What do you think about this psychiatrist?

[Anonymous]

OP, if you are the patient, I don't think this is the therapist for you. Please try another therapist.

There has to be a therapeutic alliance between a therapist and a patient for therapy to be successful. Regardless of whether a therapist is willing to prescribe upon request, this therapist did not win your trust or even seem to try to. Please find another therapist.

[Anonymous]

This story is hard to believe as told.

[Anonymous]

If the OCD is severe then meds should not be a last resort. My mother was diagnosed with OCD and the doctors told her to take meds, but she refused. She ended up losing jobs and friends. Despite this it took years for her to accept she needed medication. Medication has helped her maintain a job and a social life, therapy alone hasn't.

Also, there is nothing wrong with a doctor prescribing meds at the first appointment. Every time I went to a psychiatrist I always walked out with a prescription, and was never dismissed as drug seeking. Though I don't know about OP. I suggest getting a second opinion.

[Anonymous]

I would think the thought the 21 year old was a spoiled little A-hole who needs to get on with life. He will probably have an earful for the mother as to how the family enabled this.

[Anonymous]

Anonymous wrote:Patient is 21 years old tells the psychiatrist she has OCD. She explains symptoms "such as walking back and forth, repeating certain phrases, counting steps," etc. Patient said her OCD is becoming unmanageable and she needs medication. Doc asks checklist questions about OCD which you can only answer "yes" or "no" to such as "do you wash hands" "do you arrange objects" "do you have religious obsessions"? Doc asks a bunch of questions about the patient's history. Then he asks to speak to the patient's mother, who is in the waiting room. Patient says no but doc says he needs to ask a few questions. Doc asks questions about history such as marriage, pregnancy, young child, etc. Then mom starts complaining about patient sleeping all day, how her husband started yelling everywhere for something patient did last night, etc. Patient tells mom to be quiet but doc insists she let her mom speak. Doc says patient has no regime and thought a residential facility would help with establishing a regime. He thought the patient was too smart for a residential facility and suggested a supported apartment. He asks the patient about her career plans who she wants to become. He said to call a family service organization that offers a supported apartment and employment training. In the end patient asked doc why he didn't prescribe meds. Doc thought patient didn't need meds. Patient asks what is he going to do about the OCD and he answers with the dismissive gesture that he will treat the OCD.

Are you in a European country?

[Anonymous]

Anonymous wrote:I would think the thought the 21 year old was a spoiled little A-hole who needs to get on with life. He will probably have an earful for the mother as to how the family enabled this.

What made you come to that conclusion?

[Anonymous]

Psych sounds like a jerk. I would seek a new psych, but good ones are very hard to find.

[Anonymous]

Patient is an adult and therefore doctor is bound by confidentiality. I suspect that speaking to patient's mom was intended to gather collateral data and a family medical/psych history, but given that patient is an adult, that information should have been requested from patient, or patient should have been asked to consent to mom being consulted.

Aside from that issue, doctor is assessing patient's current functioning and identifying barriers to treatment as well as support systems currently in place. As a mental health worker (but not a psychiatrist), I would not be willing to make a diagnosis and recommend medication in the first appointment absent a history of medication treatment. If a patient came to me and said that they needed medication to help manage what they believe is OCD and had taken medication for that in the past, I might be inclined to recommend a short-term course of something, but without a more qualitative interview about symptoms and an actual diagnosis, I would not be willing to recommend medication without further consultation.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Isn't it illegal or a violation of HIPAA to talk to the mother?!

Depends on what the patient signed.

Also, if this was the interview to determine whether the psychiatrist would accept her as a patient....

Wrong on both accounts. The doctor cannot discuss the patient with the mother against the express wishes of the patient because there is no reasonable basis to infer that the patient does not object. The patient is a patient for HIPAA purposes regardless of whether the psychiatrist was going to continue seeing her as a patient. That's just HIPAA. Most states have heightened confidentiality laws for mental health PII.

[Anonymous]

HIPAA only applies if the doctor is giving information to the mother, not getting information from the mother.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I would think the thought the 21 year old was a spoiled little A-hole who needs to get on with life. He will probably have an earful for the mother as to how the family enabled this.

What made you come to that conclusion?

Yes. NP here. I’ve also seen a psych in the past.

I’ll bet you anything the doc thought that the mother/family/household was much of the problem. That’s why he’s trying to get patient away from family.

[Anonymous]

Anonymous wrote:I would think the thought the 21 year old was a spoiled little A-hole who needs to get on with life. He will probably have an earful for the mother as to how the family enabled this.

+1. OP, he invited you in not only to get intel on the patient, but to size you up.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I would think the thought the 21 year old was a spoiled little A-hole who needs to get on with life. He will probably have an earful for the mother as to how the family enabled this.

What made you come to that conclusion?

Yes. NP here. I’ve also seen a psych in the past.

I’ll bet you anything the doc thought that the mother/family/household was much of the problem. That’s why he’s trying to get patient away from family.

I also see a psychiatrist. Suggesting she live in a facility is ridiculous. OCD can be treated with SSRIs and therapy on an outpatient basis. If that fails they do ECT and if that fails they do psychosurgery as a last resort. OCD is a very disabling condition. In fact, the WHO lists the most disabling mental illnesses which are schzophrenia, dementia. depression, OCD, bipolar and alcohol disorders. OCD actually comes before bipolar and alcohol disorders. It's total hell. Also my psychiatrist prescribed meds at the first appointment and told me to do psychotherapy in addition. I take Prozac and saved my life. I have ADHD and OCD and DH doesn't care if I miss my ADHD meds but freaks if I forget my OCD meds. It also sounds from OP that the patient is not functioning (sleeping all day, not working or going to school). If that's the case and the psychiatrist is not prescribing meds, it's time to look for a different psychiatrist. A residential facility is not the answer. My response is based on the details OP gave. I know OP could be leaving out details.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I would think the thought the 21 year old was a spoiled little A-hole who needs to get on with life. He will probably have an earful for the mother as to how the family enabled this.

What made you come to that conclusion?

Yes. NP here. I’ve also seen a psych in the past.

I’ll bet you anything the doc thought that the mother/family/household was much of the problem. That’s why he’s trying to get patient away from family.

I also see a psychiatrist. Suggesting she live in a facility is ridiculous. OCD can be treated with SSRIs and therapy on an outpatient basis. If that fails they do ECT and if that fails they do psychosurgery as a last resort. OCD is a very disabling condition. In fact, the WHO lists the most disabling mental illnesses which are schzophrenia, dementia. depression, OCD, bipolar and alcohol disorders. OCD actually comes before bipolar and alcohol disorders. It's total hell. Also my psychiatrist prescribed meds at the first appointment and told me to do psychotherapy in addition. I take Prozac and saved my life. I have ADHD and OCD and DH doesn't care if I miss my ADHD meds but freaks if I forget my OCD meds. It also sounds from OP that the patient is not functioning (sleeping all day, not working or going to school). If that's the case and the psychiatrist is not prescribing meds, it's time to look for a different psychiatrist. A residential facility is not the answer. My response is based on the details OP gave. I know OP could be leaving out details.

I’ve never heard of ECT for OCD.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I would think the thought the 21 year old was a spoiled little A-hole who needs to get on with life. He will probably have an earful for the mother as to how the family enabled this.

What made you come to that conclusion?

Yes. NP here. I’ve also seen a psych in the past.

I’ll bet you anything the doc thought that the mother/family/household was much of the problem. That’s why he’s trying to get patient away from family.

I also see a psychiatrist. Suggesting she live in a facility is ridiculous. OCD can be treated with SSRIs and therapy on an outpatient basis. If that fails they do ECT and if that fails they do psychosurgery as a last resort. OCD is a very disabling condition. In fact, the WHO lists the most disabling mental illnesses which are schzophrenia, dementia. depression, OCD, bipolar and alcohol disorders. OCD actually comes before bipolar and alcohol disorders. It's total hell. Also my psychiatrist prescribed meds at the first appointment and told me to do psychotherapy in addition. I take Prozac and saved my life. I have ADHD and OCD and DH doesn't care if I miss my ADHD meds but freaks if I forget my OCD meds. It also sounds from OP that the patient is not functioning (sleeping all day, not working or going to school). If that's the case and the psychiatrist is not prescribing meds, it's time to look for a different psychiatrist. A residential facility is not the answer. My response is based on the details OP gave. I know OP could be leaving out details.

I’ve never heard of ECT for OCD.

But this is the treatment if both therapy and medication fail.