I believe part of the apprehension in meeting with a psychiatrist is the unknown. Hopefully, in sharing some information about initial appointments with the Psychiatrist, you can know what to expect. Now, again, no one schedules with a psychiatrist for fun and I don’t think after reading this you’ll expect to leave the Psychiatrist’s appointment with a huge smile. I do believe information is important and knowing what to expect can lower anxiety.
Every psychiatrist has a different style to their assessment. Assessments are essentially a series of questions that provide information for the Psychiatrist to create an idea of how someone lives and if symptoms are impairing how they want to and need to live. Some assessments with Psychiatrists may seem like a job interview answering questions. Some Psychiatrists prefer a conversational interview style. Other Psychiatrists begin therapeutic techniques with the interview process (and I’ll tell you, the best Psychiatrist assessments I’ve seen include therapeutic techniques as soon as the appointment starts but that’s a topic for another day).
Given that all Psychiatrist assessments are unique, and all Psychiatrists seem to have their own style, I’ll stick to the common elements for this blog. I believe this will serve our purpose here for sharing information to ease apprehension in meeting with a psychiatrist for the first time.
A Psychiatrist’s Assessment at its core is a medical assessment. In medical school, a very important thing future doctors learn is how to gather information and formulate an idea of what the issue is (aka “the pathology”). First, Psychiatrists are Physicians. So, in meeting with a psychiatrist, you’re completing a medical exam. So many features of a medical assessment like when you meet with your Family Doctor or Pediatrician are the same. These features common to all medical exams, including Psychiatric Assessments include
-“Chief complaint” (the reason the person is meeting with the doctor)
-in Psychiatry, this is often mood concerns like depression, anxiety, insomnia. In truth, it can be anything. I prefer to use the person’s own words. In other fields of medicine, a chief complaint can be “Chest pain”, “abdominal pain”, “headaches” or “yearly physical”
-“History of Present illness” (description of the chief complaint
-This is a very important part. This is where the description of the chief complaint is gathered. It is also important to gather information about other aspects of someone’s life that may impact the chief compliant. For example, if someone comes to the Psychiatrist concerned about low mood, along with all kinds of other possible depressive symptoms, the psychiatrist should find out about other commonly co-occurring issues with depression, like sleep issues, anxiety, and stressors in that person’s life. This is very important in making sure other issues are not occurring. One of the most important lessons I learned in medical school was that “the issues not going on are as important the reason the person came to the doctor”. When I heard an older doctor say that it made my head spin. Now years later, I think about that important lesson daily: It’s important to not miss another issue when providing recommendations to people and creating treatment plans. The information you provide in describing the chief complaint and other possible issues is used by doctors to formulate what’s called a “Differential Diagnosis”. What a serious-sounding term right? DIFFERENTIAL DIAGNOSIS. I think adding Differential to it brings up memories of high school math class unnecessarily. Anyway, the Differential Diagnosis is an important part of the final assessment-the reason you came to the appointment in the first place: what is the problem. Because without knowing the problem, you don’t know how to fix it. More on that later.
So, after gathering information, the doctor starts thinking of what the issue could be. This is more like a list of possible diagnoses. Some diagnoses are more likely, and some are less likely. To confirm what is likely and less likely, the doctor should gather more information. This information is coming with an exam.
-Mental Status Exam
-Psychiatrist assessments are equivalent to a physical exam like you would have at another doctor in that they both include the doctor gathering objective information. This is what a Primary Care doctor is doing when listening to your heart and lungs. They are listening for physical signs to support or rule out concerns on their differential diagnosis after speaking with you.
Doctors can decide to complete portions of the exam depending on the chief complaint and history of present illness. For example, if you saw your Primary Care doctor for a chief complaint of fatigue, the doctor is going to listen to your chest, lungs, and abdomen (remember, it’s important to rule out other illnesses. So even though someone is in for chest pain, a good doctor should make sure it’s not something else like an upset stomach or heartburn causing chest pain) among other things. Now, if you mentioned that the fatigue is worse after certain events, the doctor would then be sure to do a complete exam checking your nervous system because a neurologic issue is higher on their differential diagnosis list of possible issues going on.
-Psychiatrists do not check physical exam issues like other physicians but we do have observable signs of certain illnesses. Psychiatrists are watching for many things that could be indicative of certain issues or problems with medication. These things include how someone is behaving, how they are dressed, how they walk and move, how they are talking, how they answer questions. This information also includes things the person needs to clearly state such as suicidal thoughts, homicidal thoughts, or hallucinations. I’ve noticed many people are surprised these questions are asked, but believe me, they are asked of every patient every time. Please do not be surprised or put off. If anything, it’s important to ask everyone for safety reasons but also to make it an easier topic for everyone to discuss.
ASSESSMENT:
-Here is the important part! The part everyone loves to ask, “What is the diagnosis?”
-With all the information you provided and from the Doctor’s observation, they have that list of possible issues, the Differential Diagnosis, in mind. The Psychiatrist will then share with you what they believe is going on. Many times, this is in the form of a diagnosis. It may also include a discussion of other factors such as insomnia, stress, or patterns in your life.
RECOMMENDATIONS and TREATMENT PLANNING
-Here is what I believe is the important part: What does the Psychiatrist think would be helpful for the issue bothering you. This can include therapy, medications, or other changes in your life. At the end of this discussion, the Psychiatrist may want to get started on that plan by scheduling another appointment or starting a medication. You should feel free to ask questions, know how to communicate with the doctor and what to expect in the future with treatment. The Psychiatrist or you the patient may decide this initial appointment will be the only appointment and you’ll be given information about starting treatment with another clinician. Your initial appointment then is called a “Consultation.”
