Helping Your Psychiatrist Help You: The Office Visit
Helping Your Psychiatrist Help You: The Office Visit
"Helping Your Psychiatrist Help You: The Office Visit"
by Steven A Weisblatt, M.D.
Due to a variety of factors, psychiatric consultations are often allotted less than an hour and follow-up visits often last as little as 15 minutes. Yet it is nearly impossible to adequately review what has happened to you and your symptoms since you were last seen in the office in that kind of time frame. Given this limitation of psychiatric “face time”, it is critical that you be able to describe your symptoms and any changes that have occurred quickly and accurately. If you and your doctor can spend less time clarifying what the status quo is, you can both make the most of the already limited time to discuss how the treatment can be moved forward so that you can achieve full remission and function at your best. Here are some ideas:
Always come to your visit with notes prepared:
As well as being prepared to take notes. This will increase the likelihood that you won’t forget to tell the doctor something important and allow you to jot down notes on any instructions you are given, items you wish to discuss later in the session or even topics you want to research online.
At the beginning of the appointment:
Make sure you tell your doctor if you have had any adverse physical effects from any prescribed medications. These include – but, of course, are not limited to – tremors, fatigue, appetite change, hair loss etc. This should take priority over discussion of mental health concerns as you and your doctor need to be clear about any adverse effects before any further plans are made about treating your mental health disorder.
From the first consultation:
It is important that you and your doctor agree not only on your diagnosis, but also on what symptoms and signs are particular to you. These should be noted as your “targets” of treatment and should be followed over time. When all the signs and symptoms disappear, you can say you are in remission – which is the treatment goal you should seek. [Note: symptoms are generally those things you feel or experience and signs are those behaviors that are noticed by others, for example: parents, spouse, children, teacher, boss, colleagues, therapist, doctor, etc.]
In my practice:
I give out clipboards and pens and ask patients and whoever accompanies them to make two lists. Specifically, under the two headings of “depressive behaviors” and “manic / overarousal behaviors” we list all symptoms and signs the patient has currently and, separately, even those symptoms and signs which the patient has had in the past. These become the target symptoms we use to evaluate the efficacy of the patient’s treatment.
When you tell your doctor, for example, “I had a good week” or “I’m feeling o.k.”, or “the medication is working”, it isn’t clear if you mean you are a) 100% free of any symptoms, b) having fewer symptoms under stressors similar to those you reported during your prior visit, or c) haven’t had any change in your symptoms – but merely had a good week (fewer stressors). In a sense, this kind of non-specific, non-symptom-based communication not only doesn’t help you and the doctor understand how you are responding to the doctor’s interventions, but it sets the stage for further confusion as the visit progresses.
It will be more useful for both you, your doctor and your support system to discuss the presence of symptoms and signs as they are specific to your diagnosis and not ambiguous comments about your function. It gives a more accurate and quicker sense of how “symptomatic” you are if we “track”, for example, decreased sleep, racing thoughts, amplified anxiety, depressed mood and irritability, than if we track whether or not you are arguing with a spouse, doing more household duties, or cursed at a driver who cut you off, etc. Whereas these anecdotes can “round out” the presentation to the psychiatrist, the behaviors described may have changed due to other factors and may not specifically reflect whether your illness has improved or worsened since the last appointment.
At every follow-up appointment:
It is critical to establish whether target symptoms are increasing or decreasing in frequency (how often), intensity (how bad) and duration (how long). This is important in determining whether the intervention(s) you and your doctor have tried are moving you towards remission. However, to be sure a change in the severity of your symptoms is real, it’s important to know if circumstances in your life have changed. A decrease in amplified anxiety, racing thoughts and irritability during vacation – or an increase in the same symptoms during finals week at school may not reflect a true change in the severity of your symptoms, but only a change in the amount of stress you are under. Thus, a cardiac patient may have an increase in chest pain only because the elevator is broken and they have been walking up more steps. This doesn’t mean their cardiac condition has deteriorated. Similarly, you must review any changes in bipolar symptoms in the context of any change in the amount of stress you are under.
Visits to the doctor are often stressful and almost always too brief. In spending time checking on how you have responded to interventions since the last session, there is a tendency not to have sufficient time for questions and discussion about future treatment direction and options. However, if you “prep” in advance – possibly with the help of a trusted friend or family member – you can get the most out of your session.
Dr. Weisblatt (www.drweisblatt.com
) is a Former Assistant Professor of Psychiatry at S.U.N.Y. Downstate Medical Center
and has private practices in New York and Pennsylvania
. He has spoken and consulted widely about accurate diagnoses and effective treatments.