[livednlearned]

I don't know. It seems like you have to show that there is some harm from the excessive doctor visits. I'm not even sure what that really means. Some kids get sick a lot and have to go often. What are the downsides to seeing a lot of doctors? Do the kids feel they are excessive? Do they have to take medication for illnesses they don't have? Are they missing a lot of school?

You may not get much support from the doctor if it's know that you're winding up for a court case. Medicine is so litigious.

Not saying that she isn't being excessive, just looking at it from the point of view of the courts. They will probably want to know what harm is being done to the kids.

[Matt]

I don't know. It seems like you have to show that there is some harm from the excessive doctor visits. I'm not even sure what that really means. Some kids get sick a lot and have to go often. What are the downsides to seeing a lot of doctors? Do the kids feel they are excessive? Do they have to take medication for illnesses they don't have? Are they missing a lot of school?

You may not get much support from the doctor if it's know that you're winding up for a court case. Medicine is so litigious.

Not saying that she isn't being excessive, just looking at it from the point of view of the courts. They will probably want to know what harm is being done to the kids.

This is one issue:  Are the doctor visits excessive, and are the kids being harmed?

There's another issue:  Is their mom cooperating with their dad, communicating information like she should, for the kids' best interests?

Those are both important.