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 Shy, withdrawn and socially awkward.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.