Finding the Perfect Psychiatrist

There’s no such thing as a perfect psychiatrist. But I’m trying to find someone who will be the best fit for me. This has been a very time-consuming endeavour, as well as disappointing, at times stressful, and expensive. I have had two good psychiatrists over the last four years and I am no longer under their care. I am currently in limbo. I am in between psychiatrists and it is disconcerting.

I’ve been with Dr. K. for the last nine months. He made me cry on our first session. His medication management appointments are only 15 minutes long, pretty standard for how psychiatry has evolved nowadays. Fifteen minutes isn’t enough to get to know your patient. This doctor was always abrasive, blunt, to the point. But he was also always looking at his computer screen and typing notes instead of looking at me when he asked questions. I feel like we didn’t connect. I knew I didn’t like him from the start but I gave it a chance. I gave it nine months.

I found a new doctor at the beginning of last month. She also accepted my insurance. It sounded ideal because she had been a recommendation from a friend. Rather than being an in-and-out practice, she actually spends 30 minutes with her patients for medication management appointments. We had our first meeting and it seemed to go well. I told her about my history, she listened and asked questions. I already felt like she cared more than my previous doctor. And she told me she specifically works with only women who have been abused. I thought, perfect! However, to my utter surprise, just this week I received a letter in the mail stating that she is closing my file. She doesn’t want to work with me and I have no idea why. She is also not obligated to tell me why. She simply said that she feels I would be better off with someone who has more resources.

Shocked, I called back my previous psychiatrist’s office to schedule a new appointment with Dr. K, but they had already mailed me the termination letter after I had said I wasn’t going to meet with the doctor any more, and he is not willing to take me back. Panic! I have no psychiatrist! I have enough medication refills to last me a while but I want to be talking to a professional. I have been on the same medication regimen for the last three years and someone might have an opinion of making some changes. I want to know those options.

In shock and disbelief, I texted a friend to ask her to think of some referrals. Then I went online to Psychology Today and called a number of different offices. I had an appointment this week with another psychiatrist who, by coincidence, works in the same office as the one who rejected me last month (yes, I took it as a total rejection and it made me feel awful. What did I say or do that was wrong?). I met with this new lady and the first thing I did was cry for ten minutes because I was feeling overwhelmed. Then I started talking to her. She seems okay but not the gentle and caring type. Still someone who is direct and to the point. Halfway through the session she asked me if I was committed. I said “yes, why?”. She told me it didn’t seem like I was that committed. Granted, I did tell her that one of my goals is to eventually get off of medications. But I didn’t like that she was making an assumption. On top of that, she gave me dating advice! She told me that she does not think it’s a good idea for me to start dating because I am not fully healed yet, and I have a lot of work to do on myself. Then I told her I have a date scheduled with a man already and she told me to not tell him anything. “He doesn’t need to know. Do not talk about medications or your past with your marriage.” Yes, a friend of mine has been reminding me to do “moderate self-disclosure”. But I did not appreciate receiving dating advice from someone who doesn’t even know me.

Because of this most recent and very expensive last session, I am still looking. The good psychiatrists do not take insurance and are considered out-of-network. They take cash-pay only. They will provide what is called a “superbill” with billing codes. I will need to meet my deductible for the calendar year before they will cover anything, and they will only reimburse me for 60% of the cost, according to the insurance plan that I have. At least it’s something. A year ago I would not have had the emotional energy or mental space to 1. Look for a new psychiatrist, and 2. Deal with processing and keeping track of my own billing with the insurance companies.

So this brings me to Dr. B. The first thing I liked was that when I called and left a message, it was his voice on the message. I was calling him directly. He runs a private practice by himself and does his own scheduling. He will even text message! When he called me back in the morning, I said I had already found a new psychiatrist. Then, after that disappointing last session, I called him back. He asked me if I already am seeing a psychotherapist. Because most psychiatrists these days will do only medication management, but he is rare and unusual in that he also does psychotherapy. His patients see him once or more a week. It’s $250 cash, upfront, per session. At once a week this is $1,000. I only make net $2,000 per month in income and can barely cover my current expenses.

Dr. B said that he might not be the best fit for me if I already have an established, solid relationship with a therapist. I asked him, why can’t I have two therapists? Dr. B said my therapist might feel threatened and I said, no way, that’s not him. We have a good relationship and he lets me do whatever I want (for my treatment). This doctor is willing to meet with me. All of this doctor-shopping is taking a lot of time away from my work week and this is really not ideal, but it needs to be done. My TalkSpace therapist is supporting me in that it might be to my benefit to see a psychiatrist who is interested in how I am doing and how the medication is affecting me from week to week, as opposed to a 15-minute appointment every six weeks. I do like that idea. The only thing, she said, is that talking to multiple therapist providers might be counter-productive or uncoordinated. I would like to find a way to coordinate my care.

I will see how my new psychiatrist appointment goes next week on Tuesday, and you can bet I’ll be talking about it with my therapist on Wednesday. Dr. B has a kind and gentle voice and I already like him, the question will be is whether he will accept me into his practise as a patient and whether we get along.

A lot of people confuse the terms “psychiatrist”, “psychotherapist”, and “psychologist”. A psychiatrist is a medical doctor and can prescribe medications. A psychologist is not a medical doctor, but has a PhD or a PsyD doctorate degree and can teach psychology, as well as practise psychotherapy. A psychotherapist usually has a master’s degree and a license as a Marriage and Family Therapist (MFT / LMFT), Licensed Professional Clinical Counselor (LPCC) or something similar. A psychiatrist and a psychologist can also be psychotherapists, but a therapist cannot be a doctor or call themselves a psychologist without the doctorate degree. Usually the psychologists who have a doctorate degree can teach at universities, however, my therapist has the MFT license without a doctorate and is teaching future therapists and educators at the local state university.

In addition to all of this doctor shopping, I have been putting a considerable amount of effort working with the claims department and my victim advocate at the Office of the District Attorney. There is a Victim Compensation Program that I am eligible for whether or not the crime actually occurred. (This has nothing to do with whether they believe my story – they do, and no one has been prosecuted.) My victim advocate tells me that it is my right, as a victim of a crime, to have access to this program. My first application to the program was denied because I’m only allowed a three-year grace period from the time the crime(s) occurred, or “that it can have reasonably been known that a crime took place.” It has been way over three years, but I am claiming that I was too suicidal and traumatized to have fully realized what had happened to me until 2014, when I made the first report to the District Attorney and filed the case. This gives me technically until 2017 to apply to the program. In order to file an appeal I have been giving authorization to past medical offices to provide my medical records to the District Attorney claims office. There is so much information, years of records, and inches thick of printed paper to go through. I still don’t know if this will work out and if I will be approved into the program. But if I am, it would really help. Had I known about this program a year ago, I might not have had to file for bankruptcy due to medical bills resulting from the crimes (suicidality). It makes me sad just thinking of that fact.

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