5 Reasons to Fire Your Psychiatrist

[David Baxter PhD]

5 Reasons to Fire Your Psychiatrist
by Deborah Gray
Wednesday, December 1, 2010

Psychiatrists are essential partners in our quest for recovery from depression. I consider a good psychiatrist the most important component in recovery. Fortunately, there are many good, committed psychiatrists out there. Is yours one of them? Or do any of the problems below apply to your doctor?

Your doctor:

1. Does not respect you.
We sometimes forget, when depression has beaten down or smothered our self-esteem, that we do deserve respect from our doctor. Meaning, your doctor should listen to you (really listen, not just pretend to), treat you like the intelligent person that you are instead of a child and take your wishes into consideration.

2. Is not committed to your full recovery from depression.
Your doctor should not be satisfied until you honestly tell her, "I'm back to normal. I feel normal sadness once in a while, but no depression symptoms." If she tries to persuade you that feeling better than when you were severely depressed is enough, even though you're not back to normal, she does not have the commitment necessary for your successful recovery.

3. Dismisses your concern about antidepressant side effects.
Some psychiatrists dismiss patient concerns about weight gain, sexual dysfunction and other side effects that have a profound effect on quality of life. Their reasoning is that if the depression is partially or wholly alleviated, the patient should be happy or grateful. This is, to put it bluntly, bunk. It may not be easy to find an antidepressant that will treat your depression successfully without major side effects, but it's possible, and that should be your doctor's goal.

4. Doesn't keep up with new developments in psychiatry.
I had a psychiatrist who, although not a psychopharmacologist (a doctor who specializes in psychiatric and psychotropic drugs), was fascinated with the medication side of psychiatry, so he was more knowledgeable about the specifics of antidepressant treatment than other psychiatrists I've had. No one is saying that your psychiatrist needs to devote all his free time to reading medical journals, but if he wasn't interested in the topic, why did he become a psychiatrist?

5. Is not interested in finding the best treatment for you.
This means that your doctor shouldn't recommend that a new antidepressant just because it's new, for instance. If it's better than the one you're on as far as effectiveness or fewer side effects, great. But if the only attraction is that it's cutting edge, your doctor should not be willing to put you through the potentially painful transition. You are not a guinea pig.

As a final note, don't assume that if you're getting care from a clinic instead of seeing a private psychiatrist, that you don't deserve good care and/or can't get it. When I was first diagnosed with depression, my insurance wouldn't cover my treatment for eighteen months because they considered it a "pre-existing condition." My family doctor had noted on a prior visit for something totally unrelated to depression that I seemed to be under stress.

I was able to afford to pay for my treatment myself because I went to a local mental health clinic that operated on a sliding scale (you pay what you can afford). Psychiatrists were at the clinic on a six month rotation, and in the time I was there I had three different doctors. Two were great; one was not. But my therapist and the doctor who ran the clinic were caring and competent. So don't assume that you need to settle for second best at a clinic.

 

[Retired]

4. Doesn't keep up with new developments in psychiatry.I had a psychiatrist who, although not a psychopharmacologist (a doctor who specializes in psychiatric and psychotropic drugs), was fascinated with the medication side of psychiatry, so he was more knowledgeable about the specifics of antidepressant treatment than other psychiatrists I've had. No one is saying that your psychiatrist needs to devote all his free time to reading medical journals, but if he wasn't interested in the topic, why did he become a psychiatrist?

Call me picky, but although I find the article as a whole to be informative ans insightful about variations in certain competenceor skills of one's psychiatrist can affect the outcome of treatment, I'm at a loss to understand the point the author is trying to make in statement #4.

Although most psychiatrists do not have the overall training of a psychopharmacologist, every psychiatrist I have known through my work has extensive training and a clear understanding of the specifics of every medication with which they use to treat their patients. It is a pre requisite of a specialist to understand the biology of the disorder, the theory of the ways in which medications work and the pharmacological interventions sometimes required to modify treatments.

Looking at Ms Gray's profile it soon becomes obvious her background does not provide her with a clear understanding of how the medical community functions.

No one is saying that your psychiatrist needs to devote all his free time to reading medical journals, but if he wasn't interested in the topic, why did he become a psychiatrist?

Here again, the statement seems to lack understanding of the role of a medical specialist. Any specialized medical practitioner constantly reads published literature, attends conferences both locally with his/her peers to discuss ongoing cases, new developments or to hear visiting speakers as well as continuing medical education in various other ways. Does the author of the article expect her doctor to sit on his/her laurels from the day of graduation?

Personally I would fire my psychiatrist if I discovered s/he was not doing the things Ms Gray alludes to.

 

[David Baxter PhD]

Any specialized medical practitioner constantly reads published literature, attends conferences both locally with his/her peers to discuss ongoing cases, new developments or to hear visiting speakers as well as continuing medical education in various other ways. Does the author of the article expect her doctor to sit on his/her laurels from the day of graduation?

Personally I would fire my psychiatrist if I discovered s/he was not doing the things Ms Gray alludes to.

While most mental health professionals do keep up with the literature, sadly not all do beyond the letter of the law regarding minimum CME credits. I think the author's point is that mental health consumers (and indeed all medical consumers) should understand that they have a right to expect current knowledge from their practitioners, and if that is lacking they should probably seek another practitioner.

 

[tasha]

4. Doesn't keep up with new developments in psychiatry.
I had a psychiatrist who, although not a psychopharmacologist (a doctor who specializes in psychiatric and psychotropic drugs), was fascinated with the medication side of psychiatry, so he was more knowledgeable about the specifics of antidepressant treatment than other psychiatrists I've had. No one is saying that your psychiatrist needs to devote all his free time to reading medical journals, but if he wasn't interested in the topic, why did he become a psychiatrist?

This is precisely why I have anger towards a previous psychiatrist of mine. During our weekly sessions all he talked about was the pharmacological aspects of the a/d's he had me on (including two different ones at the same time, which damned near drove me over the edge). At no time did he bother to delve in to my actual psychological situation. I gave it a year and when there was no improvement in my condition (despite the abnormally high dosage of meds he had me on!), I was convinced it was all my fault and gave up with therapy. He also told me I'd be on the medication for the rest of my life.

It's clear to me now that my psychiatrist WAS more fascinated with the medication side of psychiatry than actually treating patients through proper diagnosis.

 

[Daniel E.]

It’s Really Easy to be a Bad Psychiatrist

Psychiatrists are doctors, which means med school. Med school means lots of barriers to entry. We simply aren’t training enough psychiatrists to keep up with the growing demand for their services.

On top of that, they tend to congregate in the richer urban and suburban areas, where people have higher rates of insurance and can pay more for services. Some rural counties may only have a single psychiatrist; some have none.

These factors all contribute to crappy psychiatrists. They’re impersonal, they don’t remember you, they don’t spend much time with you, and they cycle you through their system like clockwork. It’s like getting your prescription from a grumpy machine...

There is a lot of demand and not enough capacity, so a psychiatrist is often pleased to get an “easy” client like me. I take my meds and am mostly stable most of the time. I’m a low-risk, low-effort patient.

So, I get cycled through. The psychiatrist doesn’t need to know much about me because I’m stable. I’m employed, insured, and can pay on time. I only really need the appointment to fill my prescription, so small talk is kept to a minimum and real effort is dedicated to other clients who need it more. If I have any mental health issues, I can take it up with my therapist.

Unfortunately, when easy patients stop being easy, warning signs get missed, and people die...

 

[Daniel E.]

How Do I Find a Good Psychiatrist?

Go to a teaching hospital to get a psychiatric consultation.

Try the psychiatry department of a large university or college. Because the psychiatrists there will be less likely to take the samples from the cute pharmaceutical reps and be lazy about reading all the research today on which drugs work and why. Like my doctor, these psychiatrist will probably be more willing to stick with the older, dependable, well-researched drugs...

I found the right treatment at the Johns Hopkins Mood Disorders Center. You could start there too. Because they have a list of referrals–-trained psychiatrists all over the country...

 

[Daniel E.]

More US Psychiatrists Restricting Practices to Self-Pay Patients -- Medscape.com
July 16, 2020

A growing number of psychiatrists in the US no longer accept insurance and will only see patients who can pay upfront, out-of-pocket for office visits, a new trends analysis shows.

Authors Ivy Benjenk, BSN, MPH, and Jie Chen, PhD, from the University of Maryland School of Public Health, College Park, Maryland, say psychiatrists may be more likely than other specialties to adopt a self-pay-only model due to low insurance reimbursement rates, particularly for psychotherapy, as well as a demand for psychiatric services that outstrips supply.

There is a "limited supply" of psychiatrists in the US and a "great deal of administrative hoops that go into accepting insurance for pretty minimal payment. So it makes some sense for psychiatrists to move entirely into the self-pay market," Benjenk told Medscape Medical News...

The percentage of psychiatrists who work in predominantly self-pay practices has also trended upward (from 16.4% in 2007-2009 to 26.4% in 2014-2016), whereas the percentage of primary care clinicians who work in predominantly self-pay practices has not changed significantly (from 1.5% to 1.7%).

Self-pay visits lasted longer than visits paid for by a third party (average duration 38.3 min vs 28.8 min; P < .001). Self-pay patients also made more visits to their psychiatrist than patients with third-party payers (mean 18.3 visits vs 9.4 visits in preceding 12 months; P < .001)...

Benjenk believes with COVID-19 and a large shift to telepsychiatry, more psychiatrists might be interested in accepting insurance because they may be able to see more patients in a day.

"With telehealth, psychiatrists also can practice anywhere in their state, so that opens up a whole new pool of patients. And it's cost-saving; they don't have to travel to an office, worry about office space or about no-shows, and there can be less lag time between appointments," Benjenk said.

 

[Daniel E.]

7 Signs Your Psychiatrist Is a Keeper

In my work as an advocate, the most common complaint I come across is that folks feel their appointments are always cut short, or that they never have enough time to say what they need to.

The pace of the conversation and allotted time ultimately makes them feel like a burden, and they ask fewer questions, share less information, experience significant anxiety, and ultimately receive subpar treatment because they feel rushed.

I realize this varies widely depending on the clinic and clinicians you have access to, but I encourage folks to explore their options as much as possible.