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“how to fool a neuropsych exam”

Posted Sep 30 2013 7:21am

To whomever found this blog by Googling ”how to fool a neuropsych exam” yesterday:

Dude, you’re wrecking things for the rest of us. Cheating on a neuropsych exam (NPA) is no laughing matter, and given how difficult it can be to get real help — especially for those of us with legitimate issues of us who really need help — your cheating is helping the system to trash countless lives.

So, knock it off.

I have been wondering who searched on this term, and what the context was. Could be, it was a student athlete who needs to take an NPA, and they know they’ve been hurt but they still want to keep playing, even though doing so could cost them their health (even their life, thanks to second impact syndrome). That’s very unfortunate, and I wish to God I — or anyone — could talk some sense into that individual.

Or it could be someone who is trying to “game” the system and get some sort of disability compensation. That just pisses me off.

Or it could be someone who genuinely needs help, and their neuropsych is being a dick, so they feel they have to cheat – just to level the playing field.

In all cases, none of the scenarios are good – and they all have their own little tragedies wrapped up inside, just waiting to unfold.

I have a lot of issues with how things are set up for those who need help after TBI. Hospital staff often don’t know nearly enough to be truly helpful, rehab facilities have varied levels of quality, insurance companies are notoriously stingy, and general knowledge in the population is sorely lacking.

Our current “system” for addressing concussion/TBI is a partial solution, no matter how you look at it. The real problem is, people seem to think they are going to get all the help they need from the systems that are in place.

It’s not going to happen. These are all systems, and they cannot possibly meet all the needs of individuals who turn to them. The system is a collection of frameworks and procedures and approaches put in place based on knowledge from years ago, vetted by intensely risk-averse authorities, and implemented by underpaid people who often have huge gaps in their knowledge as well as a ton of compassion fatigue. They’re set up to deal with acute situations to keep you from dying and address the most basic initial problems, but long-term, they run out of benefits pretty quick.

So, if you’re looking to the system to help you with your most pressing TBI needs, I fear you’re going to be sorely disappointed. Maybe not in the first few days or weeks, but over the long term, the TBI/concussion recovery systems we have in place are woefully lacking. And the people behind those systems have a variety of motivations — money, power, influence, being a VIP, making a name for yourself, etc. Every now and then you’ll come across someone who genuinely wants to do the right thing for the right reason, but human nature being what it is…

Anyway, I can understand someone’s desire to “game” the system and cheat on a neuropsych exam. Sometimes it seems like the only way to get what you truly need. I know when I was first starting to look for help with my own TBI issues, my insurance would not cover me for the help I needed, unless I went to a neurologist and got an assessment. But finding a neurologist who would talk to me about TBI — who was in my network — was next to impossible. And then finding someone who could tell that I was having neurological issues, rather than mental health ones… that was a source of pain and hardship for me, for a couple of years before I finally got focused 100% on dealing with TBI.

The first neurologist I saw was a “TBI expert”, but they were in charge of the TBI group at a big mental health hospital (one of the best in the nation). Before long, I found the discussion moving towards mental illness issues, rather than TBI issues. Dude, I’m not here to talk about my relationships with my parents. I got clunked on the head a bunch of times, and my life is falling apart. Now.

The second neurologist I saw was a specialist in Multiple Sclerosis, which is in another ballpark entirely, but they were in my network and I had dealt with them before with regard to a family member’s neuro issues. I thought they might be sympathetic enough to my situation to at least listen to my issues, and my PCP willingly signed off on them. Unfortunately, I was in a pretty diminished state when I went to see them, they were suspicious of me because I’d gone to see the other neuro first, and the whole experience felt more like a colonoscopy than a consult. Dude, I’m not here to get drugs. I just need some answers with regard to TBI.

Yeah, it was pretty bad.

The thing is, I was forced into that situation because A) my insurance required that I see a neurologist before going to see a neuropsych, and B) my coverage also required that I stay “in network” and there weren’t any TBI-savvy neurologists in that network.

So, I was stuck. I did the best I could, but it wasn’t very good. And until I pitched a holy fit with my PCP’s office and demanded that they just sign off on the damned request to go out of network, and I found a neuropsych who actually knew how to fill out the forms, I was stuck dealing with these hostile individuals.

Who were probably hostile because so many other people try to cheat the system.

When you try to cheat the system, you just ruin it for everyone else. The thing of it is, the system lends itself to that, because sometimes it seems like it’s the only way to get what you need out of it. I sometimes wonder if it could ever work even if we all told the truth all the time. I’m not advocating cheating. I’m just saying…

Again, we come back to the underlying issue — that the people who are most in need of help, are required to step up and advocate for themselves and manage the whole neurological kit-n-kaboodle, exactly when they’re least likely to do that well. It’s like asking someone who’s broken their leg to run after a speeding ambulance in order to get treatment. You would never ask someone who’s broken all the fingers in both hands to sign a piece of paper with their precise signature, would you? Nor would you ask someone who’s blindfolded to direct a physician who’s removing a piece of shrapnel from their neck.

So, why are TBI survivors and folks who have been through concussion required to advocate for themselves and independently herd all the “cats” involved in getting adequate care?

It makes no sense.

Small wonder, people feel like they need to pull a fast one on the system, just to get their basic needs met. All the rules, the labyrinth of requirements, the criteria, the qualifications… who can make sense of it? Especially someone with TBI.

Of course, there are genuinely bad-hearted people out there who are trying to pull a fast one to get over on the system. But I’d bet good money that 9 times out of 10, the person who’s “cheating” is just trying to get their most basic needs met, and they neither understand the complexities of the system, nor are they equipped to deal with the ongoing intricacies. With TBI, you can think that you’re telling the truth and providing all the right information, but confabulation has you sounding like a bald-faced liar.

Not good.

On the other hand, once you get past all the system stuff and learn how to handle things for yourself, a whole new world of possibility opens up for you. And then true recovery can begin.

But first you gotta get there.

Speaking of getting there, the day is waiting. Onward.


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