9-22-14 Earlier this month, I asked: What makes a good psychiatrist?
Many of you responded with insightful comments and poignant stories. I asked my daughter, Traci, who earned a Masters Degree in mental health counseling this year, to help me review the emails and prepare today’s blog. Here is her analysis.
Being a psychiatrist is a challenging job.
As one reader put it, psychiatry is “not an exact science.” Psychiatrists cannot rely on tests or physical exams when trying to treat an illness. Their skill at prescribing a treatment for an illness hinges on their ability to assess symptoms reported by their patients. Psychiatrists then must manage both a patient’s symptoms and possible side effects, while working to find the medication, or medications, that work for each individual patient.
What works for one, may not work for the other.
For many individuals who have a mental illness or for the loved ones helping that individual, it is difficult to know where to even start. So before we get into deciding if a psychiatrist is a good fit for you, lets begin with where you should look for a good psychiatrist based on tips from readers who have navigated mental health care.
1. Follow professional word of mouth and don’t be afraid to shop around. K.P. wrote: “The first step is to ask your primary medical professional. Often times they may have a therapist or counselor that they refer patients to.”
2. Ask your friends and family members if there is someone they know or someone they personally like. If that specific psychiatrist is unable to take you under his/her caseload, then ask for a referral for another psychiatrist.
3. Look within your insurance network, but also consider a psychiatrist who offers sliding scale fees. R.T. writes, “If you’re lucky, you’ll be able to find someone good in-network. I think that’s unlikely. If you have out of network coverage, use it. You can ask for a sliding scale fee. If you don’t, it may be worthwhile to pay out of pocket for a good initial consultation, especially if it’s for medication that won’t require much follow-up once it’s been stabilized.”
4. If you do not have insurance, pursue care from the local Community Mental Health Center. Community services boards, if you are in Virginia, or community mental health centers can provide proper care for you or your loved one if insurance is an issue. K.P., points out “one of the barriers to care is insurance. If you have good private insurance is would be rather easy to find a good private psychiatrist. However, most individuals with psychiatric problems have either Medicaid or seek care from Medicaid funded programs.” Look into what kind of programs are offered within your community for persons with mental illness and contact these programs. They will likely be able to answer your questions in regards to not having insurance and can point you in the right direction to getting the help you or your loved one needs.
5. Contact the National Alliance on Mental Illness and speak to members in your local NAMI group. They can tell you who is and isn’t good. D.J. noted that the best psychiatrists are often doctors who have a family member who has a mental illness. They have first hand experience.
6. Consider psychiatrists who are a part of a therapeutic team. You will likely find a psychiatrist working as part of a team if you pursue care within a community mental health center. Other times, private therapists and private psychiatrists will work together to provide comprehensive care for individuals. M.M., suggests, “a team approach may be most helpful in getting your loved one accessible and more affordable care (psychologists and social workers may be able to provide some sensitive counseling more affordably and save some of the more expensive appointments with the psychiatrist for medication management).”
7. Seek out research trials or contemplate going to a leading psychiatric unit, such as the National Institutes of Mental Health. When M. L.’s son was sick, for the first five and a half years of her son’s diagnosis she struggled to find an appropriate psychiatrist to work with her son. She eventually took matters into her own hands, did research, and found a psychiatrist who specialized in her son’s diagnosis and was one of the leading researchers in the field. After advocating continually for her son, she was able to secure an appointment with the leading psychiatrist’s partner. She credits her sons success to these doctors and offers the following advice: “follow research on your/your loved one’s diagnosis or symptoms and look for research trials that will allow you or your loved one to be comprehensively evaluated and treated by our nation’s leading researchers psychiatry. If you are within a 3-5 hour drive of a leading psychiatric research unit, strongly consider scheduling an appointment, as many researchers will consult with local psychiatrists. Consider entering yourself or your loved one in research studies.”
Now you’ve found a psychiatrist, but is he/she a good fit? How would you know? Here are your suggestions.
1. You just know. R.T. says, “at least, you know if it’s a bad fit”. Follow your intuition, if it feels like it is not a good fit then move on.
2. Good psychiatrists listen to your concerns, input, perspective, opinion, questions, and are willing to discuss any and all of those with you and they are empathetic when doing so. It’s true that your psychiatrist went to medical school and is likely armed with vast knowledge of mental illness and medication, but you know yourself and your loved one best, and you are the one who has to deal with the side effects of the medications. R.T. advises, “If what you’re looking for is someone who will listen to you, then make sure the psychiatrist you meet with actually listens. He or she should be able to accurately paraphrase your concerns. He should not be in a hurry. If your doctor doesn’t get enough information in one session, he/she should schedule a second without hurrying to write a prescription. You should feel comfortable. You should feel able to disagree and be taken seriously. If medications are a possibility, you should be able to ask as many questions as you have, and you should be asked your opinion and your preferences. You should be clear on what to do if you have questions after you leave. Basically, you should be treated like a person, not a checklist.”
3. You are included as part of your treatment. If they listen to you, then they should include you when making treatment decisions. Your psychiatrist should be willing to collaborate with you and come up with plans that work for both of you. The psychiatrist should not be making all the decisions and should offer you the choice and ability to make decisions in regard to your treatment. For instance, K.B. wrote of a wonderful psychiatrist that she credits helping her in her recovery and whom she now works with and said, “She always listened to what I had to say and gave me a say in what path my treatment took. If I felt like I was overmedicated she backed of my med. If I thought a new drug was needed she didn’t always change it but she always gave me the chance to discuss it. When I took the idea of VNS therapy to her with my research, she agreed to train to help me succeed.”
4. If you or your loved one has a serious mental illness, then your psychiatrist should have experience treating serious mental illness. Check to see what kind of experience the psychiatrist has and inquire about their specialties or areas of expertise. If they specialize in working with those with depression and you or your loved one has schizophrenia, it might not be the best fit. M.M. states, “Not all psychiatrists do, or want, to treat persons with mental illness, so do not assume just because of the degree the provider is experienced.”
5. The psychiatrist does not shut family members out. This can be a tricky area for the psychiatrist to navigate. They have to adhere to both patient confidentiality and HIPAA, while looking out for the best interests of their patient. Families can become heavily involved in the treatment of persons with mental illness and this is something that M.M. says psychiatrists need to keep in mind. When looking for a good psychiatrist, she asks “does the psychiatrist recognize family members are desperate to help their loved one and offer them strategies to assist in care without compromising patient privacy (this includes making contact available to express concerns and alert healthcare providers to their patient’s history, medication response and worrisome behaviors)?” For reader M.R. this meant that the psychiatrist listened to her input when it came to her son’s medications. The psychiatrist noted the parents’ perspective and was able to help the son stop hearing voices for the first time in five years.
6. You should not be made to feel ashamed of or blamed for your illness. Reader A.P. tells a story of coming to the realization that she had depression, and not admitting it to anyone expect for her husband and three health care professionals. One psychiatrist whom she opened up to informed her that she had no idea what depression really was. This response put A.P. back into a place of hiding her depression and not asking for help. When she spoke to a pastor of her problems, he blamed her childhood abuse on her. Again, A.P. was embarrassed and ashamed, avoiding asking for help until much later.
Stories like these remind us that not all professionals are as compassionate and empathic as they should be. Your psychiatrist should not make you feel embarrassed about your mental illness or reluctant to seek help for yourself. In fact, your psychiatrist should do the opposite. K.B. had such an experience. For K.B. her psychiatrist “helped me to not take my illness so seriously that I was seeing it as a death sentence. She gave me hope that I could recover and I have. But she always reminded me that I had to stay in treatment and make a commitment to recovery or it just wouldn’t work.”
7. The psychiatrist remains focused on you, the patient. Everyone has bad days, even psychiatrists. They may be experiencing some trouble in their personal life or going through other problems. However, the appointment should not center on their problems. A little self-disclosure from the psychiatrist may be appropriate at certain points in the relationship, but this should not be the entire session. A.P. brought up a psychiatrist who was able to help her with medications, but “spent our sessions talking about her problems and me giving her advice”. You are paying for a service, not for your psychiatrist to unload his or her problems onto you.
8. A great psychiatrist goes above and beyond. A good psychiatrist is all of the above, but a great psychiatrist goes beyond the call of duty. For many readers, this meant being available to them in a crisis. M.J. states, “I never hear “call 911 or go to your local emergency room,” when I call between appointments when my son is in crisis. I am connected to my doctor or the doctor on call for her. I have her mobile phone and have had direct access for virtually the entire 15 years.” K.B. testifies that her psychiatrist separates herself from others by truly caring and following up with her patient, for example, the psychiatrist went out to find a client who had missed a shot because she knew how important it was.
9. The appointment is not rushed. A psychiatrist should not be in a hurry or spend only a short amount of time with you. K.S. tells us, “a good psychiatrist does not diagnose you with something after your first appointment. They spend good quality time with you or your loved one. Anything less than 15 minutes is a joke…Don’t settle for someone who will get you in next week only to spend 5 minutes with you, diagnose you with bipolar disorder and then send you along with a laundry list of medications. You will be doing yourself or your loved ones and injustice.” The overall consensus is that short, 5-15 minute appointments are not helpful, and may actually be harmful. If you are making the time to see a psychiatrist, have them make the time to see you too.
Overall, K.B. summarizes a great psychiatrist as “ psychiatrist that cares, is dedicated, stays on top of advancements in the field, is knowledgeable about medications, advocates for his or her clients, and, most of all, helps them find their voice.”
Even with these tips, bear in mind that there may still be some trial and error in finding a psychiatrist for you or your loved one to work with. A.P., said it best when she wrote, “There are some really great counselors, therapists, and psychiatrists out there. Some might be great but just clash with your personality. Some just outright suck and should be parking cars with little human interaction of any kind. Keep searching. Your life depends on it. And the happiness of your loved ones depends on it, too.”
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