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FINDING THE RIGHT PSYCHIATRIST

Finding a psychiatrist in private practice is often fraught, partly because this task usually comes at a time when we are emotionally distressed, but also because it's an area most of us have thought little about until we bang right up against it.

Relationships between doctors and 'ordinary people' have changed since the 1970s. Although there are still many people who choose to take only a small role in the decisions that affect their health care, there are now many of us who want to be active players.

Doctors, including psychiatrists, are beginning to get used to this but many remain sceptical.


Doctor shopping

The term 'doctor shopping' often has quite negative connotations - some people in the medical field see 'doctor shoppers' as 'bad' people going from doctor to doctor to get medications, or 'dependent' people who seek services they do not need.

For many consumers, however, 'doctor shopping' is about assertively searching for the psychiatrist who has the attributes we are looking for.

Of course, the first step is to decide whether psychiatry is the way we want to go. Then we need to find the best professional relationship we can.

GPs often have a set of specialists to whom they have sent people before. Sometimes they rely on professional reputation, and feedback from patients can also influence their decisions. Sometimes GPs' criteria for making particular referrals are rather rudimentary, such as, "other patients say she's very nice". What does this mean in terms of this psychiatrist's practice? Probably not much to us.

We don't have to go with the GP's suggestion. We can do our own research about who we would like to see. GPs react in different ways when we do this. They are generally not used to 'their' patients being involved in making decisions in this way. Some GPs will be grateful for our guidance; some will be threatened.

Sometimes age, gender, social class, culture or life experience leave people with unreserved faith in the information and referrals we are given by general practitioners (GPs). Others no longer have this faith. Neither position is right or wrong. They are just different.

Other places you can go to find some names of psychiatrists include friends and family, consumer/patient organisations, and even Google - internet-based chat rooms may (with care) be a useful place to start your research.

Whichever way we go, we will need to have conversations with our general practitioner about our decision because without a referral from a GP to a psychiatrist we will not be able to claim from Medicare.


Questions for ourselves

Before you start your search for a psychiatrist, ask yourself some questions:


Questions about and for them

Once we have a shortlist, it's vital to start with researching some very basic information:

You can easily get this information from the Medical Board of Australia.

Next, it's time to ask some questions of and about your psychiatrist. Here are some questions you might want to ask about a psychiatrist to help you assess whether or not they will be a good match for you.

(Of course, you do not have to try to find out about any of this if you don't want to. Some people need to find trust through belief that 'doctor knows best' and this is completely acceptable and may, in some cases, save confusion and extra worry.)

A word of warning

It is empowering for many of us to know as much as we can about the psychiatrist who could potentially 'mess with our mind'; however, some very fine practitioners with good work ethics and empathic skills can spit the dummy at being "cross examined" by a patient they hardly know. Be prepared for the possibility of that reaction before you wade in.


The therapeutic relationship

Finding the right psychiatrist can sometimes be difficult because the 'clinical relationship' gets entangled with the bare bones of our health decision making.

As a general rule our intuition is not a bad tool.

During the first few visits you will be getting to know the psychiatrist and s/he you. You should start to have some ideas about their personal qualities. Intuitive feelings will usually come before you pick up on skill and practice competence.

You might find someone who on paper looks experienced, has done lots of ' first class' research and is often on the radio. However, face to face this person might be bullish, arrogant and dismissive.

During these first weeks we also start to gain more clarity about what we are looking for, about what we can engage in and what we can't, about definitions of professionalism and ethics and so on.

We are all different. Someone might really be impressed and relieved when the psychiatrist turns up in Blundstones and someone else might find this 'unprofessional'. It's all about finding a relationship that is right for you.

Sometimes psychiatrists use eclectic practices that are hard to describe. It is extremely difficult to give informed consent to something that can't be explained to you; but this doesn't necessarily mean it isn't any good.

What clinicians call the 'clinical relationship' is important and this is always evolving. It's one of those intangible things that we recognise as important but find hard to describe. It is easier to describe when it's bad.

Understanding issues of power is crucial. Other consumers will best be able to tell you whether a clinician actually understands the role of power issues in 'the clinical relationship' and his/her practice.