MHM #8: 7 Signs You’re Seeing the Wrong Shrink
Welcome to MHM #8! Mental Health Moments are shorter posts with practical tips, suggestions, and other helpful things.
I’m on my fifth psychiatrist since 2004, and I’ve seen many more during my hospitalizations. There are some great men and women in this profession who care about their patients and go above and beyond their duties for our mental health. But there are also some doozies out there that should be avoided at all costs.
Picking out a pdoc randomly from the yellow pages (I’m going old-school here) is NOT the way to go. You could end up with someone who doesn’t give a shit or who can hardly remember who you are from visit to visit because they simply aren’t paying that much attention to you when you’re there.
That said, here are seven signs that you might want to high-tail it and run to the next pdoc on your list:
- Their building is old, the waiting room is musty, parking sucks, and the furniture has a little too much of that “lived-in” look. One of these alone might not be a big deal. But all of them put together put me on high alert. My previous pdoc, whom I saw for something like 4 years (!) was in this kind of place. Not long after I stopped seeing him, the building was sold and razed. It is now a parking lot.
- Their records are not yet electronic. Okay, this one gets me every time. It is 2019, for Pete’s sake – get with the program! My thinking is that if they’re still using paper folders to keep track of your progress, they don’t have very good business sense. Maybe they don’t have the money to upgrade, which is understandable, but electronic records are so much more convenient and easier to track patients with. My last pdoc, Dr. V., had to look through pages and pages of records in my file just to find out what psych meds I was taking every single time I saw him (he could never remember). It took up valuable time in our 10-15 minute sessions.
- Your pdoc’s office is a shambles. This one could actually go either way. In my case with Dr. V., it was a bad sign. He could never find anything, even on his desk (but it was easy to find his MENSA certificate on the wall!). But I know that some people can work just fine under these conditions. It’s your call, depending on your experience.
- Your pdoc doesn’t seem to remember much about you from appointment to appointment. This is a really bad sign! Dr. V. could never remember what drugs I was taking or the dosages, and he had to spend time looking through my file to find his notes. It’s a good thing I was on top of things.
- They will prescribe anything you ask for. If you’re an addict or alcoholic trying to stay clean and sober, be careful about this. It’s very easy to ask for a script for fun anti-anxiety drugs like Xanax or Ativan, which definitely have the possibility for abuse. Also, benzodiazepines are ripe for abuse. You don’t want to be with a pdoc who doesn’t know anything about substance abuse and addiction.
- They’re always running late. I don’t mean 5 minutes, I mean like 15 minutes or more. This, to me, speaks to their inability to be efficient during their sessions. Yes, it can be hard to keep certain people on track and not chat so much, but they are professionals and need to be able to keep things moving. Being that late, in my opinion, means they don’t respect my time.
- They don’t ask you about what’s going on in your life. Life experience plays a crucial part in mental health, and it needs to be addressed accordingly. Dr. V. rarely asked if anything was going on with me; his only focus was on my medications. This is a mistake, as he could not take into consideration whatever I was going through.
BONUS TIP: Your appointments are only scheduled for 10-15 minutes. This is a biggie for me. I know this is fairly common, as they try to see as many people as they can. Some pdocs have very full caseloads, and there is a shortage of them all over, it seems. Sometimes they get overloaded. But let me tell you, 15 minutes is definitely not enough time to talk about what’s going on, have a good discussion about your treatment, and go over your med options. One time, when I was seeing Dr. V., he actually stood up and left during the middle of something I was saying. He didn’t come back. He was waiting for me at the front desk to schedule my next appointment. I only saw him once after that and finally switched to the fabulous Dr. Nelson, who schedules half-hour appointments.
So there you have it, seven (well, eight) things I’ve experienced in my own treatment with psychiatrists and I know others have, too. By the way, you can use these guidelines for therapists, doctors, and other providers, too.
I know how much it sucks to have to shop for doctors and other providers you’re comfortable with, but it’s worth it. Your mental health is the most important thing in your life, and it needs to be treated that way.
The best way to find a provider, I think, is from recommendations from people you know. Hell, in this day of social media, even from people you don’t know. I’ve asked people on social media for recommendations for a chiropractor before and gotten several good responses.
How about you? Have you had any negative experiences during your treatment? Leave a comment, suggestion, or question and we can start a dialogue.
Thanks for reading, and, as always, keep on Keepin’ it Real.
2 thoughts on “MHM #8: 7 Signs You’re Seeing the Wrong Shrink”
As a retired psychiatrist, this article made me sad—not because it isn’t true, but because it is. Managed Care is destroying medicine in general—but psychiatry in particular. An initial appt. should be at least 45 min. and you should have the doctor’s full attention. He/she should be asking germane questions. If necessary, in another appt. of 45 min, another family member or spouse might be met with. It’s usually a good idea to have the patient in the room for this appt., but not necessarily.
Once the doctor has established a sense of what is going on, he/she formulates a diagnosis, but also has a good idea of what has led up to the patient presenting as he/she is presenting now. He/she should be aware of new or increasing stressors, and ways that the patient has tried to work the problems out.
Then, the patient’s medical history should be assessed and if the patient hasn’t had a complete physical in awhile, they should get one. The practice of the psychiatrist doing physical exams on his/her own psychiatric patients falls in and out of favor. I think it can cause more trouble than it’s worth, especially w/ victims of abuse, domestic violence, paranoia etc. Certainly if the psychiatrist is prescribing medication, a weight, BP, pulse and temperature should be gotten at each appt.
Then the psychiatrist discusses w/ the patient what he or she thinks is causing the trouble and offers options for treatment. Psychotherapy isn’t generally supported very well by managed care—it seems that they think medication is enough. Together the patient and doctor formulate a treatment plan allowing for the patient’s preferences, insurance coverage and financial resources.
If the underlying issues aren’t addressed, but the symptoms are medicated away, the symptoms will return even if the patient stays on the medication.
Although behavioral type therapies might be done in a half an hour or so, therapy sessions should be 45-50 min in length. This includes “depth” therapy, EMDR, and behavioral therapies. If medication is to be used, the purpose of it should be explained as well as common side effects. If the therapy is completed, but medication must continue, “med check” appts every month to three months should be scheduled. They can be a half an hour in length.
The patient should feel by session # 4 that the doctor is a good “fit”. The patient might even feel like some initial progress is being made.
Something to watch out for is “transference.” We base our expectations of others (especially psychiatrists) on our earlier experiences w/ important people (Mom and Dad, usually). The psychiatrist’s job is to understand why you are doing what you do in context but also in regard to your beliefs about the psychiatrist. This makes it hard for a patient to see abusive behavior on the part of the psychiatrist—if the patient has been abused, he or she might expect that that is the norm—which it is not. If the patient’s symptoms are getting worse, or if he or she feels that the doctor doesn’t understands them, it’s time for an exit. This is harder to do than it might seem. An intermediate step would be to get a second opinion from another psychiatrist.
The psychiatrist shouldn’t talk much about his/her personal life. That’s because it interferes w/ the development of the transference. Also, the patient is the one in therapy. He/she should be saying more than, “hmmm, hmmm.”
Word of mouth is perhaps the best way of finding a good psychiatrist. Your physician may know of one, but not necessarily. The BEST resource are nurses who work in psychiatric units or clinics, if you know of one. The same is true w/ psychiatric social workers.
Psychiatric treatment can be life-saving or traumatic and destructive.
One very good reason that some psychiatrists don’t keep records on computers, is that computers can be hacked. If the psychiatrist is using a word processor, ask him or her if it is connected to the Internet. It should not be.
If the patient cannot see real progress in a year, a consultation is necessary. If it feels like nothing has improved, it may be because nothing has.
Laura,
I’ve had several bad experiences with pyschiatrist myself. One put me on to much medication and another took me off all my meds with out weening me off. I have a very good one now. He does have folders for each patient’s but keeps track of my medication and personal life well without sifting through his notes. He even asks for my husband’s opinion on how I’m doing.
I love your posts. I’m hoping to hear from you soon. My email again is aimeeegross@gmail.com
Aimee