Our group of psychiatrists have a listserv -- it's a wonderful tool for sharing resources and keeping everyone up to date about the latest in professional issues. From time to time, a discussion will ensue, and one psychiatrist posted his thoughts about patients who want to change psychiatrists. I thought our blog readers might want to weigh in, and with permission, I'm reprinting that doctor's thoughts.
Regarding taking patients who want to switch doctors, I have my own particular thoughts about that. Psychiatrists are a very scarce resource these days. Therefore, people who are able to have a psychiatrist are the fortunate ones. Also, like so many of us, I'm pretty booked so I do not have that many openings to take new patients. So I prefer to use those scarce openings for people who don't already have a psychiatrist. Also, people who want to switch psychiatrists very often are having difficulty communicating with their docs about what's not working for them in their treatment. Or, there are transference issues that have not yet been worked through. Or, any one of another impasses in the treatment alliance. Or, they are on an ineffective medication regimen and the treating psychiatrist hasn't been able to ascertain alternative approaches-- pharmacological or otherwise. So, I am always available to do a one-time second opinion consultation for such dissatisfied patients. Those consultations provide a diagnostic reevaluation, perhaps new ideas about treatment alternatives, recommendations to enhance communication, and observation of psychodynamic issues that might be relevant to the stalled recovery and/or treatment relationship. I identify aspects of their doctor's practice that could be modified to make for a happier patient (e.g. returning the patient's phone calls in a timely manner). I make my written consultation available to both the patient and the treating psychiatrist. I am also available to discuss the case with the current psychiatrist. But, I will not take the dissatisfied patient in transfer. This is really no less than I would hope if one of my patients has been dissatisfied with our treatment and calls another psychiatrist to jump ship and short-circuit the process of working it out with me. I would hope the colleague would respond in kind to what I have described. Sometimes, that is been the case, but sadly other times it has not. Just like, sadly, sometimes my patients go to the ER and are hospitalized and the treating docs there never call me.
I know another psychiatrist who once mentioned that he wouldn't take on patients who are already in treatment with another psychiatrist. I didn't ask why, I just assumed he didn't like the idea of taking someone else's patient, that perhaps he thought it made for poor professional relationships.
As you can tell from the title of this blog post, I don't agree. I think if there are times when treatment comes to an impasse, and it just gets stuck. I think there may be transferential issues to work through, but that should be the patient's choice. Sometimes people are less concerned with issues in the therapeutic relationship and are more focused on concerns that they aren't getting better. Some psychiatrists are better than others in general, and some psychiatrists are better than others with specific patients. And psychiatrists offer different services: I've heard from many people who've tried med-check only treatment who come looking for psychotherapy as well how, "That fifteen minute thing doesn't work for me." I'm also not so sure that because a consultant recommends that the treating physician should return phone calls in a more timely manner that it necessarily happens.
Finally, the psychiatrist assumes that when the going gets tough, the psychiatrist wants to continue. If a patient isn't getting better, or if therapy has become a war zone, then sometimes everyone agrees that it would be best for a fresh start. Also, do remember that this is one psychiatrist's personal policy for his own private practice, and certainly, I believe doctors should practice in ways they find ethical and comfortable. No one has actually suggested a true Hotel California policy where "You can check out any time you like, but you can never leave" and patients can never change psychiatrists.
At the other extreme, Roy once told me that if ever returned to private practice he would see patients for only one year: by that point they should be better or they should try treatment with someone else.
I think patients should be able to change doctors -- of any flavor-- if they aren't happy with the care they are receiving. I didn't post this to poke holes: the psychiatrist above makes some very good points, and he does a nice job of putting into words what others may not verbalize as well. His comments gave me the opportunity to think about this, so I wanted to give our readers the chance to ponder and discuss as well. Note that comment moderation is off, so please do be kind to one another.