Philip R. Muskin, MD, MA
Philip R. Muskin, MD, MA, professor of psychiatry, Columbia University Medical Center, New York City, and current secretary of the American Psychiatric Association.
Bottom Line: It can be harder to find the right psychiatrist than to find the right dentist or family doctor.
As long as they have the right credentials, it’s helpful—but not critical—that you personally get on with your family doctor, dentist, gynecologist or surgeon. With a psychiatrist, it’s a different story. You’ll be spending a lot of time together, sharing your most intensely personal thoughts. It can be challenging to find someone who’s good…and also makes you feel good about talking to him/her.
Like psychologists, social workers and other kinds of psychotherapists, psychiatrists are trained to provide psychotherapy (talk therapy) to treat mental health disorders. But unlike other kinds of psychotherapists, psychiatrists are medical doctors and also can prescribe psychiatric medication. Note: Psychiatric nurse practitioners also can prescribe medication and have some training in psychotherapy, but usually psychotherapy is left to other kinds of psychotherapists. Psychiatrists, on the other hand, receive a minimum of four years of education and training in both prescribing medication and several kinds of psychotherapy.
You don’t have to be severely depressed or hearing voices to benefit from going to a psychiatrist. Based on your symptoms, your primary care doctor may refer you to a psychiatrist for further evaluation. Or if you’re seeing a psychotherapist, he/she may feel medication in addition to psychotherapy might be helpful. According to the American Psychiatric Association (APA), you may need to consult a psychiatrist if you…
If you have been treated successfully in the past with medication, or believe strongly that you would benefit from medication, the mental health professional you should contact for the current episode is a psychiatrist.
Besides getting a referral from your primary care doctor, friends or family, you can also…
Your insurance may or may not require a “gatekeeper” referral to go to a psychiatrist, so it’s a good idea to check what your policy covers before starting treatment. Also, check whether the psychiatrist you’re considering is in your plan—many do not participate in insurance at all. Make sure that he is certified by the American Board of Psychiatry and Neurology…and, if appropriate, also certified in a subspecialty, such as child, geriatric or addiction psychiatry. Being affiliated with a medical school or university hospital is another plus—it generally means that he is likely to be up to date on the latest treatments.
While you can search online for patient ratings and/or comments, keep in mind that these are not always reliable. For instance, patients with a gripe might be more motivated to post a rating, while satisfied patients might not bother.
Depending on the mental health disorder, your treatment options might include different types of psychotherapy (for example, cognitive behavioral, interpersonal or psychodynamic)…lifestyle changes (such as quitting smoking, cutting back on alcohol, maintaining a healthy diet and regular exercise)…and/or medication. You should feel that the doctor takes your preferences into consideration and that you have a choice in decisions that are made.
Example: You might see a psychiatrist for depression and agree that a combination of psychotherapy and medication would be appropriate. However, you’re worried about gaining weight from the medication. Does your doctor discuss different medication options and their side effects? Or does he brush off your concerns and push you into the final decision?
You might also ask to have a “trial” period without committing to long-term psychotherapy to see if there is a personality fit between you.
Bottom line: Be patient with the process—but also stay alert for red flags. It might be time to choose a different doctor if, for instance, you feel that you’re not improving or are getting worse…your psychiatrist is hard to reach or often unavailable…he seems to ignore medication side effects that bother you…or you become uncomfortable with your treatment plan or your doctor.
