Psychiatry Bait-and-Switch

New patient appointments with psychiatrists are usually 90 minute appointments, and subsequent appointments are generally 15 to 20 minutes to deal with medication issues, unless you are also seeing the psychiatrist for your psychotherapy, which many insurance companies don't like anymore.

I do not know if it is an acceptable practice for a psychiatrist to "farm out" part of the initial interview to a colleague at their practice, such as an LCSW (Licensed Clinical Social Worker) or other mental health professional, and then come in for the last 20-25 minutes and be filled in on the most pertinent details (things like family history that I had already addressed in the New Patient Information packet that I had been asked about again in the interview were not brought up in this "fill in the psychiatrist" process, thank goodness; perhaps it was assumed that she had read the history, and that she'd read the interviewer's full notes later) . . . . . .

I do not know if such a thing as this is an acceptable or accepted practice . . . I do not know what my insurance company would say about it, either.

Shockingly, I wasn't interviewed by anyone I'd consider a mental health professional, though I think the people within the group practice there might disagree. I was interviewed by an Energy Healer. AN ENERGY HEALER. Of all the mumbo jumbo hocus pocus crap, pardon my language . . . . . this is fine, for those who believe in it. It is not fine for me, because this is not what I was there for, and despite the fact that her "degree" includes courses in psychology and psychodynamics (when I first went there to fill out the new patient forms, I picked up the business cards of everyone there, and a flyer or two, including the one for this Energy Healer, to take home with me to read, to get a "feel" for this different kind of a place that I'd be going to), I do not consider her a mental health professional.

I also consider it a wasted opportunity on the part of the psychiatrist, because with the limited time we are allowed in subsequent "med check" appointments by the insurance company, she has missed the opportunity allowed in this first, longer appointment in getting to know me that she could have had in interviewing me herself.

Now, if her practice is busy enough that she can't take new patients on without farming part of the interview out to a colleague, then at least do it to one of the LCSW's or PC (personal counselor? professional counselor?) at the practice, and not to the energy healer . . . . .

With as long as it took me to find a psychiatrist last time, and as quickly as I found one this time (although that might be a warning sign, I don't know, although the open philosophy the practice holds would indicate, I HOPE, that they'd not try to force one down a path you aren't comfortable with), I AM happy to have gotten in to a psychiatrist at all, AND the time I DID spend with her (none of it one-on-one, though, the energy healer was still in the room the whole time) I thought she was sharp, in a good way, on the ball, knew her stuff, made a decent impression for the negative impressions that I'd already had going, having been thrown for a loop or two by being farmed out to the energy healer, and a really negative interaction with the office staff at the front desk, which was another throw-me-for-a-loop interaction that is causing a huge amount of anxiety.

The thing is, I cautiously quite like her; the psychiatrist, that is. Based on the little time I had with her.

Counter-balancing that, though, is the resentment at being forced to open up to someone that I'd never have opened up to, had I not been forced to. She's not going to be part of my ongoing visits, as the med checks will be with the psychiatrist herself, but when my arthritis and the prognosis would come up it was assumed that what the doctors had said about my future wasn't really how things had to be, because what the Energy Healer does is supposedly supposed to change that kind of thing. I resent that she or they assumed that I was or would buy into that way of thinking, as well. Although, since that's their worldview, how could they not think that way? It would be like asking them to be something other than who they are, so I suppose I couldn't ask anything else.

At my next appointment, my problem with the staff in the office will be mentioned, unless the anxiety becomes so great that I have to call her and mention it before then (ie, it might prevent me from coming back, and if it does so, I may be done with psychiatrists forever), as well as my resentment at being forced to open up to someone that I was not prepared or expected to open up to, that I would not naturally trust, will also be mentioned. These things are important to maintain a good working, trusting therapeutic relationship between the psychiatrist and myself, although I worry about complaining about the office staff, as well as complaining about the procedures she's established for taking on new patients. I have to counter-balance those worries with how much anxiety the office staff interaction has and is causing me, as well as the amount of resentment caused by the bait-and-switch thing, the amount of resentment caused by the fact that I never would have opened up to this other woman if I hadn't have been forced to.

I still wonder if it makes me a bit of a, pardon my language, bitch, that I had this office staff problem, and problem with the new patient procedure, though. Still, on the latter, I've never HEARD of anything like it, especially involving a non-mental health professional, at least as most of the mainstream world would define the term . . . . .

I was raised to be a bit leery of psychiatry/psychiatrists, and this whole experience just leaves me extremely unsettled, despite the fact that the psychiatrist seemed really good, although I don't have much to go on, there, and I have to make some judgements of her based on more than our interactions; I have to judge her on her intake procedures, office polices, and other things.

She's got me titrating up EXTREMELY QUICKLY on Seroquel, so we'll see how that goes; depending on side effects, we may slow it down a little.

I'm hoping that the peeps over at Shrink Rap see this post, and respond with a post on if they've ever heard of acceptable or not practice of farming out part of the new patient intake interview . . . . whether it be to a more mainstream mental health professional with a lesser degree, or to a more odd "specialty" such as happened to me. Even if it's acceptable within the profession, it's still a missed opportunity on the part of the psychiatrist, as I stated above, to get a good read on the patient.

I see her again in a couple of weeks, on a Saturday morning of all things!