Made appointment with psychiatrist but session was with his PA....Need advice

[Anonymous]

Hello,

I have been struggling with depression and anxiety for a while and have A LOT of other things going on. I know they're all symptoms of the depression. I made my first appointment with a psychiatrist and had high hopes about talking to him about my problems and starting therapy. I was told to go in the office and some guy introduced himself and asked me what "brings you here today?". I asked him who he was and where the doctor was and he answered that he's the doctor's PA and that the doc was not there.
Can doctors do that? Is that even legal? Can a PA prescribe medications? I feel that this guy had no clue what was going on. He seemed overwhelmed by what I was saying and started sweating profusely at one point. He told me at the end that I DO have a lot of different issues going on. That is like a big joke.
He gave me three prescriptions: wellbutrin, adderall and some anti anxiety medication. Wouldn't it be wiser to start me on one medication (anti-depressant) and see if that helps me before giving me three different medications? Also, we was looking through this medication book before writing down the prescriptions...
I looked up wellbutrin and started it this morning.
I also would like recommendations for a good psychiatrist that takes BCBS. I really need someone who does good talking therapy.
TIA

[Anonymous]

What is a PA?

I've had much better luck with licensed clinical social workers than with P-docs (psychiatrists). I don't know what a PA is though. While a LCSW can't actually prescribe medicine, s/he can call in the recommendation to your primary care physician for prescription.

I wouldn't take "any" drugs until you get a second opinion, but that's just me.

[Anonymous]

PA is a physician's assistant....

[Anonymous]

I would find a different person and not start on any of those meds, personally. It's absolutely not appropriate that you made an appointment with the psychiatrist and saw only the PA, and if there's a way to file a complaint about that, I would.

That kind of stuff pisses me off. I made an appointment with a woman gyn and then at the last minute (literally, feet up in the stirrups) some man walks in and she tells me her PA is going to do the exam. I was too flustered (for other reasons relating to why I was there) to protest but I was ripped!

[Anonymous]

That's really strange. I'm shocked that a psychiatrist would have a PA handle the first visit.

[Anonymous]

I'd be totally irritated with the situation you encountered, would not even begin that medication and would find another psychiatrist.

My psychiatrist prescribed medication and recommended a talk therapist (LCSW) who really helped me tons. I've never seen a psychiatrist who actually did talk therapy and listened to my problems other than to determine what type of medication I need.

Dr. Shahzad Rahman is in Arlington, takes BCBS and has a ton of therapists in the practice-- of all differing education levels and expertise areas [phone].I think he also sees patients out of a Gaithersburg office, but not certain.
http://www.renascencecenter.com/contact.htm

You must shop around or get a recommendation to find a good psych and therapist.

[Anonymous]

Anonymous wrote:PA is a physician's assistant....

I know PAs are trained in physical health, but are they ever trained in mental health? Why would a p-doc have a PA on staff? Just seems weird to me.

[Anonymous]

That is shocking and unprofessional. I would run the other way.

[Anonymous]

Sorry to hear you had that experience, OP, I agree that having the PA sub in wasn't professional, fair, or considerate. My husband had experience with this, when thinking he was going to see a specialist. Each time he has an appointment supposedly with the "Dr.", it turns out he is seen by the PA. At least in his case, luckily the PA had some welcome and valuable attributes (listened well, was open-minded to the patient's perspective, and could prescribe).

[Anonymous]

I am a physician (not in psychiatry). There are many valuable roles for PA's in medicine, particularly in the ER, assisting surgeons, and seeing patients in busy primary care settings for routine general medical needs (cough, blood pressure etc). However, I have never heard of psychiatrists using PA's. The fact that you weren't told this in advance is unacceptable. You should tell them not to charge you or that you will complain to your insurance company. As somebody who takes her professional responsibilities very seriously, I am disgusted that this happened. Do not take those medications without seeing a trained psychiatrist. It doesn't matter how good a PA is, this is a matter for a trained psychiatrist.

[Anonymous]

Anonymous wrote:

Anonymous wrote:PA is a physician's assistant....

I know PAs are trained in physical health, but are they ever trained in mental health? Why would a p-doc have a PA on staff? Just seems weird to me.

My psychiatrist uses a PA, and there is definitely an appropriate use for one in his practice. I'm on medication that is a controlled substance (a stimulant, for my ADD), and it has to be written on a prescription pad per federal law and refills are prohibited. Thus I must go in monthly to get the prescription order. PAs can write prescriptions. I go in, the PA asks about side effects, checks my weight and blood pressure to insure there are no adverse effects, and writes the prescription. The psychiatrist, though, did the initial intake, determined the course of treatment, and saw me for the first three or four follow-ups. No need to take his time with monthly visits three years later. (I do see him every four months or so.) I also see a social worker in his practice for talk therapy.

So yes, a PA is appropriate in a shrink's office, but certainly not for the first few visits. Could be that the doctor had an emergency and the PA was just filling in so as not to have to cancel. Also sounds like this particular PA may not be that experienced yet.

[Anonymous]

I'm a little shocked, too. Welbutrin tweaks your Norepinephrine, Adderall goes for the Dopamine, and then the anti anxiety will be to bring you down from all that? That is a heavy bit of stuff to jump into all at once with what could be comorbid conditions. Second opinion and a call to the insurance sound like what I would do.

[Anonymous]

Anonymous wrote:I am a physician (not in psychiatry). There are many valuable roles for PA's in medicine, particularly in the ER, assisting surgeons, and seeing patients in busy primary care settings for routine general medical needs (cough, blood pressure etc). However, I have never heard of psychiatrists using PA's. The fact that you weren't told this in advance is unacceptable. You should tell them not to charge you or that you will complain to your insurance company. As somebody who takes her professional responsibilities very seriously, I am disgusted that this happened. Do not take those medications without seeing a trained psychiatrist. It doesn't matter how good a PA is, this is a matter for a trained psychiatrist.

I completely agree. I'm a physician as well and this is just bad medicine. I work with nurse practitioners and in the District they cannot evaluate a new patient. They can only see patients who have established care with their supervising physician (unless they are working independently). I'll be honest, I don't know the laws in DC/VA/MD regarding PAs but I doubt it's much different.