8 doctors weighed in:

Should psychiatrists converse with patients or should they simply write everything down like a machine? I went to a psychiatrist a few months ago in which he conversed with me like a person. Unfortunately for whatever reason he didn't prescribe me medica

8 doctors weighed in
Dr. Pamela Pappas
Psychiatry
4 doctors agree

In brief: Variability

Like all other physicians and humans in general, psychiatrists vary in how they interact & do their work.
Maybe the one you saw didn't feel pharmaceuticals were indicated, and felt that talk therapy would be the best treatment for you. Sounds like you expected something else, though. I do take a lot of notes with patients, yet they know i'm with them through eye contact, pertinent questions, etc.

In brief: Variability

Like all other physicians and humans in general, psychiatrists vary in how they interact & do their work.
Maybe the one you saw didn't feel pharmaceuticals were indicated, and felt that talk therapy would be the best treatment for you. Sounds like you expected something else, though. I do take a lot of notes with patients, yet they know i'm with them through eye contact, pertinent questions, etc.
Dr. Pamela Pappas
Dr. Pamela Pappas
Thank
Dr. Heidi Fowler
Psychiatry
3 doctors agree

In brief: The

The psychiatrists that are best known for writing everything down are psychoanalysts.
They are the type of psychiatrist who may have the patient lie on a couch and who usually remain very quiet while the patient talks. But, it surely doesn't sound like you saw an analyst. In today's world of hmo's and insurance companies that often provide minimal behavioral health coverage, psychiatrists may have very little time with each patient. When that is the case, the psychiatrist may have to be very efficient during his or her evaluation and may be alotted a brief period of time for a medication management session. Most of us would like to see a provider who is helpful and who interacts. When a provider can combine efficiency with great medical care while letting the patient know that they hear them and that they care- that is when is when things are at their best.

In brief: The

The psychiatrists that are best known for writing everything down are psychoanalysts.
They are the type of psychiatrist who may have the patient lie on a couch and who usually remain very quiet while the patient talks. But, it surely doesn't sound like you saw an analyst. In today's world of hmo's and insurance companies that often provide minimal behavioral health coverage, psychiatrists may have very little time with each patient. When that is the case, the psychiatrist may have to be very efficient during his or her evaluation and may be alotted a brief period of time for a medication management session. Most of us would like to see a provider who is helpful and who interacts. When a provider can combine efficiency with great medical care while letting the patient know that they hear them and that they care- that is when is when things are at their best.
Dr. Heidi Fowler
Dr. Heidi Fowler
Thank
Dr. Richard Bunt
Psychiatry
3 doctors agree

In brief: Psychiatrists,

Psychiatrists, like patients, are human, and each has their own style.
I, for one am very proud of my reputation for listening to my patients and moreover, explaining the details and rationale of whatever meds i may (or may not) be recommending. At least 2 - 5 times/week, a new patient tells me that I am "the first doctor who's ever" treated them this way. My clinical philosphy is that - all things being equal, i will have both better treatment compliance, and better results overall, if my patients understand that they are a member of the treatment team, and that (as i usually put it) I am here to provide them with the benefits of my experience, education, and expertise, but ultimately, the final treatment decisions are theirs. That does not, of course, mean that i will give anyone anything that i don't agree with (e.g. I make my negative opinion towards benzodiazepines very clear - but i explain why, in detail). Frankly, your first guy sounds like a psychologist (who's treatment options include only talk therapy - not meds). Are you clear on the differences? Here are some other possibilities: there are a few docs i've met who went into psychiatry for reasons i don't fully understand, because they are desparately uncomfortable around other human beings. Shy, withdrawn and socially awkward. I worked with one up until about 6 months ago, and frankly, your description nailed him. I know he practices pretty far down your way, so i won't say anything more about him. The compulsive note taking can be due to a number of reasons. I like a lot of detail myself, because it helps me to fine tune my treatment decisions, and quite frankly, when you have maybe a thousand active patients, i don't know how anyone could keep all the details straight from one month to the next... But i learned early on that it is essential to make frequent eye contact, and to recognize the importance of nonverbal communication, especially when the subject matter dictates. There are also those who "hide behind" the notepad, which sounds a bit more like your guy. Then there is the analyst. Psychodynamically based psychotherapy tends to consist of very little in the way of conversation. Like many psychiatrists, my training followed this orientation, wherein the therapist is not really there to converse with the patient "like a person", per se, which is to say, not like a friend, or really like anybody you might meet outside the psychiatrists office. In this orientation, the psychiatrist is not going to suggest solutions to your problems, or necessarily even express opinions about, well, anything! in fact, the whole point of the therapy is centered on an analysis of what attributes you ultimately attach to that person who you will actually know very little about. It's not actually as creepy as it sounds, unless it's done really badly. Basically, the psychiatrist will listen, and occasionally prompt further processing of certain points you might bring up. Only rarely will he or she offer up an interpretation of the deeper meaning of something you've said.... But this brand of therapy is a model which isn't meant to produce really significant results in less than 6 months to a year, or more, of 1-4 sessions/week, so good luck getting an insurance company to cover it. A third type of psychiatrist who doesn't converse is what i call "the technician". This is the one who realizes that his medications don't care why a person is depressed, anxious, etc. He just knows that any given antidepressant is likely to work 65% of the time, and if one doesn't, he'll try another. He doesn't really care about the human beings he treats. He's just there to do a job, and frankly, he'd like it a lot better if he didn't have to feign polite interest in his patient's problems, because it just cuts down on the number he can see in a day, but he knows better than to let that show, so he talks the talk, writes the scripts, and moves the patients along @ 4/hr.

In brief: Psychiatrists,

Psychiatrists, like patients, are human, and each has their own style.
I, for one am very proud of my reputation for listening to my patients and moreover, explaining the details and rationale of whatever meds i may (or may not) be recommending. At least 2 - 5 times/week, a new patient tells me that I am "the first doctor who's ever" treated them this way. My clinical philosphy is that - all things being equal, i will have both better treatment compliance, and better results overall, if my patients understand that they are a member of the treatment team, and that (as i usually put it) I am here to provide them with the benefits of my experience, education, and expertise, but ultimately, the final treatment decisions are theirs. That does not, of course, mean that i will give anyone anything that i don't agree with (e.g. I make my negative opinion towards benzodiazepines very clear - but i explain why, in detail). Frankly, your first guy sounds like a psychologist (who's treatment options include only talk therapy - not meds). Are you clear on the differences? Here are some other possibilities: there are a few docs i've met who went into psychiatry for reasons i don't fully understand, because they are desparately uncomfortable around other human beings. Shy, withdrawn and socially awkward. I worked with one up until about 6 months ago, and frankly, your description nailed him. I know he practices pretty far down your way, so i won't say anything more about him. The compulsive note taking can be due to a number of reasons. I like a lot of detail myself, because it helps me to fine tune my treatment decisions, and quite frankly, when you have maybe a thousand active patients, i don't know how anyone could keep all the details straight from one month to the next... But i learned early on that it is essential to make frequent eye contact, and to recognize the importance of nonverbal communication, especially when the subject matter dictates. There are also those who "hide behind" the notepad, which sounds a bit more like your guy. Then there is the analyst. Psychodynamically based psychotherapy tends to consist of very little in the way of conversation. Like many psychiatrists, my training followed this orientation, wherein the therapist is not really there to converse with the patient "like a person", per se, which is to say, not like a friend, or really like anybody you might meet outside the psychiatrists office. In this orientation, the psychiatrist is not going to suggest solutions to your problems, or necessarily even express opinions about, well, anything! in fact, the whole point of the therapy is centered on an analysis of what attributes you ultimately attach to that person who you will actually know very little about. It's not actually as creepy as it sounds, unless it's done really badly. Basically, the psychiatrist will listen, and occasionally prompt further processing of certain points you might bring up. Only rarely will he or she offer up an interpretation of the deeper meaning of something you've said.... But this brand of therapy is a model which isn't meant to produce really significant results in less than 6 months to a year, or more, of 1-4 sessions/week, so good luck getting an insurance company to cover it. A third type of psychiatrist who doesn't converse is what i call "the technician". This is the one who realizes that his medications don't care why a person is depressed, anxious, etc. He just knows that any given antidepressant is likely to work 65% of the time, and if one doesn't, he'll try another. He doesn't really care about the human beings he treats. He's just there to do a job, and frankly, he'd like it a lot better if he didn't have to feign polite interest in his patient's problems, because it just cuts down on the number he can see in a day, but he knows better than to let that show, so he talks the talk, writes the scripts, and moves the patients along @ 4/hr.
Dr. Richard Bunt
Dr. Richard Bunt
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1 comment
Dr. Pamela Pappas
Very sad characterization of psychiatrists, overall.
Dr. Sophie Duriez
Psychiatry
2 doctors agree

In brief: Good question

Each psychiatrist has her/his own style of working w/ some pple but not all.
What patients r expecting from a psychiatrist may b very different. Some pple just want to b prescribed meds without having to talk, they like "in & out" & "med refill" style. Some r "drug" seekers only. Lots of pple still want 2 b helped w/talk & meds, i like working w/them: they r brave enough 2 share their pers. Issues.

In brief: Good question

Each psychiatrist has her/his own style of working w/ some pple but not all.
What patients r expecting from a psychiatrist may b very different. Some pple just want to b prescribed meds without having to talk, they like "in & out" & "med refill" style. Some r "drug" seekers only. Lots of pple still want 2 b helped w/talk & meds, i like working w/them: they r brave enough 2 share their pers. Issues.
Dr. Sophie Duriez
Dr. Sophie Duriez
Thank
1 comment
Dr. Sophie Duriez
I think it's important 4 the psych 2 ask pt's expectation(s) from her/his visit so that both of them will know if on the same page or not.
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