At some point, you may find yourself in need of a good psychiatrist. There are three critical rules in doing this. Understanding the terminology in distinguishing between a psychiatrist, psychologist, and psychiatric mental nurse practitioner is the most important step. Setting your expectations appropriately and not sabotaging your approach is second. Third is the rule of not forgetting your ultimate goal.
Rule 1: Know the Terminology
If you are in need of general mental health medications, approaching your primary care physician (PCP) is a good first step. These tend to be general practitioners or family practice doctors. The advantage is one of accessibility; chances are, you already have an established relationship with your doctor and they know a little about you already. However, they may be limited in their specialty or be cautious in terms of dealing with in-depth psychiatric disorders. If you are dealing with run of the mill depression or anxiety, it can’t hurt to start here.
When you need more in-depth experience or are dealing with issues relating to medication side effects, it’s time to seek out a specialist. This generally falls into two different types of prescribers: Psychiatrists, and Psychiatric Mental Health Nurse Practitioners (PMHNP). Here’s where the difference becomes essential.
Psychiatrists are highly specialized and tend to know mental health issues and psychiatric medications inside and out. If you are concerned that you have been misdiagnosed, or are dealing with competing and unwanted side effects from your medications, you can’t go wrong in choosing a psychiatrist. It’s not uncommon to describe a psychiatrist as someone who can tell you that if you take medication A while spinning on one foot during a full moon on a Thursday, backwards, then you can likely expect results B and C. The disadvantage is that there aren’t as many psychiatrists around who are accepting new patients and, if you do find one, it may be several months before you can actually secure an appointment! Psychiatrists have an M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathic Medicine) degree.
Another specialized type of prescribing provider is a Psychiatric Mental Health Nurse Practitioners (PMHNP). They do not have as much in-depth training or education as a psychiatrist, however there tend to be more of them available and they can be easier to get in to see (and often sooner!). They often practice independently and have a good blend of skill and approachability. If you need specialized help but can’t get in to see a psychiatrist, a PMNHP is a good bet.
Rule 2: Set Your Expectations
Remember the vintage combination TV/VCR? It was relatively uncommon; you usually had a TV (for watching shows) and a VCR (for recording). The same is true in seeking psychiatric medications and therapy. Medical doctors, psychiatrists, and psychiatric mental health nurse practitioners are good at prescribing but often have limited training in counseling per se. Psychologists and therapists are good at providing counseling (talk therapy) but they cannot prescribe medications. Where we get into trouble is when we confuse the two roles.
I have had a number of patients who have fired their psychiatrist or PMHNP because they weren’t personable or only offered short, 15 minute sessions. Others have made appointments with therapists hoping to get a prescription but did not understand the limitations of what such providers can do. Don’t confuse the roles. Just as a TV is for watching and a VCR is for recording, a prescribing provider is for prescribing medications and a therapist is for talking out your problems to. This doesn’t mean that your prescribing provider won’t talk with you; in fact, they likely are interested in this and want to be able to help. However, it’s not their primary role.
Rule 3: Know Your Goal
When you try to make an appointment with a prescriber, you’ll probably get a list of names from your insurance company. Your need to remember that your goal is to make an appointment. Prescribing practitioners tend to be overworked, understaffed, and it can take a while to coordinate with them to make an appointment. You want to go through your list, calling each provider. Speak clearly, be specific, and to the point. Mention that you are looking to make an appointment as a new patient and tell them what your insurance is. If you don’t get an answering service, they may ask you want you are seeking treatment for; this is not the time to provide a full autobiography of your life story. Simply state what you are looking for help with (e.g., depression, anxiety) and anything significant that should be known (e.g., if you are at risk or have a history of suicide attempts). Again, be brief unless asked to explain further. Above all else, if you are leaving a message, make sure to clearly spell out your name and provide a single phone number for them to call. The goal is to make it easy for them.
One of my colleagues once remarked that he decided who to return calls to depending on how the message sounded when someone called. If they complained, slurred their words, were argumentative, or did not follow basic instructions from the voicemail message, they never received a call back. Another described a voicemail he received where a prospective patient criticized their inability to reach a live person and then complained about not knowing why no one was returning their calls, all before leaving the main part of their message (they never got a call back). While many would consider these to be of questionable practice on the part of a provider, it does happen and it is a reality. Finding a prescribing provider is much like applying for a job: You need to put your best foot forward (just remember not to hide your symptoms and issues).
If you’ve gone through your list, call your insurance and get another list of names. Call these as well. Lather, rinse, and repeat. Since your goal is to get an appointment, you need to put as much effort into getting an appointment as you have in other important areas in your life. Follow up with any returned phone calls promptly, however it’s best if you can be immediately accessible to avoid voicemail tag. If you haven’t hear back from anyone, call again after a few days and inquire again, without complaining.
When you finally get an appointment, verify that they can take your insurance. Know ahead of time if you have a deductible and what your out of pocket expenses will be. Make an appointment even if it’s months away. Ask to be put on a waiting list if they have one, and call back once a week to gently inquire if any openings have appeared. If leaving a message, leave your phone number again, even if you’ve already provided it.
When you have your appointment, remember that this is an appointment for psychiatric medication. You should have with you a list of your current and previous medications, including dosages and who prescribed them. Remember that now that you have an appointment your goals have changed; initially, it was to get an appointment. Once you actually have the appointment, you now have two new goals: Leave with a prescription (assuming you’ve been accepted as a patient), and do not leave without scheduling your next appointment.
Remember, prescribing providers are people too. If you treat them well, chances are you’ll receive the same. If you get upset that some aren’t personable, remember that the goal isn’t to find a best friend; it’s to get a prescription. By reframing your approach in terms of tasks and goals, you will keep yourself from getting frustrated by a system that can be confusing and overwhelming even at the best of times.
In choosing a good psychiatrist, most people focus on their interpretation of the word “good” and neglect the word “choose”. Hopefully, this has helped narrow down your approach and made it more manageable for you with real-world suggestions.