Seeing a Psychiatrist in Private Practice: What to Expect
What is a psychiatrist?
Psychiatrists are specialist medical doctors who assess, diagnose, and treat mental illness. They have completed medical school, followed by years working as a junior doctor in the public health system and then go on to undertake at least 5 years of specialist training in psychiatry. They can work in private practice once they attain their fellowship with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) by completing the specialist training course and passing the College’s fellowship examinations.
Choosing a Psychiatrist in Private Practice
Some psychiatrists are generalists that treat a broad spectrum of mental illness in adults, while others sub-specialise in specific patient populations such as children and adolescents or the elderly. Many psychiatrists have areas of interest where they focus their practice, such as on specific psychiatric disorders. While GPs usually make referrals to named psychiatrists, it is nevertheless important for the patient when choosing a psychiatrist to check with the practice that they treat the condition for which they are referred. Patients should also consider other factors when choosing a private psychiatrist, including whether gender and language are important, and the waiting time for the initial appointment. Patients do not necessarily need to attend the psychiatrist that the GP has referred them to.
The Initial Appointment
Prior to confirming the initial appointment, patients should check the fees charged by the psychiatrist and other terms, including the cancellation policy. Private psychiatry practices should be transparent about these fees and terms and usually ask patients to read and agree to the terms prior to the initial appointment.
Once the initial appointment is made, the psychiatrist may request that the patient provides documents ahead of or at the initial appointment. For example, patients referred for an ADHD assessment may be required to provide school reports and testimony from family members as per best practice guidelines set out by government health authorities.
The initial appointment is usually long, often 1-hour, as the psychiatrist needs to take a comprehensive psychiatric and medical history, even if the patient already has an existing diagnosis. The psychiatrist will also conduct a physical examination. This occurs to ensure that the presenting complaint is not due to a physical illness and to ensure that the treatment provided minimises the risk to the patient (for example, certain medications should not be taken if the patient has an underlying heart condition). The psychiatrist will usually refer the patient for blood tests as part of the process. Increasingly, psychiatrists also refer patients for genetic testing which can identify the optimal medication with the lowest risk of side effects.
During the initial assessment, the psychiatrist asks the patient a large number of detailed questions about their personal and family history. Some patients may find these questions deeply personal and confronting, though this is an essential part of diagnosis and treatment formulation. It is very common that follow-up sessions are required to complete the history. The psychiatrist will only formulate a diagnosis and treatment plan once the full history is taken, the physical exam complete, and the pathology results received. This usually takes several appointments. At this point, the psychiatrist will send a letter back to the patient’s referring doctor, summarising the history, physical exam, pathology results, diagnosis and management plan. Psychiatrists won’t usually prescribe any medication, if it is applicable for the patient, until a diagnosis is reached.
Patients should be aware that the diagnosis made by a psychiatrist may be different to that which they were expecting or even different to an existing diagnosis that they may have. In some cases, the psychiatrist may find that the patient’s symptoms and history do not meet the threshold for a diagnosable mental illness at all.
The Management Plan
If a mental illness is diagnosed by the psychiatrist, the findings and management plan will be discussed with the patient in an open and collaborative environment to ensure that the patient understands and wishes to participate in the recommended treatment. This often entails psychotherapy or medication and usually a combination of both. The psychiatrist will also usually recommend a range of lifestyle changes to maximise the efficacy of treatment. It is important to note that psychiatrists are extensively trained in providing psychotherapy, including psychodynamic psychotherapy and cognitive behaviour therapy (CBT), and usually provide this as part of a holistic management plan. By providing both ongoing, regular psychotherapy and medication to patients, psychiatrists can see the impact that medication is having and can adjust dosage or type of medication provided if necessary.
The patient’s relationship with their psychiatrist is often long-term and therefore it is critical that good rapport, trust, and respect is developed. Without this, the prospects of recovery and good outcomes are diminished. Psychiatric disorders are complex and can often take time to treat. While there is significant online noise about new treatments and remedies, these rarely have any reliable evidence base and, in some cases, are counterproductive. Patients interested in understanding such novel treatments should discuss this with their psychiatrist in an open and collaborative manner.