What do you think about this psychiatrist?

[Anonymous]

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.

[Anonymous]

Good. Ned's should be a LAST resort. Not a first line of treatment.

[Anonymous]

I'm shocked a psychiatrist would say the patient's case is severe enough to require supported housing but not severe enough to need meds. Though isn't Exposure Response Prevention usually the first line of treatment?

[Anonymous]

He was wrong to ask the mother for information about the patient against the patient's expressed request he not do so. He likely also realized that the patient was not telling the whole story and potentially med-seeking versus giving all info so the doc could put together the best plan.

It sounds like he thinks a change of environment might make a difference in the severity of symptoms and therefore that is a better first approach than meds. Once the patient is in a more stable environment then he might suggest therapy to address the OCD

[Anonymous]

All sounds bizarre.

[Anonymous]

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

[Anonymous]

Doc thinks patient needs to move out and get away from parents.

[Anonymous]

Anonymous wrote:Doc thinks patient needs to move out and get away from parents.

But the doc said she needed supported housing!

[Anonymous]

Anonymous wrote:He was wrong to ask the mother for information about the patient against the patient's expressed request he not do so. He likely also realized that the patient was not telling the whole story and potentially med-seeking versus giving all info so the doc could put together the best plan.

It sounds like he thinks a change of environment might make a difference in the severity of symptoms and therefore that is a better first approach than meds. Once the patient is in a more stable environment then he might suggest therapy to address the OCD

DCUM loves SSRIs. Am surprised to see someone post that a person wanting to try an SSRI for anxiety (OCD is a type of anxiety) is "med-seeking."

Agree with poster that ERP is the gold standard for OCD. Meds are often given initially to take the edge off the initial stages of ERP, which can be hard for OCD sufferers. But ERP can be done without as well--depends on person.

I'd definitely get another opinion from a second psychiatrist.

[Anonymous]

I don't believe the patient is drug seeking. SSRIs which are used to treat OCD are not the drugs typically abused unlike Xanax.

[Anonymous]

There are the rules, and there's intelligent diagnosis - none of which this psych did.

1. There are privacy rules, etc, but often it's critical to see what the family members are like, so frankly I don't fault him on that.

2. However you can't explore OCD without a quantitative evaluation. If the psych did not ask how long rituals took, how often the patient did them, or how many times, then this session was not about OCD at all. It's likely this psych had preconceived notions and wanted something else.

I would most definitely obtain a second opinion.
Good luck.

[Anonymous]

Oh and

3. good for him for not prescribing drugs on the first session. A good diagnosis takes time and meds should not be a first line of defense in such a situation.

[Anonymous]

Anonymous wrote:Oh and

3. good for him for not prescribing drugs on the first session. A good diagnosis takes time and meds should not be a first line of defense in such a situation.

YES, your point about #3 was the best thing to come of that appointment. They do need a second opinion but I am very happy to hear that the original physician did not prescribe anything (although that seems to be the issue about which OP is most indignant).

[Anonymous]

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....

[Anonymous]

Anonymous wrote:I don't believe the patient is drug seeking. SSRIs which are used to treat OCD are not the drugs typically abused unlike Xanax.

Perhaps OP left out a request the patient made for specific meds?

At any rate, unless it's life threatening I have no problem with the doctor delaying prescribing anything after one visit.