tag:blogger.com,1999:blog-26666124.post5135242798042641271..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: What Makes a Good Psychiatrist?Unknownnoreply@blogger.comBlogger43125tag:blogger.com,1999:blog-26666124.post-3430616463050286262013-05-31T17:21:51.704-04:002013-05-31T17:21:51.704-04:00All of the things that Dinah lists contribute, but...All of the things that Dinah lists contribute, but above all, trust, empathy and hope. From both sides. Maybe part of what makes a good psychiatrist is a willingness to be a good patient?<br /><br />I know I'm mentally "interesting" - that's why I ended up seeing a psychiatrist to start with. Actual diagnosis is BP2 with a heavy emphasis on the depressed bits. From there on in it's a partnership - I trust my psychiatrist to look for the best solution for me, and in turn, I will be treatment-compliant. And he trusts me enough to know that if I say it's unworkable, it really is. Be it meds or meditation or any other suggested treatment. I know he cares enough about me to give me 24/7 contact info for when I really need it (and oh boy, there have been times when I have needed that), and in turn, I care enough not to abuse it. The biggest one though is the hope - not that I am going to miraculously be cured and live meds-free forever, but that there are ways to have a pretty good life in spite of the diagnosis, and that he is fully invested in finding the ones that work for me, and in being around to tweak them when they don't.<br /><br />I guess that I am really lucky, in that over the twenty-plus years since I first tried to kill myself, I have had four really good psychiatrists, who have all offered me those three things. I know that there are doctors out there who aren't that good.jcathttps://www.blogger.com/profile/03736961961261409218noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-2711466869847882492013-05-31T17:21:14.721-04:002013-05-31T17:21:14.721-04:00All of the things that Dinah lists contribute, but...All of the things that Dinah lists contribute, but above all, trust, empathy and hope. From both sides. Maybe part of what makes a good psychiatrist is a willingness to be a good patient?<br /><br />I know I'm mentally "interesting" - that's why I ended up seeing a psychiatrist to start with. Actual diagnosis is BP2 with a heavy emphasis on the depressed bits. From there on in it's a partnership - I trust my psychiatrist to look for the best solution for me, and in turn, I will be treatment-compliant. And he trusts me enough to know that if I say it's unworkable, it really is. Be it meds or meditation or any other suggested treatment. I know he cares enough about me to give me 24/7 contact info for when I really need it (and oh boy, there have been times when I have needed that), and in turn, I care enough not to abuse it. The biggest one though is the hope - not that I am going to miraculously be cured and live meds-free forever, but that there are ways to have a pretty good life in spite of the diagnosis, and that he is fully invested in finding the ones that work for me, and in being around to tweak them when they don't.<br /><br />I guess that I am really lucky, in that over the twenty-plus years since I first tried to kill myself, I have had four really good psychiatrists, who have all offered me those three things. I know that there are doctors out there who aren't that good.jcathttps://www.blogger.com/profile/03736961961261409218noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-83736415839572359902013-04-22T22:15:31.122-04:002013-04-22T22:15:31.122-04:00lol... it seems this Dinah fellow believes that l...lol... it seems this Dinah fellow believes that life is a bitch and people should suck it up (despite him being a doctor, whose job is to cure/manage illness). For what it's worth, I accept that life has challenges, but I genuinely feel that people who hold a downbeaten attitude shouldn't push their misery onto others.<br /><br />I would generally agree with the list, but I would also add that a psychiatrist should pursue any feasible length to cure/manage the condition. Even if this is unconventional means such as taking up sport (if it makes one happier/more content), or even going to church often (if one is religious of course), then these should be avenues to pursue. <br /><br />The basic point of a doctor in any branch is to remove or limit illness, so IMO any means to do so should be considered. A bad psychiatrist IMO is one who shows no overarching desire to treat the condition, or is limited to specific approaches/treatments.<br /><br />I would also say that social understanding is key. A good psychiatrist understands the norms, values, and culture of the society s/he practices in, and thus is able to relate to the customs and experiences patients face in that context. A good psychiatrist, in this context, will not berate a client for not going to church, if religious attendance is not common in his or her society or at the least is not condemned or made taboo.<br /><br />Lastly, a good psychiatrist should be able to relate to a patient's personality and acknowledge that everybody is different. they should not scold a patient for being loud, quiet, shy, boisterous, or any other trait s/he may display. This also pertains to beliefs and values. Even if a client admits s/he is a neo-Nazi for instance, this should not influence the psychiatrist's judgments or practice. If the doctor in question is non-white or Jewish in this case, s/he should professionally state "I respect your right to your beliefs, however given my being, I do not believe I will be a good fit for you. I sincerely wish you the best in your recovery." <br /><br />Another thing is that many cite this as "pie in the sky". lol.. really? If one goes to a restaurant, doesn't one expect it to be clean? If one buys a loaf of bread, does one expect it to be mouldy? It's not even a matter of economics, but as aforementioned I don't concur with the OP's reasoning. COAlikesnamnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-37128341945194173172013-03-01T23:37:58.106-05:002013-03-01T23:37:58.106-05:00My psychiatrist meets pretty much all of these and...My psychiatrist meets pretty much all of these and I think we have a very good rapport, and he's been very helpful.<br /><br />The exception - I don't phone him or expect him to phone me, and if it is urgent the deal is to go to the ER. I actually think this is reasonable, I like reliable boundaries and I know he has a lot on his plate.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-47971527525622883612012-04-17T14:06:21.952-04:002012-04-17T14:06:21.952-04:00I know that at Brigham and Women's in Boston, ...I know that at Brigham and Women's in Boston, psychopharmacology appointments last 30 minutes. They can do this, because Partners hospitals have negotiated higher reimbursement rates than others.<br /><br />There's a cash-only psychiatrist I've heard of who charges about $400 for a 10 minute appointment. I don't care how brilliant he is, I doubt that that's enough time to use his skills to good effect.<br /><br />Once a month or once every 2 months for 30 minutes seems okay.EastCoasternoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-79034143537501851212012-03-04T21:44:31.696-05:002012-03-04T21:44:31.696-05:00Dear Dinah:
Not Treating patients like a human bei...Dear Dinah:<br />Not Treating patients like a human being.<br /><br />Some examples:<br />(1) Referring to patients by disorders (2) Insisting that patients tell them only the symptoms (my personal experience) (3) Angry at patients who didn't want to take psychiatrist's recommendation yet not interested in finding out why (4) Bossy (Like "Don't ask, just take it)<br /><br />To make it worse, some patients, who got the first impression like this, never wanted to see another psychiatrist dued to previous bad experience and feeling like psychiatrists are all the same.Jimmynoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-65065770963254641042012-01-27T08:46:23.666-05:002012-01-27T08:46:23.666-05:00A good psychiatrist would treat each patient like ...A good psychiatrist would treat each patient like they are their own family member. Simple as that.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-51912571110566707972012-01-15T21:53:07.058-05:002012-01-15T21:53:07.058-05:00I appreciate a psychiatrist considers side effects...I appreciate a psychiatrist considers side effects as important a factor as effectiveness in starting or stopping a medication.<br /><br />For example, if I say I don't want to take an SSRI because of sexual side effects, I'd rather hear "well, sexuality is important, so let's see what other options there are" than "these medications work well if you can tolerate the side effects" or "some people consider that side effect a benefit".Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-5441946011803307712012-01-14T08:58:16.590-05:002012-01-14T08:58:16.590-05:00"here's the dilemma, if the psychiatrist ..."here's the dilemma, if the psychiatrist truly feels that stopping the medication is risky, should they lie in the name of "support?" It seems to me that if the shrink feels there is risk, that a good shrink says "here is the risk, here is the benefit, the statistics are that 90% relapse and I think it's wiser to stay on the medications" That seems like it might feel like it's undermining, but it's honest. "<br /><br />Dinah,<br /><br />As an FYI, my tapering occurred close to 4 years. So my psychiatrist had plenty of time to see I wasn't relapsing. I still feel like I was undermined in a subtle way.<br /><br />By the way, I would love to see a link to a study for those statistics. As we have previously discussed, I feel the the psychiatric literature greatly minimizes withdrawal issues and confuses them with a relapse due to a way too fast tapering. I know you disagree vehemently but I wanted to mention that.<br /><br />To answer your question, no doctor should ever lie but in the end, it is the patient's decision. And you know, you actually could be wrong. <br /><br />By the way, I am not just talking about psychiatry as many patients do well going off of blood pressure meds even though their doctors acted like they were going to have an immediate stroke if they did that.<br /><br />Finally, what scares me about sentencing patients to life on meds is they could perhaps have a medical condition that is causing psychiatric symptoms that has been overlooked. Or perhaps the psych meds might worsen the medical condition so badly that the disadvantages of staying on the meds outweigh the positives.<br /><br />Just so you know I am not picking on psychiatry, I think this happens in the regular medical world constantly. In fact, I have heard of psychiatrists who actually realized the person was misdiagnosed.<br /><br />AAAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-29673116758844939072012-01-09T20:48:00.004-05:002012-01-09T20:48:00.004-05:00I think I kind of made it sound like empathy is a ...I think I kind of made it sound like empathy is a bad thing. I definitely don't mean that. I just think ethics and competence rank higher in importance, at least to me.<br /><br />That said I've met some ethical psychiatrists who were complete duds at communication, so, hmm...<br /><br />Maybe, I should rethink this.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-39285544610001568242012-01-09T20:47:08.003-05:002012-01-09T20:47:08.003-05:00These are great guidelines. The major considerati...These are great guidelines. The major consideration is time and reimbursement. Insurance companies really resist paying for appropriate payment for psychotherapy, especially when patients are not taking medications. I think one alternative is a close collaboration with a group of psychologists who perform psychotherapy.Seanhttp://www.boardvitals.comnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-72394167167985517482012-01-09T20:43:02.583-05:002012-01-09T20:43:02.583-05:00Ethics and competence rank higher than empathy, fo...Ethics and competence rank higher than empathy, for me. I had psychiatrist who was unethical and kept landing in front of the medical board, but he was a master at establishing rapport with patients. That ends nowhere good. <br /><br />My favorite physician was a bit of a curmudgeon. Anything he wrote he would have the guts to address. I may not have always liked or agreed with what he said, but I respected him and his opinions. That's the kind of doc I prefer. Open and honest, no hidden stuff to try and protect my feelings.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-42486574110863953762012-01-09T20:41:10.906-05:002012-01-09T20:41:10.906-05:00Interestingly, how the patient perceives the psych...Interestingly, how the patient perceives the psychiatrist can have a very profound effect on how the patient responds to any meds prescribed. I suggest that everyone read this: http://www.psychiatrictimes.com/dependent-personality-disorder/content/article/10168/1946385 <br /> <br />Fascinating.<br /><br />Dinah, I didn't mean to say that a good psychiatrist has to love his/her job at all times. I meant that generally, s/he has a love relationship with psychiatry. From what I gather from your blog, you more than fulfill this requirement. :) In fact, that point exists because I wish that every psychiatrist was as passionate about his/her profession that s/he would want to spend hours each week blogging about it!pre-med psych patientnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-13323729089260641422012-01-09T20:01:04.515-05:002012-01-09T20:01:04.515-05:00The iguana won't be of much use to me after th...The iguana won't be of much use to me after the medication stops working and I am at the end of my rope. Then again, neither would a warm empath who only works every other day all year and takes a three month summer hiatus.<br />Seriously, I have an iguana for a physician. That may explain why I avoid going to the doctor. if my shrink were an iguana, I would probably not go long enough to be prescribed the right med.notoreptileshrinksnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-43443434429086455872012-01-09T19:16:46.610-05:002012-01-09T19:16:46.610-05:00Ah Dr. Psychobabble...but certainly there are some...Ah Dr. Psychobabble...but certainly there are some people who get more "warm & empathic" votes than others, it's just not a clearly measurable thing.<br /><br />And the funny thing is that while patients do feel this is crucial, maybe it's not what makes a good psychiatrist? Would you rather have a warm, empathic, likeable psychiatrist you can talk to, but who doesn't get you better from your depression, or someone with the social skills of an iguana (to quote Shrink Rap the book) who finds the right medication to get your treatment-resistant depression to remit?Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-54405918473134964792012-01-09T19:15:28.733-05:002012-01-09T19:15:28.733-05:00Competent and ethicalCompetent and ethicalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-28363791425207029532012-01-09T17:54:37.676-05:002012-01-09T17:54:37.676-05:00I find it fascinating that the last item, "wa...I find it fascinating that the last item, "warmth and empathy" is the most subjective yet also the most important to the patient, as you mentioned. I think when many folks ask for a "good psychiatrist," they mean one with whom they can establish a good rapport (warmth and empathy critical here), yet that tends to be one of the more difficult to evaluate and predict....Dr. Psychobabblehttp://www.doctorpsychobabble.comnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-36609010459980869932012-01-09T08:29:50.736-05:002012-01-09T08:29:50.736-05:00Articles like this make life so much simplerArticles like this make life so much simplerCrishttp://buynasonex50mcg.comnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-19791898650042623522012-01-08T21:46:18.473-05:002012-01-08T21:46:18.473-05:00Well, I had summarized my problems with my shrinks...Well, I had summarized my problems with my shrinks which admittedly does not describe the WHOLE situation. Let's just say I would not dump a psychiatrist just cause she yelled at me once; there's other things involved, although her attitude over time tends to lead me to believe that her personality might be prone to yelling again at some future point . . .<br /><br />The first one, who jumped to conclusions and wouldn't listen after doing so, well I invested myself in working on the relationship between us and on trying to tell him what he did and didn't do (like listening, he didn't do some appointments), and there were some times when we worked together brilliantly. By the end of our relationship, though, if he hadn't been leaving private practice I was at the point where it was time to fish or cut bait; I'd put the time in and he was consistently inconsistent with me.<br /><br />Then again, he was going through some stuff, which is likely a factor in at least some of his inconsistency, among other things, but when that goes on for several years and my trying to improve the relationship doesn't help, it's time to move on.<br /><br />Anyway, my relationships with my psychiatrists were more complex than my little summary of succint problems made them sound, but that's what happens when you summarize. <br /><br />I don't feel like anyone was attacking me or what I said, I just felt the need to expand on why they were a problem for me.Sarebearhttps://www.blogger.com/profile/09208596053319110470noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-47290793491269327702012-01-08T19:22:57.468-05:002012-01-08T19:22:57.468-05:00Oh, I have spent a lot of time, sometimes a lot of...Oh, I have spent a lot of time, sometimes a lot of money, to be in the presence of a shrink who was not really there. Going forward, I will go see a shrink to help me manage meds. I have found that expecting anything else is akin to searching for the Wizard of Oz, and I am quite weary, not to mention wary, of that. Although I have not met a shrink who admitted to taking meds to manage a mental health condition, I have not met any who qualify as mentally healthier than I am.yayayatladanoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-58167704912124478292012-01-08T16:25:25.872-05:002012-01-08T16:25:25.872-05:00I agree with the previous post. Patients are payi...I agree with the previous post. Patients are paying a lot of money to have the psychiatrist's undivided attention. If the psychiatrist for whatever reason cannot provide that, then they need to take time off until they can.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-65233233920074442532012-01-08T13:35:25.819-05:002012-01-08T13:35:25.819-05:00@Dinah: I will have to disagree with your comment ...@Dinah: I will have to disagree with your comment about sick and/or bored shrinks. I would really hope a shrink fighting off the flu would not be at work. I could understand a small cold, but I don't want a shrink working while impaired. And actually, I did once see a shrink have an allergic reaction to something someone had given him as a gift while we were talking. I graciously excused him.<br /><br />For me it is more of a work ethic issue. McDonalds doesn't care if you feel bored or unwell. You still have to be quick on your feet, clean those tables, and be friendly with customers. I saw a human sign get in trouble once for taking a sip of water while on the job in scorching hot weather. He bent down, took a sip from his sports bottle, and went back to work. The employer just happened to drive by at that moment. He was informed that he had only been scheduled to hold the sign for two hours. That meant no water or bathroom breaks. And that was in heat stroke weather.<br /><br />My point is, psychiatrists get paid so much more than people who clean tables at McDonalds and people who hold signs for a living. They should not be noticeably bored or unenthusiastic about what they do. I've met pizza delivery boys with better work ethic. What if your hair stylist wasn't feeling well and didn't do a very good job with your hair? Or seemed completely bored by you? Don't you like going to hair stylists who seem to love playing with hair and make small talk with the customers?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-72186665924309423242012-01-08T12:52:24.257-05:002012-01-08T12:52:24.257-05:00I think the problem with writing things that are n...I think the problem with writing things that are not addressed is that the patient may at some point read their records and will realize the dishonesty. I would much rather have read the catty comment from my psychiatrist in the beginning before I invested all that money. I would have gone somewhere else and we would have both been a lot happier. In the end all that did was waste a lot of my time and money.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-15538967144813934942012-01-08T11:49:39.258-05:002012-01-08T11:49:39.258-05:00The good psychiatrist is not easy to find. I don&...The good psychiatrist is not easy to find. I don't meet my own criteria consistently. <br /><br />Some of the comments center around uncontrollable factors in the shrink's own psyche. Loving what they do, not being bored? What's a shrink to do if he finds a patient to be boring? What if he's preoccupied with a personal problem, or fighting off the flu? We are people, with good days and bad, and while it would be nice if we could have our hearts fully invested every moment, no one can really do that for every patient at every moment, and still it seems to me that patients who are boring or who come on a day when the shrink is not at their best, still get better from their illnesses. <br /><br />AA-- here's the dilemma, if the psychiatrist truly feels that stopping the medication is risky, should they lie in the name of "support?" It seems to me that if the shrink feels there is risk, that a good shrink says "here is the risk, here is the benefit, the statistics are that 90% relapse and I think it's wiser to stay on the medications" That seems like it might feel like it's undermining, but it's honest. <br /><br />I guess I'm commenting on comments that ask if a good shrink is honest. And for the most part, I feel like honesty is essential with the exception of what might be unprofessional or hurt the patient's feelings or violate the shrink's right to privacy. ("You're really boring" or "I'm waiting for biopsy results on my prostate and I'm a bit preoccupied"or "I find your political views despicable" etc). <br /><br />A good psychiatrist has another psychiatrist covering if they are not available by phone, for more than a day/weekend. I thought that was a given. Apparently it belonged in the original post.<br /><br />Teufelheuden-- it depends. Many good psychiatrists charge high fees and don't participate in insurance networks and make decent money. You are probably right that someone seeing 30 patients a day, every day, makes much more money. It's work I couldn't do.Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-23912859014986785792012-01-08T11:28:50.030-05:002012-01-08T11:28:50.030-05:00@military psych guy -
move to new york city, wher...@military psych guy - <br />move to new york city, where even lousy psychiatrists in their first year of practice can and do charge $300/hour and keep a full practice with a long waiting list. I think it's insane for the good ones, but at least with them you're getting what you're supposed to be paying for. <br /><br />amazing.Jennoreply@blogger.com