Walk into any clothing store and you may be met, instantly, with 20 different choices for the one item you initially had in mind. Where do you even begin? For some, the idea of going into the store without an agenda can be relaxing and restorative. But what if you wanted that item to help you? What if you wanted that item to engage with you and guide you for some time to come? How do you make a decision on such an important piece of clothing?
Finding the “right” psychiatrist can be, and oftentimes is, a daunting experience. So much so that this very factor can debilitate one’s decision making process and completely stall one’s progress towards engagement in care. This discussion will help you with the necessary steps to not only find an appropriate provider for you, but also to help you investigate more about yourself.
What does "right" mean?
This is a trick question actually. Our society has constructed a specific vernacular and we assess people, implicitly and explicitly, based on how well a person adheres to these constructs. Having an agreed upon definition for terms in our society is a must. It’s how we communicate and build organization in meaningful ways with each other. Yet, how helpful is this method in building meaning within ourselves? How helpful is this construct in understanding ourselves? The “right” fit for you may not be the “right” fit for someone else. Accepting this and understanding an incompatible fit does not devalue you remains crucial in your mental health, awareness and progress. Remember, you get to define “right.” If you don’t define it yourself, someone will attempt to define it for you.
To understand relationships externally (outside of oneself), you must first improve and understand your relationship with yourself. And to understand fit, one has to understand a few other components, such as value. Each one of us has, inherently, great self-worth and value. Understanding what you value about yourself requires awareness and self-compassion. There are different perspectives of fit, however I can offer one perspective here that may be helpful. Fit can be defined as: the appreciated and recognized values two entities share between each other. Entity being an umbrella term for people, organization, career, friends, family, etc. In other words, does the entity you are engaging with value the things about you that you value in yourself, and do you value the things about that entity that the entity values in itself? To understand this complex topic, there are pre-requisites such as understanding topics of self-worth, identity, tolerance, acceptance, etc. So the first step in understanding if a psychiatrist is a “right” fit for you, does not begin with understanding what you value about a psychiatrist, but first what you value about yourself. And then you build from there.
In general, psychiatrists you may NOT want to engage with
While I cannot guide you specifically, without meeting you, on what is an appropriate and reasonable fit for you, I can, largely, speak on what NOT to engage with.
Not all physicians are created equal. The type of experience that the provider has endured, the mindedness of the psychiatrist and the outlook of the psychiatrist are just a few examples of differences. But there are a few specific traits that I would not recommend. For the purpose of this discussion, I am referring to psychiatrists in the outpatient setting only. Different environments require different sets of skills.
1. Do not engage with an outpatient psychiatrist who cannot explain to you the risks and benefits of treatment.
Risk benefit ratio is a major topic in the field of medicine. To keep it simple, after a diagnosis has been established between you and the provider, a discussion about treatments likely will ensue. Each treatment has a different risk benefit ratio because each treatment has different risks, for the most part. It’s the psychiatrist’s duty to inform you about this ratio so that you can make an informed decision about your care. We are not intelligent enough as a medical community to have treatments that have zero risks. Even some modes of psychotherapy, if done incorrectly, can uncover topics too harshly and cause harm. But specifically to medications, it remains your right as a patient to have all the data you need to make the best decision you can for yourself. Remember, unless it’s an emergency (suicidal thoughts, homicidal thoughts, grave disability), it's your inherent right to make decisions about your treatment, not your psychiatrist. So please be mindful in situations where your psychiatrist cannot give you the information to make such an informed decision.
2. Do not engage with an outpatient psychiatrist who does not communicate with you outside of visits or delays care because of communication difficulties
You and your psychiatrist work together as a team. In any relationship, communication is key. Having access to your psychiatrist in a reasonable time frame (24-48 hours) ensures that you get the care you need in the time you need it. While there may be a time when providers have emergencies and are unable to respond promptly, this ought to be the exception and not the rule. At times you might have questions outside of visits or need a refill on your medication. Being able to notify your provider in an efficient way and then getting a prompt response from your provider is crucial and the standard of care. If your provider doesn’t answer you and you are left in a situation where you cannot get your medications or the treatment you need, it may be time to look elsewhere.
3. Do not engage with an outpatient psychiatrist who won’t collaborate with other providers
Again, the theme here is teamwork. Psychiatrists are experts of mental health. However, the medical community recognizes that some medical conditions (ex. Thyroid dysfunction) can contribute to mental health conditions. Having your collective team (all physicians working with you) speak to each other and collaborate will make a world of difference. All the best psychiatrists make time to engage with your other doctors to collaborate in care.
4. Do not engage with an outpatient psychiatrist who dismisses your attempts to advocate for yourself
While there are many different styles of providers accessible to you, the collaborative provider remains the best asset to your team. When working with a seasoned psychiatrist, you will be informed about diagnosis, treatments, risk/benefit ratio, side effects, prognosis, possible timeline for treatments and they will answer any of your questions or concerns. After all this information, it remains your right to choose which path you would like to take. Unless it’s an emergent situation (suicidal thoughts, homicidal thoughts, grave disability), you are in the driver seat. If you are placed in a position where you attempt to make a decision for yourself and you aren’t encouraged to do this or you aren’t given a space to explore this, then it may be time to take your care elsewhere.
The best psychiatrists do not just prescribe medications
The field of psychiatry continues to be divided into fragmented areas of “specialization.” It may be difficult to clarify who does what. You may ask: What’s a MD, DO, LMFT, LCSW, PMHNP, PhD, PsyD, etc.? Who does therapy? Who doesn’t do therapy? What do all these terms mean? Why should I care?
The fact is that all psychiatrists are physicians (MD and DO). Psychiatrists all go to medical school and then do an extensive residency program in the specialty of psychiatry. To have graduated medical school, physicians train in the core specialties of internal medicine, family medicine, OB/GYN, pediatrics, surgery, and psychiatry. Residency after medical school requires extensive clinical hours, clinical training and an abundant amount of patient interaction and learning. Through this, psychiatrist learn much more than just prescribing medications. We learn about how to understand diagnosis, how severe a diagnosis can be, what treatments are effective, what treatments are not effective, when to use treatments, when not to use treatments, and the list goes on. The residency specialty of psychiatry also includes training in internal medicine, family medicine and/or pediatrics. Through this post graduate training in other specialties, psychiatrists get exposed to a broader array of medicine than almost any other specialty. Virtually no other specialty rotates through psychiatry (other than neurology) whereas psychiatrist rotate through other specialties in residency.
In addition to all this, many psychiatrists learn, understand and know how to employ appropriate therapeutic techniques and specific psychotherapy modes. Because psychiatrists (MD or DO) understand how to employ the broadest range of treatments of all the different types of “therapists” available, there is a clear advantage to having your therapist be a psychiatrist. While not all psychiatrists practice therapy, if you find one that does, it would benefit you to consider continual engagement with that psychiatrist. The best psychiatrist doesn’t just prescribe. They understand diagnosis, the wide range of treatments (therapy and medications) and know when to recommend one, the other or both.
The Best Psychiatrist Los Angeles may not take insurance
In our current medical society, insurance companies were designed to help the most amount of people get access to physicians at a “reasonable” rate/co pay. The insurance companies can dictate the infrastructure of how mental health clinics operate. Because psychiatrists are the only specialists (with the most experience) in the mental health domain that can expertly prescribe medications, mental health organizations/clinics want to utilize psychiatrist for that role alone, typically. This is termed “revenue max.” In any field, when there is less experience and specialization, the cost for that entity is less. Organizations do not want to pay psychiatrists (who have the most diverse training and experience) to do much else besides diagnosis and prescribe medications. In this insurance base system, to revenue max, we have ended up with psychiatrist, who have the most diverse experience, only overseeing one part of the equation. This model, while helpful for a large portion of the population, remains inadequate if you would like peak performance from top tier psychiatrists. The best psychiatrists that give the best quality care are often hindered by the insurance model.
In a model without insurance, the best psychiatrists in Los Angeles are able to utilize the extensive experience and training to the fullest and provide a service that, typically, no other mental health provider can offer. You will get the quality time you deserve, you will get the attention to detail you need, and you will have the broad knowledge base of the expert psychiatrist to guide you on what treatments may be helpful for you, and which are not. If you truly want to optimize the mental health care team, the best psychiatrist that fits you may not take insurance.
This article was designed to give you information about how to find the best psychiatrist for you and specific characteristics to consider when choosing a psychiatrist. Ultimately the provider you work with is there to help you, guide you and be a meaningful teammate in your mental health journey. When considering engagement in care, many of these factors discussed above can help inform you on where to start and what to look for. I believe that if people can positively change the way they seem themselves, then perhaps this is one step closer to having the world positively change the way it sees itself.