Details on Approach to Psychiatric Practice
In the page on my general approach to
practice, I outlined what I think should happen in evaluation and
psychiatric work. When I see patients for evaluation, I usually spend
75 minutes gathering information and in discussion and education. I
spend 15 minutes doing documentation and related paperwork. For follow
up appointments, I usually see patients for a 50 minute 'hour', and
spend 10 minutes on paperwork. The 'hour' sessions are generally long
enough for doing therapy work as well as medication review. If a
patient and I feel a longer session is needed, we can usually work
something out. Traditional exposure therapies for anxiety disorders
last 90 minutes, for example, but that is not always necessary or
practical.
I feel it is important to spend as much time as is needed. The
above times present a sense of how my current practice works, but it is
a more pressured timeframe than in the past (as is true of many things
in our society). When I started training, people would spend three
sessions doing an evaluation. Managed care and other health care cost
pressures have stopped that long ago. I now try to strike a balance
between what a person needs and what they can afford (independent of
insurance companies).
Given my philosophy of practice,
I feel that it is more important to be regular in aiming to create long
term change (and have regular meetings) than trying to do everything
quickly. This is one of the reasons I have concerns about using medications and
prefer use of therapy.
In introducing my practice, I let people know about my availability, my fees, and I handout information about privacy. As a psychiatrist, I am very concerned about privacy and whether people can feel safe entrusting information to me. I believe the increasing reliance on technology has led many people to subtly change their expectatations about privacy. I have written on some of the impact the Internet can have in creating changes in our social expectations. I have a separate page on privacy concerns in private practice.