How do I get my concerns heard about the direction of my treatment?

On the surface, it seems easy. Just tell your psychiatrist what you want him to pay attention to.

On the other hand, there are many reasons why it not so simple.

• Many psychiatrists diagnose a patient’s illness after a 45-50 minute interview, without doing any tests to rule out potential medical causes of psychiatric symptoms and without obtaining history from corroborating sources, as recommended by diagnostic experts.
• They see patients in follow up for 15 minutes or less.
• In those 15 minutes all they care about is that the patient says he is better. Once again, they don’t use rating scales or obtain corroborating history to confirm the degree of improvement.
• In general, patients who take still unfortunately difficult step of seeing a psychiatrist want to believe that they are getting better even when they are not.
• For a patient, telling a psychiatrist they are not feeling heard might feel too risky – the psychiatrist might get upset at them and might not like them as a patient any more.
• You could just change psychiatrists. But it’s not easy. You have to reveal the workings of your mind to yet another stranger.

To be honest, the best way to be heard is to build a routine from the very first appointment.The key components of the “Getting Heard Routine” follow.

First appointment. Go to your first appointment with a notebook. Be honest in your responses to the psychiatrist. Before you leave, ask the him what is the formal diagnosis he is giving you and why. Ask questions about medications being prescribed. At the end of the appointment, in your notebook, write down a summary of discussion with the psychiatrist, treatment changes and your honest, gut-level rating of that psychiatrist on the qualities that make a good, competent psychiatrist (see previous blog posts).

Between appointments. Note any particular changes in your own or loved ones’ emotions or behavior that indicate to you change, for better or worse, in your psychiatric symptoms. Especially, note how you are sleeping and how you are feeling about work and about interacting with others. Note side-effects of medications.

One day before your next appointment. Take 15 minutes to think about how you are doing overall since the last appointment, and jot down in your notebook all the questions and concerns you want to discuss in your appointment with your psychiatrist.

At a follow up appointment. Do not reflexively answer “fine” when the psychiatrists asks, “How are you doing?” Insetad, say, “I took some notes and want to share my observations and questions with you” as you open your notebook and begin sharing and asking. At the end, of the appointment, note down if you felt satisfied with the psychiatrists response.This becomes a concern to discuss in the next appointment. Note any change in your gut-level impression of this psychiatrist.

At occasional appointments. Take a loved one to the appointment to make it easy for the psychiatrist to get corroborating history and corroborate your own impressions of that psychiatrist.

If none of this works, unfortunately, there’s not much you can do other than voting with your feet, assuming there are no constraints to you choosing another psychiatrist.

Dheeraj Raina is a psychiatrist who practices at the Depression Clinic of Chicago.

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