Psychiatry Appointments: What to Expect and How to Make the Most of It

By Cheryl Rohlik, RN, PMHNP

Consider the following scenarios:

1. Situation: You’ve been seeing your regular doctor for depression. You’ve tried a few medications, and none have really helped you feel better. At your next visit, your doctor tells you, “It’s time to refer you to a psychiatrist.”
2. Situation: Your child has been having stomach pains, and the GI specialist tells you, “All of your child’s tests are normal. We need to refer you to a psychiatrist to see if there’s something else that could be causing these problems.”
3. Situation: Your regular medical doctor tells you, “I know you’re stable on your medication, but I can no longer write prescriptions for your ____________ (ADHD, Anxiety, Sleep, etc.) medication anymore. I need to refer you to a psychiatrist if you want to continue taking this medication.”
4. Situation: You think to yourself, “I am not getting anywhere with the psychiatric provider I have now. I need to switch to another practice.”

Depending on the scenarios above, different questions could be running through your head:

• “Am I crazy?”
• “Am I a hopeless case?”
• “What’s wrong with me?”
• “What if I still don’t get better?”
• “What’s wrong with my child?”
• “Is my child holding something back from me?”
• “Did something bad happen?”
• “What if this isn’t the solution? What then?”
• “I’m doing really good with what I’m already taking. What if they take it away from me?”
• “What if they want me to try a different medication?”
• “Can they force me to take medications?”
• “What if they don’t listen to me?”

These are all fears many people commonly experience when learning they (or a family member/loved one) need to see a psychiatrist for the first time or even for an established psychiatric patient who decides to switch to a different practice.

Change can be scary. Fear of the unknown can be unsettling. In reality, being referred for psychiatry services isn’t as scary as it might seem. When another doctor refers a patient to see a psychiatrist, it is the same motivation behind any other doctor-to-doctor referral: it’s the belief that someone in another specialty has the expertise in that area to better evaluate and treat the patient. This is actually a good thing: the psychiatric provider will ask more pertinent questions regarding the symptoms the patient is experiencing, which oftentimes will allow the patient to experience relief sooner, and at least minimize or resolve their symptoms.

The psychiatrist will discuss medication management. It is ideal if the referral happens before several medications are tried; sometimes, medications already tried may have been good choices, but they may not have worked at the time because:

• The dose wasn’t tweaked enough to treat the symptoms
• It may have been part of the solution, but something else was going on that wasn’t being addressed or treated, so the medication was stopped
• The right type of medication was selected, but the patient would have benefited more from a different medication in the same classification

Once you’ve made your appointment, the psychiatric practice will send you paperwork and consents to fill out prior to the appointment. These will include a demographic form (name, address, insurance, etc.), consent forms, credit card authorization forms, and questionnaires. Some individuals may make a psychiatric appointment just to obtain an opinion about their symptoms and may prefer to take some time after the appointment to make a decision about taking medications. Or, they’re not sure about taking medications at all and just want to find out if medications are even an appropriate option for them. That’s okay!

By making an appointment, all you’re requesting is a professional opinion, not to automatically be given a prescription. You are in control. When completing the forms, it is crucial to fill out all the documents as completely as possible and be as detailed as possible. For most practices, if the forms are not filled out before the appointment, your appointment may need to be rescheduled, as certain forms and consents are legally required to be in your file before the appointment starts. Also, if the forms aren’t completed, the gathering of information will take longer, and scheduling an additional appointment may be necessary in order to complete the interview and go over the recommended treatment plan. Since the first appointment involves obtaining a thorough history, it is typically a little longer than the appointments you have after that (follow-up appointments).

When the day and time of your appointment arrive, your psychiatric provider will review the information you provided, and additional questions will be asked. Your provider will likely ask some of the same questions you already answered in your forms because additional clarification is needed or is just double-checking to ensure everything is correct. Once your history is obtained, medications are reviewed, and the interview is completed, your prescriptions will be sent to the pharmacy, and a follow-up appointment will be made. How far ahead your follow-up appointment will be scheduled depends on:

• Whether medication changes were made
• What symptoms you are experiencing at the time of the appointment, and the degree of how much these symptoms are currently impacting your life, relationships, and functioning
• How stable you’re feeling on your current regimen
• Office policy regarding the length of time recommended in between appointments

After that, the provider will answer any remaining questions you may have. If any side effects or problems with the medication are experienced, or if you start to feel worse, call the office and leave a message for the provider you interviewed with. They will answer whatever questions and address any problems you have. If a resolution cannot be achieved with a brief phone call/message, a sooner appointment is generally recommended in order to avoid further setbacks in your symptoms. For follow-up appointments, you will be asked:

• How the medication changes are doing (if any were made)
• If you’re experiencing any side effects/troublesome issues
• Effectiveness of the medication regimen since the last time you spoke with your provider

You will want to keep track of:

• Any ongoing, recurrent, or unresolved symptoms, when they occurred, how long they lasted, how severe they were
• Any new symptoms
• Side effects
• Job/school performance
• Sleep
• Appetite
• Overall functioning
• Any stressors which may be affecting your symptoms
• Significant life changes coming up: marriage, divorce, job changes, family events, graduation, children, vacations (to name a few)

The patient-provider relationship is a partnership; the more information you can give to your provider, the better your chances of receiving quicker, more effective treatment. Whether this is your first time seeing a psychiatric provider or you need to switch providers, we will do everything in our power to make the process as smooth as possible. Call 940.360.4245 today to make an appointment, and please let us know how we can help you.