I thought that it would be helpful to jot down some of my thoughts and observations about the field of Psychiatry after almost 40 years of manning the front lines.  My field is one of the most unique medical disciplines. Unlike other specialists, psychiatrists cannot rely on objective laboratory tests or radiologic imagery to help with diagnosis and treatment planning. Psychiatrists have to rely exclusively on our patients’ subjective report and our subjective observations of how our patient presents their story. Cardiologists can obtain electrocardiograms, lipid assays and cardiac stress tests to accurately measure cardiac functional capabilities. If you present to your internist with concerns about fatigue, weight gain and impaired exercise tolerance, a battery of objective certified blood tests will help determine whether your complaints are due to anemia, hypothyroidism, diabetes, etc. That is why your psychiatrist should be a “stickler” for getting you to clarify the language you use to describe your problem – more clarification means you can be guided into the psychiatric services that will benefit you the most.

When a patient indicates that they are seekeing psychiatric services because of “depression” it is critical that they be asked to be specific in describing in as many words as possible what they mean by “depression”. Often, as a patient begins thinking and talking about it, I will hear words more appropriate for the presence of an anxiety disorder than the experience of depression. Or, the individual may be concerned that they are having “mood swings” that may represent bipolar disorder (manic depressive disorder), but it turns out upon further questioning to be a shifting from a normal mood to one that is sad and blue; the depressed mood is so severe and debilitating that when their mood shifts out of this state and back to a normal mood state, the relative difference is so great that it feels like a“high”.  In summary, you want your psychiatrist to be a careful detective who is a stickler for details and language.

Every patient deserves a clear, easy to understand explanation of their problem and the treatment plan that will address it. Included in this discussion should be a straightforward description of the process that your psychiatrist followed to come to these conclusions.  Is the problem genetic? Is it a situational or reactive state? Are there complicating non-psychiatric medical factors that make diagnosis and/or treatment more difficult? If the treatment plan consists of medication is there a role for psychotherapy? What is the rational for the medication recommended and what can one expect over the first few weeks of therapy? What are the most common side effects one can expect and how available is your psychiatrist if there are problems?  And most importantly, is your psychiatrist open to share information with concerned family or friends if you would like them to be involved in the evaluation and treatment planning process?  If you have been working with a therapist, is your psychiatrist available to discuss your care with your therapist?

Certainly, you want to feel like there is a “chemistry” between you and your psychiatrist. The technical term for this chemistry is therapeutic alliance. A critical component of this relationship is having a psychiatrist who is a good listener. If you feel that your psychiatrist clearly hears your concerns and is taking them seriously as the evaluation unfolds, your confidence in the forthcoming psychiatric services and treatment will be greater.  All too often I hear from patients who felt that their psychiatrist jumped to conclusions about the nature of their problem too early in the evaluation process; “my psychiatrist immediately assumed that I was depressed, handed me a prescription for an antidepressant and sent me on my way before I had a chance to discuss my failing marriage and serious medical problems.”

The mental health services evaluation process should comprehensively include biological, psychological and social components. Is there a genetic family history suggesting that your unhappiness represents a biologically inherited genetic depressive predisposition?  Are there maladaptive psychological personality traits acquired from family of origin experiences that complicate your presentation to the psychiatrist warranting intensive psychotherapeutic intervention?  Are the social stressors (e.g., problematic boss, marital turmoil, plummeting finances) amenable to practical solutions? Sometimes the most effective recommendation I have made to patients has included the need to consult a financial advisor.

The psychiatrist’s office staff is a mainstay of the mental health care practice. Historically, psychiatrists primarily provided psychotherapeutic services and had need for limited support staff, relying primarily on an answering machine for office communication. The twenty-first century psychiatric practice relies on office staff to set up appointments, pre-authorize treatments and trouble shoot clinical patient problems. Is there an emergency after-hours answering system? How long does it take your psychiatrist to return an urgent or emergency call?  What kind of vacation coverage does your psychiatrist provide? How long does it take to see your psychiatrist on an urgent basis? These are just some of the essential questions to be answered when you seek psychiatric services for mental health issues. I do hope that this brief summary aids you in your quest for quality psychiatric care.

To find out how our psychatric services can help you or someone you love, please contact Dr. David A. Gross for help in the Delray Beach, FL area at 561-865-6734 oremail Dr. Gross today.