Adult Psychiatry Evaluations and Treatment

An important reason involves the time devoted to each patient. Because of the time spent with each patient, psychiatrists cannot “make it up on volume. Even when treatment is essentially medication without formal psychotherapy, I still want to talk with my patients. I want to know and understand them. I do not believe in 15 minute medication checks because I hardly then have much of a feel for my patients as human beings. I don’t want to know my patients simply as a disorder for which I give them medication.

I do have provision for reduced fees with my psychiatric nurse practitioners, all of whom I have personally trained when they were my students and with whom I collaborate when needed.

My ethic is not partial improvement, but instead I strive for as full recovery as possible. A number of patients have told me that sometimes previous practitioners have been content to achieve partial but incomplete improvement, leaving some of their impairment still ‘on the table.’ I do not believe in leaving any reasonable stone unturned. Not simply symptom improvement, we strive for quality of life.

 The short answer is no. I was originally trained in a psychiatric residency which placed great emphasis on psychotherapy. However, with the remarkable advances in the understanding of the biology of the mind, I now treat most, but not all, of my patients with medication. However, I still believe in talk therapy. And I talk with my patients even those on medication. I particularly enjoy the opportunity to work with victims of abusive relationships. There is no medication treatment for that problem.

 If you are undecided, still complete the contact and the intake forms. Know, however, that you can only be helped when and if you determine that you need help. There is the following joke: “How many psychiatrist does it take to change a light bulb?” Answer: “Just one. But the light bulb has to want to change.” Take your time if need be. But don’t neglect yourself.

 Unfortunately, there can, indeed, be stigma against having a psychiatric problem. Many people are more forgiving of traditional medical problems than they are of psychiatric problems. They may think you can just stop having a problem if you simply tried harder. People mean well when they say, “Get over it” or “Don’t be so depressed or so anxious.” But they do not necessarily understand that rational arguments often do not change self-defeating thoughts or behavior. Free will is not what it's cracked up to be. I can help. But I need to understand the person you are first.

I don’t blame or criticize my patients or their parents. None of my patients or their parents really want to have or create their problems. While life experiences play a part, most significant psychiatric problems have a biological and hereditary contribution. There are reasons for even bad or imperfect parenting. Often bad parenting involves a transgenerational transmission from the parent’s own childhood. And that parent’s own parents similarly are the product of heredity and their own childhoods. While it might seem that I am saying nobody is really responsible, do not misunderstand me. You are responsible for taking care of your problems. I can help.

I begin with an intake form (questionnaire). Then I listen and gather information from the patient and/or the family. These are the first steps and are crucial to my understanding the problem and how to best help. I believe there are 2 elements crucial to being a good doctor. One is for the patient to know that I care and want to help. The other is the goal, at the end of the day, not go home and have a nice dinner - while leaving the patient suffering or incompletely treated. I am not satisfied with partial improvement and residual impairment.  I strive, as much as possible, to free my patients from the diminished functioning and distress that brought them to me. 

I am not satisfied with symptom reduction alone if my patients tell me they still don’t feel well. Medication alone may not be enough. Patients may require psychological interventions to attain further relief from distress and restore them to productive lives. I want my patients ultimately to be able to tell me their quality of life is improved.

And finally, I don’t try to change people. I just try to release them so they can be who they really are. I want to free my patients to be themselves.