Curious if anyone has gone through the process of an adult adhd diagnosis at Kaiser SF.
Through my attempts, I've been told they don't really do adult adhd diagnoses without documentation of issues as a kid. I was recommended Wellbutrin to deal with symptoms in 2017. Got onto adderall when I moved health insurance in 2021. Back to Kaiser in 2024, I was routed to the same psychiatrist who once again wouldn't budge on adderall and once again recommended Welbutrin.
I used an online clinic to get my assessment (which I understand isn't taken seriously) which is what she cited. I asked what aspect of the assessment documentation did she think left me unqualified and she cited marijuana use in 2016. I asked her how she squares the fact that I'm an adult professional that makes comparable money to her, I have experience using both wellbutrin and adderall and see the former doing nothing and the latter helping,
there's hundreds of times more evidence for adderall efficacy vs the flakey data on wellbutrin... She responded with something like: "I believe in my heart of hearts that what I am doing is right".
I thought the entire situation was kind of insane. Further research into the person makes me think they're a bit of a loon.
When I was on Kaiser, it was an absolute nightmare trying to get any traction. They had me do a computer test and, I guess because the results of it (which aren't disclosed to you) did not indicate ADHD, they would not consider the wealth of documentation I had ready to take a look at my old school records. I asked for a second opinion and the next psychiatrist they assigned to me was aloof and refused to consider anything, either. They did give prescribe me bupoprion which did absolutely nothing for me (though I have heard it works for others).
I'm now on a PPO plan and have been using Vyvanse for over a year now. It's lead to a dramatic improvement in my quality of life. I grieved for the time and opportunities I had lost due to not having been diagnosed and treated in childhood.
HMOs have a lot of upsides, but Kaiser's behavioral healthcare is awful (at least in the DC Metro area) and there's not much recourse unless you want to/can afford to pay out of pocket.
There's so much cynicism about ADHD even existing, even among healthcare professionals. Any time on HN any mention of ADHD seems to invite a lot of cynicism as well. That, compounded with that one of the most effective treatments for it is something that pretty much everyone can see a positive effect from (stimulant medication), makes it really difficult to navigate.
I hope that you can find a better option because it seems like Kaiser is just very antagonistic towards ADHD.
I didn't get a diagnosis at Kaiser SF, but I was able to get meds through them. Maybe this will be of use to you.
I was diagnosed by a non-Kaiser psychiatrist I found on my own. After trying different prescriptions, we eventually settled on Concerta. I stayed on that (and continued seeing the same psychiatrist, whose service I paid for out of pocket) for about 4 years.
Then my psychiatrist had some family stuff come up and had to move out of California. Since she was no longer going to be licensed here, she couldn't keep prescribing my meds to me. But she was able to write a letter describing my situation and laying out how she'd arrived at the prescription I was on, with particular emphasis on the fact that she hadn't seen any evidence of misuse on my part. I gave that letter to my Kaiser primary care doctor, who agreed to take over the prescription. After that I was able to get my meds from Kaiser each month without any issues.
I imagine this kind of setup depends on your primary care doctor; I may have just gotten lucky with mine.
Too many psychiatrists do very little continuing education in their practice. I have heard more than a few try to asset that ADHD can only be diagnosed for children.
As if a neurodevelopmental disorder just magically vanishes when you hit age of majority.
It's pretty wild that despite it being a disorder that has been documented for hundreds of years, people still make the argument that people are just lying.
This is exactly my experience. I got diagnosed as some variant of bipolar 9 years ago and put on a mood stabilizer, but the symptoms never really fit. I’m in general high functioning and got great grades up through postsecondary, didn’t start really having a problem until I started experiencing burnout after having kids during the pandemic. Got evaluated for ADHD, psychiatrist focused on childhood symptoms. Refused to prescribe anything for ADHD because ADHD meds can cause manic episode in bipolar patients, they put me on Wellbutrin instead. Wellbutrin (which affects different people very differently) caused me to have a crisis and spent a week in inpatient care at a non-Kaiser facility.
It was the best thing that has happened to me in years. Inpatient psychiatrist disagreed with the bipolar diagnosis and said that inpatient care was a safe space so we could try Adderall and a different antidepressant (Lexapro). On Adderall I feel calmer, less anxious, and if I’m tired it actually puts me to sleep, which is all in line with ADHD patients. I can focus at work again and have my life back.
I don’t feel like I’ve “lost” anything on Adderall, I would describe my experience with ADHD as having a buggy thread scheduler that would overallocate CPU time to background threads. On Adderall I feel like I have control again. I can still daydream, but all 5 trains of thought are not trying to enter the station at the same time.
I’ve had 3 different Kaiser psychiatrists and all have been sub-par, refusing to re-visit prior diagnoses, being aggressive and overly rigid in their own opinions, and sometimes just being plain incompetent. My recommendation is to seek mental health care from somewhere outside Kaiser that accepts Kaiser insurance. Kaiser’s mental health division is oversubscribed and probably underpaid. Overall our experience with Kaiser has been that no matter which division you’re dealing with, you have to be pushy and advocate for yourself or they’ll just slap the easy label on you and throw medications at the problem that may or may not actually address the root cause.
I’m very open about my experience because mental health issues are highly stigmatized in this country and there are a lot of people who don’t get the care they need. Accepting that I needed inpatient care was one of the most difficult things I’ve ever done, but coming out the other side it was nothing but a positive experience and I feel like I have my life back.
I made an account just to post this as I’ve gone through something similar. Get a formal psychiatric evaluation done out of network by a neurologist who specializes in ADHD. The exam will take a few hours and they will send you a full report and diagnosis. This paperwork will help you a LOT. I’ve used it multiple times when I’ve had difficulties getting care and was well worth the time and money.
I don't even know why they have formal tests. Any health professional and half of the repairmen I've had to my house that has talked to me for more than two hours knows I have it. And probably you too.
Personally I had success with my primary care doctor. But you could also look into online telehealth diagnosis. That was my backup plan to ensure I have access to medical treatment.
Try to talk your doctor into gaunfacine. It was an attempted BP medication that had stronger action on the prefrontal cortex, reducing rejection dysphoria (which exacerbates executive function issues). At the very least it might make it easier to confront your doctor about not prescribing stimulants. It's also compatible with Wellbutrin.
Downside is you have to absolutely avoid grapefruit unless you want to find out what bradycardia feels like.
I had pretty much the exact same experience even with a childhood diagnosis and extensive records indicating I only responded well to stimulant-based medication.
The whole process became so burdensome I just gave up and now I self medicate with Nicotine pouches.
Not proud of it and probably not the best alternative but it helps me focus and keeps me out of the stress of the constant back and forth that healthcare providers put you through.
> Curious if anyone has gone through the process of an adult adhd diagnosis at Kaiser SF.
Yep. It appears to be different by region. When I left the bay area and moved to a different kaiser region, they didn't accept any of the medical history from the bay and I had to start over again. Yes, I did have the prescribing pshyc from the bay area send the detailed clinical notes to kaiser but because I didn't take _their preferred_ computer diagnostic tests, I had to start over. Nevermind that the psych I was seeing in the bay area has been treating ADHD since Reagan was in office, the computer test was worth more than the medical professional's experience and opinion!
this app is replicating a set of women only facebook groups. there's one for every major US city. it's sort of an if you know you know situation.
the vast majority of posts are speculation on someone being douchey or a cheater. women in their twenties seem to really enjoy browsing through the gossip.
To be fair, and not that you're saying otherwise: that seems like a pretty natural and chill response to the fact that men have always been assaulting and raping them. Like, it would be weird if women didn't ever speculate on which men could be a threat.
years ago, a friend of mine built something functionally equivalent to Denuvo in his spare time over the span of a few years. I think his original idea was "DRM for the little guy", recognizing that indie games probably lose massive revenue from initial release piracy.
He had no idea how to sell it. After it sitting around for awhile, I tried pitching the technology to few friends in VC, who had absolutely no idea what I was talking about.
It bothered me for a long time to see such a culmination of talent and effort get 0 reward for it. I've wondered if such technology would be interesting to some large publisher to just buy outright, bringing their anti-piracy in-house rather than relying on Denuvo. Any ideas/help appreciated :)
> recognizing that indie games probably lose massive revenue from initial release piracy.
This seems like an odd claim _especially_ for indie games. Indie games tend to already have trouble attracting buyers, it feels like anyone considering pirating it would just move on if they couldn't do so.
Plus having a pirate version is essentially advertising for them if their product is good. Many indie title success stories I think is thanks to pirates trying them out for free and then telling everyone "Wow I just played this awesome indie title that you never would have heard of because its an indie title with little to no marketing and it is really good!" which lead to people looking at it and talking about it and getting more sales. I myself have bought numerous titles that I never would have bought based on the steam shop page. This is especially true for building, survival, or physics based games, which are pumped out en-mass, but take real talent and vision to do well enough to be worth the time and money to buy and play. Just a few games off the top of my head that I own but never would have otherwise bought without first pirating and playing them include, Project Zomboid, World of Goo, Besieged, Neo Scavenger, Oxygen Not Included, Banished. And even some pretty large titles like Crusader Kings I would never have considered buying without playing it first, and now it is one of my favorite games. Factorio would be the same thing if they didn't have a old version as a demo to play.
A indie game dev phoned home how many players were playing his game that pirated it and he addresses your claim too in the article he posted about it[0]>
They'd play it for free* but how many would pay? Would that number go down if DRM were involved?
Personally, Steam's about where I draw the line. They've given me enough value as an ecosystem and their native 'DRM' doesn't seem that obtrusive, so they've got a lot of my money over the years.
I've regretted every single time I happened to buy a game, which turned out to have other DRM or any form of 'anti cheat' client side. They just never work in the long run.
I played both Oris for 1€ on gamepass only to buy it when it's in a steam sale (~11€ for both iirc).
I have free games from epic only to buy them on Steam for 5€.
I have no problem pirating games. The last big title was Cyberpunk. It runs like shit on my end but once I buy a GPU I'll buy Cyberpunk. Until then I can wait.
I pirated GTA5 to test it on my machine back in the days. Textures popped in seconds later because the HDD was way too slow to handle the game. I prefer pirating a game over dealing with refunds.
I have it for free from Epic. Would I buy it now? No. I don't like the game at all after playing for 4 hours.
What is my favorite single player game? Cyberpunk. Do I share that information? Yes.
I really enjoyed this article, thanks for sharing!
It's a shame that OP didn't add a tracker to the pirate plea button. I would wager that he made practically zero sales from it - looking at how well donations seem to work in software development in general. I think that this is why microtransactions work well. They give away a nerfed version of the game for free, and after the player formed an attachment to it, the game can be upgraded for a price. In a way, this is a much more human design, than forking up the entire cost in advance.
Many years ago I was publishing work independently with a few other colleagues, and yes, piracy was a big deal. It was flattering, because you knew the demand was there, but maybe the audience couldn't or wasn't willing to pay for the product, but you don't want to see your work obtained for free when you're charging for it.
I pay for games because it's convenient. Most DRM is decidedly inconvenient for me, especially Denuvo-tier DRM. The end result is that if there's DRM, I'm more likely to pirate it or not play it if there's no crack.
One situation it regularly fails is with no internet connection. You download a game on your steam deck, get on the plane, and then it refuses to launch. You can prime it by loading the game while connected, but every now and then it randomly unauthorises itself leading you to regularly get stuck in this situation.
The main problem with this is that some of us who buy indie games specifically buy them because they are available on DRM free platforms like Itch.io and GoG.
Adding DRM is just going to stop me from ever wanting to purchase the game. Its the same problem with Steam sucking up indie devs who started to only release on Steam. Will never purchase their game on a platform where I can't keep my own offline backup for when the service eventually fails.
It's nice to see such effort into user-hostile technology go unrewarded. When your product is, "what if we made everything we touch a bit worse?", you deserve to get 0 reward. It's sad to see that things like Denuvo haven't met the same fate as your friend's software.
I love that the only example of inconvenience presented in this thread is that a person might open the wrong game while on a steam deck while possibly not having internet while on a plane. The agony!
I was right there with you with this opinion back in the day. Distribution was terrible, people didn't have near 24-7 access to internet. The times have changed. You're also not 11 years old anymore. You can afford to pay your peers in your industry.
"The wrong game"? What about the game they want to play..?
Or what if they want to play the game they bought on different computers they own?
Or what if they're troubleshooting something?
What about when I wanna play the game again in 10 years and your activation servers are down?
> You're also not 11 years old anymore. You can afford to pay your peers in your industry.
I haven't pirated a game in forever, and as a paying customer, I'm harmed by anti-piracy measures. Pirates usually get a better experience since crackers strip out the DRM.
>"The wrong game"? What about the game they want to play..?
the fleeting circumstances that impact a user's ability to play a particular title don't outweigh the hundreds of thousands of dollars of theft. your examples don't even make sense
>Or what if they want to play the game they bought on different computers they own?
this is not an issue with steam/denuvo
>Or what if they're troubleshooting something?
what?
>What about when I wanna play the game again in 10 years and your activation servers are down?
denuvo style drm isn't intended to be permanently used on a game. eventually the cost of licensing per year exceeds the extra revenue (usually after one year). You don't even understand what you're talking about
i combed through quite a few hobbyist gb emulators while writing mine and found audio to be pretty rarely finished or finished without issues. not sure if it's the same for NES
Audio is *surprisingly* tricky on both platforms. NES has DPCM, which cheerfully interrupts the CPU and causes untold issues with controller reading. Gameboy has envelopes that are semi-required with phase-resets, and a wave channel which you in theory cannot write new samples to, and developer hacks to work around both. Both systems have various hardware revisions that have subtly different behavior, and a handful of games that will break on that specific model. It's fun!
It's also more involved to verify operation. Graphics are easier to "measure" and compare. Sound is also much more timing-dependent, e.g. when timers are running on their own all the time. It's disconcerting when sound is slightly off in games.
i made https://perfectpitch.study a week or so ago. i am old and musically untrained and wanted to see if rote practice makes a difference (it clearly does).
most of the sites of this type i found annoying as you can't just use a midi keyboard, so you just get RSI clicking around for 10 minutes.
I tried getting adsense on it, but they seem to have vague content requirements. Apparently tools don't count as real websites :-(. I couldn't even fool it with fake content. what's the best banner ad company to use in this situation?
i had media queries set up and they seemed to show up as working in devtools simulator. but trying on my actual iphone14 pro max doesnt seem to work. devtools seems to imply that an iphones resolution is much lower than the actual resolution
the layout is also tough to reconcile on phone. if you enable a large note range and keep a true piano layout it will not fit on phone. my plan was to break each octave into a row. not very satisfying visually
Gave it a try. After a few minutes I felt more like I was recognising the samples than I was recognising the notes. Not sure what you can do about that short of physically modeling an instrument.
> Currently includes the following built in exercises:
> [...]
> 7. Interval recognition - the very popular exercise almost all app has. Although I do not recommend using it as I find it inaffective in confusing, since the intervals are out-of-context.
I am using midi and open source instrument packages, so this is all handleable. There's a few instrument options to choose from in the top right settings.
Will probably add a "randomize instrument used per round" setting or something to really dial it in. I added a randomize velocity option but didn't test it much
Starting from the second note the brain switches to reative mode (at least a brain that got some relative recognition trained before) and no AP pitch will be memorized.
Agree. And for relative pitch training, I love this tool! The creator should read the paper to get ideas on how to turn it into an actual training tool for absolute pitch.
It’s probably possible to have copyright laws that aren’t a net negative, but they’d be very different (perhaps they’d be very short and only restrict commercial use/exploitation), and we don’t.
I’m pretty confident the optimum is at or near or zero copyright restrictions and finding other ways to fund the creators. Which, yes, means accepting that free markets are not the best tool for every job.
Copyright is the antithesis to free markets. It's based on state given monopolies for individual product. There are many examples for free markets being bad solutions, but this is not one of them. To the contrary, more free market for once would be good here - and also why one can only hope that big tech wins the fight described in the article, to maybe arrive at that change.
Why? What is wrong with the idea that I can put work into something and be (somewhat) sure, that not someone else makes a lot of money with it before I can?
You're not arguing for existing laws here, you're arguing for the concept of copyright which I'm not opposing.
Current laws aren't about protecting the authors, it's about allowing a bunch of (non creative) people to manage portfolio of IP and get loads of money from it while ripping off the artists. That's why current copyright laws are bad.
incumbent networks don't really lose. they saw potential blood in the water at the time with the rumblings of a mass exodus and made an excellent attempt at capitalizing though.
threads as a product was DOA when that didn't work. you need a network of interesting important people for it to be useful. when the migration didn't happen, you ended up with a bunch of instagram meme influencers reposting their content across two apps instead
I think their strategy combined with an open offer exclusivity bonus could have given them the stickiness. up front 5k, 10k, 15k, etc to a twitter user that matches their follower of at least 25k, 50k, 75k, etc count on threads and agrees to exclusively post there for a year. people weren't getting paid on twitter so this would have been alluring
Through my attempts, I've been told they don't really do adult adhd diagnoses without documentation of issues as a kid. I was recommended Wellbutrin to deal with symptoms in 2017. Got onto adderall when I moved health insurance in 2021. Back to Kaiser in 2024, I was routed to the same psychiatrist who once again wouldn't budge on adderall and once again recommended Welbutrin.
I used an online clinic to get my assessment (which I understand isn't taken seriously) which is what she cited. I asked what aspect of the assessment documentation did she think left me unqualified and she cited marijuana use in 2016. I asked her how she squares the fact that I'm an adult professional that makes comparable money to her, I have experience using both wellbutrin and adderall and see the former doing nothing and the latter helping, there's hundreds of times more evidence for adderall efficacy vs the flakey data on wellbutrin... She responded with something like: "I believe in my heart of hearts that what I am doing is right".
I thought the entire situation was kind of insane. Further research into the person makes me think they're a bit of a loon.