The pitfalls of psychiatry

Earlier in the week, I heard a snippet on NPR's Fresh Air about the pitfalls of psychiatry. Dave Davies who filled in for host Terry Gross interviewed Dr. Daniel Carlat, psychiatrist and author of the new book Unhinged: the trouble with psychiatry.

Dr. Carlat touched on a number of different topics, but the one that has always troubled me was that so many psychiatrists typically do not do any counseling at all. Instead, it's literally a 15-20 minute med check where only questions of whether you had any side effects are asked, a decision of med adjustment is made, and then you are on your way. There are never questions of what is going on in your life, how you are truly feeling, etc., because that is left up to the therapist whom hopefully you are also seeing.

Now, I know this is not always the case, and there are psychiatrists who also counsel, but in reality, the number is few and far between. (1 in 10 or a measly 11 % is cited in his new book based on a Columbia University survey who give counseling to all their patients) I think psychiatrists are missing out a lot in not looking at the whole patient. They miss that the patient may be drinking alcohol while also taking a sleeping medication. Or the patient may be purging their medication or not eating enough to make the medication effective, etc. How does that help the patient in the end? Why is it difficult to ask the right questions that would enable the most amount of information? Even more so, if you are seeing a therapist, there is rarely communication between the two.

Just think how much better the off the patient would be if there was more collaborative efforts between professionals. This is not to say this never happens, but the majority of time, everything must be separate, at least in the case of outpatient care.

I realize with the way insurance us set up, the idea for most psychiatrists is to see as many patients as possible, and if they were to do an hour long session with each one, they would have less patients. Still though, as many psychiatrists are seeing hundreds of patients a week, how are they even to remember who you are in the first place?

Maybe I'm slightly biased here, because I never had great relationships with the psychiatrists whom I saw versus my therapists. They just did not have the time, and there was always a feeling of a rush to get you out the door. Even years ago when I had wanted to go to medical school, I had decided that if I were to be a psychiatrist, I would not become a pill pusher but rather do a combination of both meds and therapy.

It's funny how this issue is still at the forefront and probably even more so. It'll be interesting to see what will happen in the field of psychiatry.

What are your thoughts and experiences with psychiatrists? Have yours offered therapy and should they?

Links to listen to the story: "A psychiatrist's prescription for his profession" or to read the transcript.

Anxiety medication dilemma take two

I'm still agonizing over the decision to go on medication. One, I'm incredibly impatient when it comes to medications working. Two, I'm worried about the side effects--yes weight gain which is always a fear. Three, I'm worried about the cost. Four, I'm worried it won't work and that my time will be wasted.

On the up side, a medication could work. I could perhaps think more clearly and process things better. I may not be as overwhelmed when faced with difficult decisions. It could possibly help with my continual vacillation between some denial and actual problem with exercising. :-/

So I bit the bullet and spent most of my morning making calls to psychiatrists' offices. I had a few names from my previous therapist. The two through the university who I wanted to see are booked until February and not taking new patients. I wouldn't even get to see them unless I saw their LCSW first and then had her refer me to one of their pdocs.

I called a few others that were on my insurance list. On one call, this guy was super nice and answered my questions and knew of one who worked with ED patients extensively. The funny thing was that I asked him if he knew of this other psychiatrist whom I'd called. His answer was that "she had been around forever, and given my age and problem, he highly suggested I went to see the ED pdoc." Hmmm, that kind of left me confused since she is the one I'm waiting to hear back from.

Another psychiatrist, I was able to speak with personally. She seemed very nice and worked with patients who were referred to her by my former therapist. The rest I called don't take my insurance with the exception of two psychiatric nurse practitioners.

As my analytical brain likes to do, I've made a list of the possible psychiatrists. This is the rundown, * indicates they accept my insurance.

Pdoc C. is an anxiety specialist who founded the Anxiety Foundation. He does both psychotherapy and pharmacotherapy and also uses animal assisted therapy. He has some experience working with eating disorder clientele. His fee, however, is a bit outrageous. Either he's really good, or he jacks his rates sky high.

Pdoc W. works with ED clients extensively and apparently worked under a well known ED researcher at the university. According to the guy I talked to who gave me his name, this pdoc, in his opinion, was the best ED one in town.

Pdoc L. was a a name given by my former therapist K. His specialty is addictions and is supposed to be a really nice guy. I think he also won some award a few years ago, voted as the best psychiatrist in town.

Pdoc G-R. is the one I spoke with. She's also worked with Ed clientele, though it is not her specialty. My former therapist, K. has referred several clients to her. She seemed very nice and even suggested if I had other names I wanted to run by her, to give her a call.

*Pdoc F. has also worked with ED clients. She is the one that the guy who I spoke to said had been around forever. I don't know if that is a good thing or a bad thing. I'm waiting to speak to her personally, as that is something she just does with all new possible clients.

*Pdoc Mc. or P. are nurse practitioners. My current therapist, C., has referred a few clients to them. She says that one is apparently blunt and gruff, but was able to find alternative meds that did not have weight gain as a side effect. The other she has not heard anything negative about.

Yes, I know this seems ridiculous. "It's just a psychiatrist" as one of my friends said. I called my mother to get feedback since she has been on what seems like every single medication known to mankind for depression. She tried really, but she wasn't very helpful.

See, this is the thing. I'm placed with a number of options in front of me, and then I have a hard time choosing. One part of me says I should just go through insurance as it would be cheaper. Another part of me thinks I should go for the specialty. Then, another part of me says I should bite the bullet for the high initial cost of the first appt. if the arrow points to them helping me more. Maybe I should just play spin the bottle?

Why am I making this so difficult? I think part of it is that I really want to be able to have an actual relationship with whatever pdoc I see. I don't want it to just be med management which unfortunately is how it mostly is since insurance companies have "ruined" the field of psychiatry. This is according to my mother's current pdoc.

The other thing is I think that the follow-up appts. would be a waste unless there were serious side effects going on. And I guess I'm just having trouble thinking about paying that much money for a mere 10-20 minutes at the max when you could just call and say how you were. I know most see pdocs much less frequently than a therapist but still.

Then, the really bad thing with all this (and why I'm really hating insurance at the moment) which I just found out is that any pdoc session would count toward my mental health coverage. Currently, I only have a ten session limit/year, so it cuts my therapy by at least two or more sessions. I can continue of course, it's just everything would be out of pocket, and I would not be able to go as frequently.

This is where everything stands right now, and I'm having a terrible time in deciding what to do. It's essentially the story of my life. :sigh: Does anyone have any special wisdom? Or want to commiserate with me?

Part one of anxiety medication dilemma can be read here.

By the way, my day ended up strangely. I went to the store to pick up a few items. When I got home to put the items away, I realized there was a pack of cigarettes in the bag! I have not a clue how they got in there. Hmm, maybe this is some sign? Just kidding, I seriously doubt someone is trying to tell me to just kill the anxiety with a few smokes.