I was going to try to post about alcohol consumption prior to New years Eve, but am still working on that post. Instead, I found myself reacting to a post on LinkedIn entitled "10 Warning Signs That Your Psychiatrist Is Not A Good Fit" by Amanda Itzkoff, MD. Look for it on LinkedIN if you are a member and see what you think. I found it fairly stark and negative. I found myself immediately typing up my own top ten list on how you know you have found a competent psychiatrist. That may not fit the usual blogger message that critical statements that apply to only a few is the only reason for commentary. One of my reasons for writing this blog is that the tremendous number of colleagues who I personally know are all very competent and the list is a composite of what anyone would find walking in to talk with any one of them. That list follows.
I had thought about posting a list of what I plan to continue to do here in the coming year but decided that was unnecessary. You can certainly go to any number of blogs to find out what is wrong with psychiatry or psychiatrists. Much of it is hyperbole. I hope that you will find what I write here is a realistic antidote to those other sites.
Top Ten Signs Your
Psychiatrist Is Competent
1. You are understood.
Your psychiatrist makes it very clear to you that he/she understands the problem and all of the
mitigating factors by formulating the problem and treatment plan, restating it
to you, and giving you useful advice.
That also includes discussing the relationship that you have with the
psychiatrist and any concerns that you have about it. That is one aspect of seeing a psychiatrist
that differs from seeing other physicians.
You should be comfortable bringing up any concerns and clarifying any
potential misunderstandings. Your
psychiatrist should also be able to answer the basic question about whether you
have any diagnosis or problem that requires treatment. Your psychiatrist should be focused on a
discussion of your problems and your best interest should be the focus of
treatment.
2. Your psychiatrist is an expert.
Your psychiatrist has
technical expertise in the field and is comfortable discussing new treatments
and innovation in the field ranging from psychotherapy to brain science. That includes an awareness of the current
limitations of treatment.
3. Your psychiatrist knows medicine.
During the initial
assessment and beyond, your psychiatrist pays close attention to any other
medical problems that you have and how the treatment he/she prescribes might
affect those conditions. That includes
being able to diagnose new medical conditions that can lead to psychiatric
presentations and ordering the appropriate tests to follow potential
complications of any new treatments or how new treatments might impact existing
conditions. That includes a willingness
and an ability to talk with the other generalists and specialists providing
your medical care.
4. Your psychiatrist takes enough time.
The assessment and
treatment of complicated problems takes time.
Many psychiatrists are in clinics where there are allowed only brief
periods of time (10 to 20 minutes) for assessment and treatment. Many people are satisfied with that amount of
time, but if you are not - a different treatment setting may offer more time. That can be discussed with the current
psychiatrist and a referral to psychiatrists practicing in different settings
can be obtained.
5. If medications are involved your psychiatrist thoroughly explains the risks, benefits, and limitations of treatment.
Like most areas of
medicine, medical treatments have their limitations. That includes medications that are not
completely effective in alleviating symptoms, side effects, and occasional very
serious side effects. Your psychiatrist
should be able to help you negotiate that area and provide you with more
detailed information for further study on request. You should believe that your psychiatrist is
taking any concern you have about side effects very seriously. The discussion of side effects is as
important as a discussion of potential therapeutic effects. Any informed discussion of medical treatment
should also include a discussion of non-medical approaches. Many people are surprised to learn than
non-medical approaches are more effective than medications in the treatment of
several severe mental health problems.
6. Your psychiatrist knows about addiction.
A significant number of
people being treated by psychiatrists have problems with addiction. Addiction can cause psychiatric problems and
complicate the care of psychiatric problems.
Even if your psychiatrist is not an addiction specialist, he/she should
be able to advise you in how to get well and not increase the risk for relapse
if you are sober. Your psychiatrist
should also be able to advise you in approaches to your problems if you are not
sober. Chronic pain is also an
associated problem and your psychiatrist should be able to make an assessment
of your chronic pain problem and how it affects associated mental health and
addiction problems.
7. Your psychiatrist is able to tell you about
things that you do not want to hear.
That can cover a broad
range of topics from your expectations about medication and psychotherapy, to
unrealistic expectations, to boundary problems involving what appear to be
straightforward problems like filling out a disability form. One example would be concerns about a
diagnosis of Attention Deficit-Hyperactivity Disorder (ADHD). A lot of adults seek treatment for this
problem and in many cases they are also expecting an approach that leads to
enhanced cognition. A consulting
psychiatrist should be able to say that they do not have ADHD and that
stimulant medications are not currently indicated for cognitive enhancement.
8. Your psychiatrist is concerned about your
safety.
One of the
characteristics of some mental health problems is that the safety of the person
involved is compromised. Psychiatrists
are trained to make these assessments and determine a plan to address the
problem. Many psychiatric disorders
result in impaired insight and judgment that is restored once the primary
problem is treated. It is often useful
to have a discussion about that in advance.
Some states have a psychiatric advanced directive that is useful to
direct your care in the event of an acute episode of illness that affects your
judgment. We live in a litigious society
and physicians are often accused of “covering” themselves by making very conservative
decisions. These decisions are most
likely driven more by safety concerns than malpractice concerns.
9. Your psychiatrist is willing to talk with
your family.
You should be certain
that your confidentiality is protected at all times per an explicit agreement
with your psychiatrist. That agreement
should include emergency contingencies and advise you about the statutes in
your state that affect confidentiality.
You should also expect that when you want your psychiatrist to talk with
your family that he/she will do that.
For certain aspects of treatment planning such as discharge planning
from hospitals and gathering diagnostic information, discussions with family
are critical.
10. Your psychiatrist is mindful of your
financial concerns.
Mental health services
are the most rationed services in medical care in the US. That typically results in more out-of-pocket
costs for people receiving psychiatric care than other types of medical or
surgical care. Your psychiatrist should
be able to discuss the cost aspects of all forms of care. That includes medication costs and also the
cost of ongoing psychotherapy. Cost effective alternatives for both
psychotherapy and medical assessment and treatment should be as easily
discussed as any other aspect of treatment.
Your psychiatrist is often placed in an impossible situation by the
insurance industry. The insurance
industry often makes it seem like your psychiatrist is responsible for decisions
that are really the result of insurance industry rationing. Any concerns you have about the financial basis
for decisions should be clarified with your psychiatrist.
Happy New Year!
George Dawson, MD, DFAPA
