How can I be a good advocate for my partner in a medical setting?

Your GP likely sees a lot of people who don't have ADHD but would find that diagnosis advantageous (pending court appearances bring this out a lot). She proably also sees people who would quite like some free speed. Unfortunately GPs do get swamped by such a lot of rubbish that they sometimes get jaded, or miss cues. Don't take her attitude personally. Make it easy for her by writing a lot of things down in advance (people always forget to mention the most important thing when they actually see the GP) and by giving specific examples (so not "I'm always late", but "I lost these five jobs for lateness"). It's also possible that she is concerned that your partner has depression or anxiety masquerading as ADHD - there can be a surprising amount of overlap. It's also true that behavioural help (checklists, routines, etc) is at least as important for people with ADHD as medication, and some people actually find it more helpful. So don't dismiss that out of hand - it certainly won't hurt. I would try to fixate less on tablets in general - not everyone finds them helpful, some people get lots of side-effects, etc. Even when they work they are not a magic wand, and the behavioural side still needs work. The other thing is that it is EXTREMELY hard to get an appointment with a psychiatrist - even when people are actively suicidal or psychotic the GP often gets deflected. It drives GPs absolutely crazy, but it may well be that your GP knows she has no chance of getting a referral to psychiatry accepted, and she is doing the best she can in a broken system (I love the NHS, but NHS psychiatry is badly broken and has been for a long time; mad people are not sexy enough to attract funding). Is there even an adult ADHD service in your local area? There isn't one near my hospital (big, central London teaching hospital you would definitely have heard of). I would go to the appointment assuming your GP is acting in good faith, and make sure she understands that this is a serious problem for your partner. Ask her politely if she thinks seeing a psychiatrist will be necessary for a diagnosis, or if the psychologist will be able to do that. If you have the money to pay privately for an initial consultation with a psychiatrist (will be about £250) you can say that that's an option if she thinks it would help (ie mention it in passing as an extra option, not in a "screw you I'm going private" sort of way). Good luck! You are right, this is a really difficult system. Your GP is actually on your side in this, but is probably more aware of what is and isn't possible locally.

Thanks everyone - both for the great advice and for pointing out that adversarial was not the best way to go. I realised when reading a lot of these responses how much my expectations had been coloured by my own bad experiences with doctors about brain stuff, which helped me be calmer and more reasonable during the appointment. It went really well. The doctor seemed genuinely concerned by the issues his attention problems have been causing both him and us, and is sending a referral to the central agency in our area that processes all mental health referrals (this is a different system than the last time I was referred by a GP near here to mental health services, which was about five years ago, so I wasn't really clear on how the system works now before today). They will then assess him and point him in the right direction, whether that's diagnosis, behavioural work, something else or a mix. I imagine it's still going to be a long journey, but we're both feeling a bit more confident. Thanks again!

It may be helpful for both of you to try to view this appointment (and future appointments) as part of a bureacratic process that is necessary to go through in order to make progress towards him being well. it will probably take time. You will meet a few hurdles. Also: your doctor's judgement or dismissiveness is not relevant to the two of you personally-- they are just people themselves, and people who see a lot of patients, many of whom may think they have ADHD or some other illness and do not. This is not at all to say that you deserve to be viewed with skepticism-- you personally-- but to help you realise that a degree of skepticism about your interpretation of your partner's symptoms is in fact part of your GP's job. Your GP may be wrong. But if they are you can keep persisting with this (making repeated appointments, seeing the psychologist, asking for a second opinion) until you get the result you want-- which is a happier, healthier partner. Take a breath and try not to see this appointment as antagonistic or adversarial. It will be helpful for your partner to have you there to remind him of things he may have forgotten to mention but less helpful for you to be a bundle of nerves because you are gearing up for a fight. Take a steady, persistent approach with the doctor rather than going in guns blazing. A patient, persistent approach is almost always the most effective one in this sort of context. I think the issues you have raised about the nature of ADHD and the doctor's last recommendation are quite appropriately phrased here. I would articulate those issues just as you have with the doctor. The same goes for the psychiatrist/psychologist issue. I would strongly recommend making a few notes about the questions you want to ask/things you want to clarify before you go in. Nerves can make everything disappear. I also think the previous advice you have received about being open to the possibility of a behavioural or simply different diagnosis, and trying the psychologist route, are very sound.

Disclaimer: I don't have experience with the NHS, but I do have experience dealing with ADHD treatment and diagnosis as an adult, with an unfriendly healthcare system. I would take the referral to a psychologist, and see if your partner can get a referral for a psychiatrist from the psychologist. It's possible that his GP is concerned that he has other issues like depression or anxiety which can sometimes be present alongside ADHD or manifest similarly to ADHD. Many people also find therapy to be very beneficial in treating ADHD, particularly dealing with the debilitating feeling of shame that can go along with feeling like you can't be a functional adult. I would ask if the GP wants to refer to a psychologist rather than a psychiatrist because she thinks a behavioral intervention should be attempted before trying medication. There are real risks and side effects to taking medications, and at least in the US, stimulant medications are treated as controlled substances and there are many people who attempt to get a diagnosis so they can get a script for recreational use or sale.

I'm an adult with ADHD, I am medicated for it, and I currently live in the UK, but my story of how I got my diagnosis and my meds is a bit more roundabout because I am from the US. I won't go into the story, but the short of it is that your GP probably doesn't feel secure prescribing anything for ADHD because Adult ADHD isn't something that is really recognized in the UK. I got my diagnosis from the States, and was completely shut down by my GP when I asked her to continue my medication. She told me that "it wasn't a thing" in the UK, and that GPs in the UK don't prescribe for adults who have ADHD. She suggested that I see a non-NHS psychologist that specializes in behavioural therapy, but she was very adamant that she wouldn't give me the medication that I was on in the US. I managed to overcome this by being really stubborn and eventually she caved and referred me to an ADHD clinic in my local NHS trust. It took about 3 months for the referral to come through, and even then I got lucky again because somebody cancelled their appointment and they were able to see at the last minute. I am now on a slightly different medication than I was before, but my ADHD is under control. I'm not sure where you live, but http://aadduk.org/help-support/specialists-support-and-coaches/ may be helpful. If you want to see somebody under the NHS, it is going to be a long and bureaucratic process, but as long as you start the referral process, you can wait it out! I wouldn't hesitate about stressing about both the toll his ADHD is taking on you, and how he is suffering for it. Get a referral to a psychiatrist, not a psychologist. Look up if there is a specific person or a clinic in your area. I got pretty lucky, because the area I live in has a really great doctor who recognized my ADHD and was comfortable medicating me from the get go. PM me if you want more details! Good luck!

I was just about to say more or less what DarlingBri said. A bird in the hand, etc. Also, sometimes it can be better to let the medical professionals come to a diagnosis on their own. You have a gut feeling, but try to be open to that feeling being wrong. Doctors are human, and can be led by patients into making a diagnosis they might otherwise be hesitant to make. Go in as a team and ask lots of questions, and if the response feels wrong or incomplete, keep asking questions. But try not to advocate for a specific diagnosis. If you feel that a doctor isn't listening to your concerns, then you can ask to see someone else.

A good information service in the UK is http://www.addiss.co.uk Call them up, I'm certain they will be able to point you in the right direction.

Everyone here sounds correct. This is a sifting process that's part of rationing services within a huge bureaucracy that's often abused by people for whom an ADHD diagnosis gets them off the hook. It can be really, really hard to get straight in front of a psychiatrist but a psychologist's appointment can be the next step towards that. Be positive and assume that both your GP and the psychologist will advocate for him within the system. But they both want to make their own minds up before they do that - everyone in the NHS hates people self-diagnosing with a vengeance and whether you are correct or not isn't relevant. In the meeting articulate and advocate for his symptoms but do not suggest or ask for a specific diagnosis. Work as a team and be polite and assertive but be open to the idea that their professional judgement may not match up with your layman's expectations, and that does not mean that they are mistaken. One way to interpret their decisions is to remember that they want to get people back out of the NHS system, and that means enabling people to get back to health. But good luck and I hope things resolve happily for you both.

While not dealing with the NHS, the US "system" makes it hard to get a diagnosis too. My ADHD was diagnosed by a counselor (kind of like psychologist lite), after I had been treated for over 3 years with a one visit psychiatric diagnosis of Bipolar. The behavioral work didn't help, but getting an outside opinion led to me getting off of meds that didn't help and onto ones that did. So there is hope. Just to outline how bizarre a process it can be, I got my original unofficial diagnosis of depression and anxiety from a rheumatologist who listened when my GP had no clue.