Let's face it.
These are difficult times. And in difficult times like these, we're more likely than ever to do the unthinkable: consider seeing a psychiatrist.
But where do you look? And even more importantly, how do tell if they're good? How do you separate the good one from those that are "mad, bad, and dangerous to know"?
Seriously, psychiatrists are really no different from other groups of individals: some are good, most are mediocre, and a few are mad and bad and...you know the rest.
Several years ago, while traveling as a national speaker, educator, and consultant, I had the opportunity to visit hundreds of psychiatric offices and clinics througout the United States. I noticed that the good ones--the superb ones--generally followed a set of principles and practices that distinguish them from their less-than-stellar colleagues.
Secret #1: Superb Psychiatrists are Board-Certified by the American Board of Psychiatry and Neurology
I know this one sounds like a no-brainer, but in an age when many people still don't know the difference between a psychiatrist and a psychologist, it's worth mentioning that psychiatrists really are medical doctors who have completed medical school, residency, and demonstrated competency in their chosen area of specialty through the American Board of Psychiary and Neurology. You can check to see if your doctor is board-certified at their website.
Secret #2: Superb Psychiatrists Return Their Calls
I know, another no-brainer, but you'd be suprised how many of my colleagues don't return their calls, not just from their own existing patients, but also from prospective new patients. Why? Partly because they're mired in patient care, but also because they have no systems in place for routing and prioritizing calls. In the high-tech alley of Silicon Valley where I practice, we have a name for this sophisticated system: front office help. A good front office person knows exactly what the doctor is doing at all times, know what the day's schedule is like, and knows how to prioritize calls. And a front office person is just that: someone who is in the front office, not at some virtual call center miles or continents away. I'm going to leave it to you to figure out how your prospective doctors process their calls....
Secret #3: Superb Psychiatrist See Their Patients at Regular Intervals
Beware of the psychiatrist who sees you for 15 minutes at the first evaluation, hands you a prescription, and says, "See you in 6 months". No. Far to many things can go wrong in that interval, and what is most likely to happen is that you, the patient, will give up. Give up because you're not seeing the results as quickly as you'd expect. Give up because you don't like the side effects of the medications. Give up because you have second thoughts about psychiatry. Give up because you found out your mother-in-law is taking the exact same prescription....the list goes on. Although there are no hard and fast rules, superb psychiatrists see their patients at intervals of 1-2 weeks at the initiation of treatment, and every 2-3 months once stable. Ask your psychiatrist about the plan for follow-up before you sign on.
Secret #4: Superb Psychiatrists See Their Patients No Less than 15 minutes Per Visit
Many of us had the experience of the 5-8 minute "clinic encounter" with our primary care physicians. This may suffice for a follow up visit for the treatment of rash, but in the realm of psychiatry, where emotions and physical symptoms collide, much more time is needed. At my clinic and those of my colleagues, the average visit is between 25 and 50 minutes. Of course, their are exceptions to these guidelines, and I can already hear the grumblings of my seasoned colleagues on this point. Ask your psychiatrist about the length of the typical follow-up appointment before you sign on.
Secret #5: Superb Psychiatrists See Patients
Believe it or not, some "practicing" psychiatrists do NOT see patients. How can this be? Over the last two decades opportunities for psychiatrists to engage in non-clinical work has exploded: corporate consulting, pharmaceutical speaker's bureaus, clinical research directors, administrators, supervisors for psychiatric residents...the list goes on. The plethora of options has enable some to focus their efforts more on these other activities than on actual patient care. I know colleagues, for example, who do speak for pharmaceutical companies full-time. Sure, they see a patient every now and then, but seeing patients, even for a few hours every week, doesn't cut it. Sorry. Those of us in the trenches day-in and day-out think otherwise. Now please don't misunderstand my point here: there is nothing unethically or morally wrong with seeing patients as a side job to a speaking career. I mentioned at the beginning of the post that I did this myself for a while. My point is this: as a prospective patient you deserve...no, you need to know...if your psychiatrist is engaged in these activities, and you need to know if he or she will be available for crises. Nothing worse than calling your psychiatrist in the middle of a panic attack and finding out that he's on a speaking gig in Hawaii. Ask your psychiatrist directly, "how many hours each week do you actually see patients?" before signing on.
So that's it: the five secrets of superb psychiatrists. Opinionated? Yes. Controversial? Maybe. But in the words of a sports legend, "I may be wrong, but I doubt it".