Picking a psychiatrist

September 8, 2008 9:05 AM

I have a minor psychiatric issue and I'd like to go see a professional. Question about picking one.

The short version: last month I hit a moment of clarity and realized that most of the time I'm operating under some sort of cognitive fog; it's not just a mental energy issue but a little more complex. So I want to see someone.

Looking at psychiatrist listings in my large town, there are (A) psychiatrists listed at the hospital and (B) psychiatrists listed in their own clinics. What's the difference here, in regards to handling minor visits like this, taking time to evaluate me, and willingness to dispense a med if it's scheduled? (I'm already aware I may be in Adderall territory here)

I tried called one non-hospital psychiatrist. The receptionist said it was $300 for the initial evaluation, which is higher than the $200 that seems to be average. I asked what they specialize in and she said they mostly see people for medications. The receptionist said only the PA sees me on that first visit but has the ability to dispense. What do I make of that? A prescription mill? Or a psychiatrist that's valuable -and- wisely managing her time?

I looked at some medical ratings sites and found a scarce few ratings. Also I don't know anyone who's seeing any psychiatrists. So no help there. Any advice on picking a psychiatrist?

posted by crapmatic to health & fitness (12 comments total)

I've never been, and I'm sure someone will chime in with the science, but my understanding is that psychiatrists pretty much only prescribe. If you want to talk the fog out or otherwise deal with your issue in an interpersonal way you have to get a psychologist or therapist to work with you and your meds.
posted by rhizome at 9:13 AM on September 8, 2008

Many psychiatrists also do some counseling -- it might be a half hour every two weeks to a month instead of a therapist who might see you for an hour every week. Every hospital affiliated psychiatrist treats loads of mostly normal people with depression and anxiety, same as non-hospital based psychiatrists. The hospital affiliated ones are credentialed to see patients and admit to the hospital (the hospital to which you refer may or may not have a psychiatric unit, the point is, they are available to consult on patients in the hospital who may have psychiatric issues) -- this *may* imply a little more peer oversight but I wouldn't put too much stock in it. If you are worried that a hospital-based psychiatrist is mainly dealing with scary severely ill people with schizophrenia and multiple personalities and you want to go to a more comfortable office, don't worry, most of the *really* mentally ill people are shunted to the community mental health clinics (if your community is lucky enough to fund these).

Many people enter psychiatric care only when they are in crisis. That's the reason why they have a PA, they expect some people need to be stabilized *now* and can't wait for the psychiatrist's next appointment in 3 weeks.

Medical rating sites, for the most part, suck. Far and away, the best way to find any doctor is through a personal recommendation. If you don't have a friend who has seen someone or you don't feel comfortable talking about it, consider asking your primary care doctor who they refer to.

And if you are really heading quickly towards crisis, I would suggest going to the place that can see you quickly. Otherwise, there really is a little trial and error in picking the right person. Most psychiatrists should be willing to talk with you about their approach on the phone for a few minutes. Tell them what you are looking for. Just meds? Lots of counseling? Alternative therapies? It is totally fine to switch after the first visit if you don't think your personality matches up.

Good luck.
posted by Slarty Bartfast at 9:51 AM on September 8, 2008 [1 favorite]

May be a silly question but do you have a GP?, as he/she may be able to recommend someone. Also, sometimes hospitals have physician referral service lines you can contact.
posted by gudrun at 9:52 AM on September 8, 2008

If you hit up your GP first, they'll not only be able to recommend someone or point you to more resources, but they'll be able to run some tests to rule out medical conditions that might disguise themselves as a subjective feeling of slowed cognition.

(Standard Ask MeFi brain question response: "Have you had your thyroid checked?")
posted by fairytale of los angeles at 10:00 AM on September 8, 2008

Wait, what do you mean by "cognitive fog"? I'm having some trouble understanding what exactly the problem is. You're having a psychological problem or a neurological one? Or a neurological problem with psychological ramifications? If it's the latter, maybe you want to see a neuropsychologist for an assessment.
posted by liketitanic at 10:15 AM on September 8, 2008

Thirding the recommendation to talk to your GP first - they will often have a couple of standard options that they recommend.
posted by machine at 10:16 AM on September 8, 2008

Psychiatrists are doctors - so they can prescribe medications. That is usually their area of expertise. In order to work on issues you'd do better working with someone who has experience under their belt (as opposed to on their wall) in dealing with what you're dealing with.

Today therapists work in tandem with shrinks - so if you will want to opt for medication - it's doable. You want to be clear on your issues. Some examples of issues might be:

Abuse
Addiction
Relationship
Inner Child
Sexuality
Phobias

After you're clear - it's not really that hard to narrow down finding someone. It just takes some finesse and leg/finger work. A good way to find someone is via word of mouth - but from experience - and seems we all have some of that - it's a matter of luck. It's like finding a significant other and it's a relationship in the full sense of the word.

Takes time to find the right one - and if there's one thing I can't stress enough here is - DO NOT settle for less than the very best for what you need. Don't cut corners on your health. If you don't feel comfortable with someone, move on and don't look back. There are PLENTY of therapists in this world who call themselves *professionals* but sadly, very few who actually live up to that title.

So do your research before hand by keeping open eyes and an open mind. And also - last word of advise - don't minimize the positive effects a group setting can have with most issues. Very effective. And although there would be those that poo poo the 12 Steps - there are many virtues to following a certain path that includes spirituality (not religion) to obtain balance and restore health to one's mind. So it would be well and wise to look into a group that addresses what it is that ails you. There are 12 Step groups for many issues that could be applicable to you.
posted by watercarrier at 10:34 AM on September 8, 2008

If you have insurance, make sure whomever you select is in-network. Or, make sure you are covered to see a psychiatrist at all. You may be limited to a counselor or therapist who, then, works with your GP for prescribing meds.
posted by Thorzdad at 10:36 AM on September 8, 2008

If you have cognitive functioning issues it might be best to start w/ a psychologist or neuropsychologist who can do testing to determine the origin and possible treatment options for neuro-functional issues...assuming you've already been to your GP to rule out thyroid/other organic issues that could cause the problems you're sensing.
posted by mumstheword at 10:55 AM on September 8, 2008

Really, I have found the only good way to get a good psychiatrist is to having gone through others in the past to find one who just has that flair or gift for their field. I have never had good experience with psychiatrists at hospitals -I think it may have to do with an acclimation to treating patients on short term bases. when, after a while, you get to know one try to see if they can describe some things to you -about your condition- that not even you saw.
posted by phllip.phillip at 12:26 PM on September 8, 2008

I would be really wary of seeing a PA for a prescription, instead of a psychiatrist. It seems like an awful idea.

If there is some acute problem that is so severe that it needs medication immediately, then you need someone with more training than a PA.

If it is a common problem that a PA can monitor, that's great. However, that's a determination that a psychiatrist should make after a thorough intake appointment.

Worst case scenario, the PA gives you a medication that makes the situation significantly worse.

I would ask your GP about the problem, and ask for a referral to a psychiatrist, in addition to blood tests.
posted by sondrialiac at 1:02 PM on September 8, 2008

Similar to other advice here, when I was in(desperate) need of a psychiatrist, I first made a list of the psychiatrists within my preferred geographical range (this list may be really long for you if you're in a bigger area than I, so maybe just start really local) using the yellow pages and if you have it, insurance providor directory. Then I just started placing calls and primarily leaving messages briefly describing my current situation and asking for a call back. I crossed off my list anyone who didn't call me back within a week. Then, I had brief conversations with several psychiatrists over the phone just filling them in on my current situation and gauging their personality a bit. I made appointments with EVERY ONE that could offer me one; they were mostly 3-4 weeks out, which didn't work with my urgent need. I was lucky to find the one I eventually chose, and felt good that he made an appointment for me obviously outside of typical office hours (7:30am on a Saturday morning). After meeting with him and assessing that he wasn't just a pill machine, I felt comfortable canceling the other appointments I made. Hope this helps!
posted by Soulbee at 7:56 AM on September 9, 2008