We psychiatrists are amazed to learn that people think we’re telepathic, or that we’re psychologists, or that we can go out for coffee, or gossip about you. So I decided to set the record straight with these ten tips. They’ll also be helpful if you are considering consulting one of us. Ten things to know before you go:
1. We can’t read minds. Although it would be extremely useful and make the job so much easier if we could read minds, we can’t. So please try to verbalize your complaints. No, seriously, many people walk into my office, believing they just have to be there and I’ll know immediately what’s wrong. Sometimes it takes months to comprehend the problem, but many times I can make a diagnosis after two visits, but you must talk.
2. Psychiatrists are not psychologists, social workers, or lay therapists. Psychiatrists have medical degrees. We spent four years in medical school, then did a residency in psychiatry, and then many times did fellowships in our chosen field, i.e., psychopharmacology or child psychiatry. Because we learned how the body interacts with the mind, we can rule out physical disorders as a cause of mental illness. This is important, since a person may have a hyperactive thyroid, for example, which can trigger panic attacks, great anxiety, insomnia, or anorexia. We can look at thyroid blood tests or have a patient consult an endocrinologist if we suspect the problem stems from thyroid disease. Psychologists have a PhD, since they have usually studied four years in a university, concentrating on a variety of therapies, e.g., CBT or behavioral therapy. Social workers often have an MSW (medical social work degree) or a CSW (clinical social work degree), which is usually a master’s degree from a university. Lay therapists do not even need any degree and are not licensed by their states. Psychologists, social workers, nurses, lay therapists, and sometimes clergy all do psychotherapy with patients, but only a psychiatrist can prescribe medications and do therapy. We work together with many types of therapists, especially in hospitals and clinics.
3. We can hospitalize you if you need it. The most common types of psychiatric hospitalizations are for suicide attempts, detoxifications from drugs or alcohol, psychotic episodes caused by mania or from schizophrenia. Most psychiatrists use hospitalization sparingly as a last resort if no other treatment will work.
4. We can’t go out to coffee, or socialize outside the office, or date you. There might be rare exceptions, but we must maintain boundaries with our patients to protect them and ourselves. Many patients feel close to their doctors after revealing intimate and painful details of their lives, but our ethics require us to refrain from socializing with you. The reasons are quite complicated, but when these boundaries are violated, patients are harmed, doctors are sued and lose their licenses, and systems collapse. The rare exception might be when a psychiatrist shares some food with a severely disabled schizophrenic patient who otherwise might not be able to communicate.
5. We are available 24/7 if there is an emergency. Like most physicians, you can call us anytime if you are desperate, e.g., if you feel suicidal, have a bad reaction to a medication, or are ready to drink or drug again after a period of sobriety. Often we will just ask you to go to the closest emergency room or call 911 for an ambulance.
6. We are still learning the causes and genetics of many mental disorders. Science is advancing rapidly, but we don’t know precisely what genes are responsible for schizophrenia, bipolar disorder, or depression. We are getting there and the research is exciting, but we may not be able to answer your questions about your risk factors for passing these conditions on to the next generation.
7. We don’t have a blood test to determine if you have schizophrenia, bipolar disorder, or depression. We have to interview you and get your history clinically before we can determine what you have.
8. We are not shocked by most of what you tell us. Don’t worry. Most seasoned practitioners have heard the worst stories that you can imagine. So please go ahead and reveal your stories so that we can help you. Many patients feel embarrassed by what they have to say and so they modify their narratives. By telling the truth the best you can, you can help us understand and treat you.
9. The only time we have to break your confidentiality is if you want to harm or kill someone else. We are bound by the HIPPA laws and can’t reveal anything you tell us. However, if you wish to harm or kill someone, we have the duty to warn. The precedent for this started with the Tarasoff case in California, in which a young man killed his girlfriend. The psychologist treating the man warned the family, but the police who questioned the man said he was harmless. The family took it to the California Supreme Court who ruled in favor of the Tarasoff’s. Since then therapists have had the duty to warn.
10. We are neither all good or all evil as portrayed in many films that show psychiatrists as Dr. Evil or Dr. Good. Movies have often shown psychiatrists like Hannibal Lecter or Dr. Caligari as completely malignant. Or we are seen as all good, like the psychiatrist who Bruce Willis played in “The Sixth Sense.” Of course, we have negative and positive qualities like any other person. During psychotherapy patients project various attributes onto their doctors that should be discussed and analyzed. When you can see your psychiatrist as negative and positive, you probably are improving.
Hopefully, these ten tips will be of use to you when you are choosing a doctor to work with.