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Old 03-08-18, 03:50 PM
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What has been your typical experience with a Psychiatrist for an ADHD follow-up visit

I used to visit an NP (a different provider than my PCP) for ADHD medications. After some time, she moved on. I used to visit the NP about twice a year. When I went to a visit previously scheduled with her, another doctor filled in for the vacated spot. After meeting with him, I was scheduled to visit with him about six months later.

During the second visit, he identified himself as a psychiatrist. He only asked two questions regarding the medication. The remaining time was filled with what I'll call "customer service filler". Questions regarding my occupation and the name of my employer, how long I have lived in town, etc… I replied as I would anyone else (dentist, optometrist). I assume since they charge by the minute, these were probably stock questions to fill time. The appointments are scheduled for 15 minutes.

Of course since I wasn’t prepared to meet with a psychiatrist, I was taken back by the style of the visit. I found it odd for him to wonder off topic so often. A question that really threw me was, "tell me about yourself". I'm thinking what? What are you looking for? I never had a doctor ask me that before. Anyway I figured it out. It was "to get to know me" – aka time filer. Everything is already in my file (relationship status, family medical history, test results, employer, etc…) it is all under one clinic roof, but they seem to do their best to separate mental health from the rest of the clinic.

Clearly I am not used to these type of visits. I understand most individuals have some kind of lengthy pre-appointment/evaluation/intake meeting with a psychiatrist/nurse. I was surprised with the switch and being assigned a psychiatrist. Since I was already "in the system" this type of appointment was skipped.

I am interested in what a typical experience you have with a psychiatrist for an ADHD follow-up appointment if you care to share. Exclude the initial meeting (since it’s a onetime thing) and other afflictions/reasons to visit other than ADHD (omitting things like mood, anxiety, etc…). Do you stay on topic of the medication, are your appointments "quick" or "long", or anything else you can offer.

Someone shared with me that some people during a visit will bring up random topics not related to anything. I asked about what kind of topics and they replied "anything". I told them I don't get it, I don’t know why someone would pay to talk about nothing relevant. During a physical, I got charged an extra fee because I mentioned I had an amnesiac memory experience during a work trip once. All I did was answer his question if I had anything bothering me. Since it wasn’t considered part of the preventive adult maintenance, it wasn’t covered. No co-pay – $200 out of pocket.

My next appointment is in the beginning of May and my last appointment was at the end of January with this current provider. I know everyone is different and I appreciate all the information shared. I can honestly say I have benefited from the information shared and discussed. What may seem obvious to some people, is certainly not obvious to others.
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Old 03-08-18, 04:26 PM
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Re: What has been your typical experience with a Psychiatrist for an ADHD follow-up v

I’ve never seen a psychiatrist for my ADHD treatment because my GP/PCP has a specialty in ADHD, and any and all treatment has been through him.


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Old 03-08-18, 05:47 PM
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Re: What has been your typical experience with a Psychiatrist for an ADHD follow-up v

I'm very happy with my new psychiatrist. I found him myself after being disappointed in a adhd centre, where they spend hours asking questions from behind their screen, barely looking at me and drawing conclusions from computer results and bias from some information i gave them. The man i'm seeing now, doesn't even have a computer on his desk, and really has a conversation with me. Very to the point also, i don't know how he does it but he asks the right questions and gets more information from me within 30 minutes than the hours of questionnaires i had before. He is very openminded and treads me like a normal person, and that differs a lot from the adhd centre. Today i had my first follow up visit with him, it was about the medication, but he also asked me about what's going on and some things i told him on the first visit, and encouraged me in executing some of my plans. It took about 30 minutes and it didn't feel like he was clocking it. In the end he patiently took my blood pressure when i asked him to and wrote a new prescription. I think that a doctor with a private practise is more personal, less protocol and system limitations?

Maybe i don't understand your point, but what comes in mind is: have you been open for the person who wants to get to know you? How can you be sure it's a time filler? Also i don't understand that if someone tells you he talks about anything with his psychiatrist, that it's not relevant? It can be a two way street, you get what you put into it, as sadly not every psych is equally skilled in making things relevant. In my experience so far, some work more from theories they've learned, and some more on 'the human level', in the now. The latter is far more attractive to me. If you're not happy with your psychiatrist, i'd recommend you to find some one with a private practise; in my country that's covered by insurance as well, but i didn't know it was possible because via the GP i was send to a centre at first.
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Old 03-08-18, 07:59 PM
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Re: What has been your typical experience with a Psychiatrist for an ADHD follow-up v

I have no problem being open and honest with a provider. Regardless if it’s the PCP, Dentist, Optometrist, or whomever. I would rather be honest and make an error, than to try to lie and conceal a problem (Do I floss? – asked the Dentist).

I am not used to meeting with a psychiatrist. The question is about context. Depending on who is asking, cues why they are asking. Then one can answer appropriately. A potential employer would receive a different reply than a neighbor just moving in next door from the exact same question, "tell me about yourself". I didn’t understand at first because I didn’t understand the context. Anything this provider required to know was already in the file compiled from the PCP, NP, Neuropsychologist, medical history, family history, medical tests, etc… Since appointments are charged per minute, up to 15 minutes, I interpreted it as, it is in their interest to maximize the full 15 minutes. He wasn't asking for new information that wasn't already available in front of him.

The person who mentioned the "anything" comment conveyed to me this was in addition to the appointment. Not directed at the reason for the visit. Therefore after I was charged an additional fee for something I thought was part of an appointment, I didn’t understand why someone would pay for something they know is not part of the appointment. If one spent 5 minutes chatting about how they need to the change dog food brand because of a coupon, it can cost an easy $60! – If I hire a plumber to fix my sink, I wouldn't pay him extra just to chat about the weather. This is different than chatting for a purpose. The service offered from a psychiatrist at my clinic is prescribing medication. Maybe they get chatty with some people, I don't know. Providers to chat with are separate providers at my clinic.

With all that said, perhaps I may have a different view next time. I will better understand the context. I wasn’t prepared to meet with a psychiatrist. I was used to a different style of appointment. I am glad you found a good partnership. I am keeping my options open.
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Old 03-08-18, 09:05 PM
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Re: What has been your typical experience with a Psychiatrist for an ADHD follow-up v

Medication management sessions are typically short.

Fifteen minutes to 30 minutes depending on the practitioner.

She asks how I've been.

I update her ... trying to remember what problems I've had and successes I have ... whether I am feeling like I need more help from my medications or whether I'm OK.

She knows I'm at work on a major creative project. She asks me about that and how that is going ...

We then get to what I'm taking and specifically whether to stay on same dose or make adjustments ...

It takes a lot of time just for the provider to to confirm what I'm taking, write out new scripts (she writes monthly post-dated scripts as "refills" aren't allowed in my state) ...

The general rule ... Unless you are paying out of network for an expensive psychiatrist, medication management sessions (that's the term for psychiatrist visits that don't involve "talk" therapy) will last 10 to 15 minutes. These meetings are incredibly short. I go to a psychiatric nurse practitioner who gives me a bit more time ... and the private out-of-insurance guy I used to go to would give me more time.

As far bringing up "anything," ... yes .... I might have met a woman I'm dating ... or broken up with a woman ... or hit a snag at my job ... When my parents died, I would share that ... Sleep problems ... stresses ... work issues ... whatever you want to share ... The more the better ... because basically there is no "irrelevant" information ...

Doesn't mean they will react to everything ... But sometimes stuff is relevant ... When my mom was ill and dying, my psychiatrist didn't want to lower my medication, something we had talked about ... he knew I would be stressed.

Sometimes we discuss my caffeine intake ... (affects sleep) ... all kinds of information can come up ...I might notice I haven't been sleeping as well and notice that I slept well when I didn't drink coffee in the afternoon ... Our bodies keep changing, so we have to keep adjusting ...

Just show up. Nothing to freak out about ... Nothing to hide ... That's the cool thing, you really don't wanna hide anything from these folks is the way I see it. They're they're to help ... and it takes a while to learn that pretty much everything in your life affects your concentration and mood ... so that's why so many topics can come up.

Tone
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Old 03-08-18, 09:20 PM
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Re: What has been your typical experience with a Psychiatrist for an ADHD follow-up v

Excellent description Tone. Thanks! Definitely different type of appointment than I’m used to and you detailed it nicely.
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Old 03-09-18, 05:20 AM
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Re: What has been your typical experience with a Psychiatrist for an ADHD follow-up v

Hope you dont mind but I copied and pastes this from my response in your other thread:
Quote:
Assuming this psyche doctor of yours is not a total jerk in general evals are usually an hour or so long. They involve a thorough history of childhood and beyond as far as how long you have had issues with examples to back them up. (its a good idea to write this down beforehand). The doctor will want to know what your impairments are now and what you do to mitigate them. Records from the doc you were getting meds from will be super helpful as well as anything you may have floating around from school (not a must just helpful). There are no tests for adhd. You can google "conner's scale for adhd" which is something they sometimes use for screening purposes for you and loved ones that live with you.
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Old 04-19-18, 04:05 PM
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Re: What has been your typical experience with a Psychiatrist for an ADHD follow-up v

So I have my appointment with a p-doc coming up in a few weeks and this topic came to mind.
I considered myself pretty open and honest when I meet with someone. A cashier, dentist, optometrist, barista, refill nurse or whomever. Although I didn’t think of sharing as much as it seems others have shared with a p-doc.

1)How often did the P-doc ask you to come in before you started to "open up"? Did they tell you to share more or how did you find out what to share?

2)Do you feel that the p-doc offers just as good shared-medical-decision-making as your regular doctor?

I am giving the p-doc a chance and see how it plays out. Otherwise I have to change my family's entire medical care to a new facility, which could prove to be a worse outcome for everyone instead of me just staying.

I was trying to explain to a friend of mine how these appointments feel to me (through my eyes), to someone who has never experienced it.

It is like getting the mail. Typically you get the mail on a "regular" basis from the mail box. On occasion the mail person would come to the door. Now a new mailperson wants to come to the door more often on their schedule for a "short" 15 minutes to discuss how the mail is going. Should the mail carrier need to reschedule, it is discouraged to use a substitute mail carrier for the already scheduled time slot. However, if you need to reschedule with them, the mail could cease to arrive.
When the mail carrier arrives, the topic of mail is not brought up. I assume if you need to change something regarding the mail you just tell the mail carrier. Changes to the mail service are only permitted at the time when the mail carrier visits you. These rules are subject to change at the mail person's discretion without warning.
After some visits from the mail carrier, due to social convention, it is expected to offer some bit of personal information that may or may not be applicable to the mail with this random stranger that comes to your door at their leisure for a "short" 15 minutes.
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Old 04-19-18, 05:01 PM
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Re: What has been your typical experience with a Psychiatrist for an ADHD follow-up v

i've seen a lot of psychiatrists. some are more brief, and some are more lengthy. i can't really answer your question about an adhd follow up, because i was diagnosed as a child and so that's just automatically in my chart. plus i have co existing conditions that take precedence when it comes to what my psychiatrist and i discuss.

that said, you seemed perplexed about being asked non medical questions (tell me about yourself, for example). what "tell me about yourself" means to me is "tell me what's bothering you". there's also the "getting to know you" part which i think psychiatrists use to see what symptoms they observe while you're talking. do you jump from thing to thing? are you able to speak coherently? do you talk about delusional **** (my case, not yours)? and so forth.

with medication questions most are concerned with 1. are you taking it; 2. are you having any side effects; 3. do you think it's alleviating symptoms? which ones is it and isn't it helping?

i've never had a fifteen minute appointment before, though, so that's...kinda short for me.

hope that helps!
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Old 04-19-18, 07:24 PM
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Re: What has been your typical experience with a Psychiatrist for an ADHD follow-up v

I'm sure there are veterans here who have had different P-docs act differently.

I'm used to going in to see someone if I have a reason/complaint. I mean, go into a Dentist for a cleaning, go to urgent care because you twist an ankle, etc.. those type of things.

This is more like they ask me to come in and you spend your time trying to figure out why, what they are looking for, how I can respond so it is applicable to my situation. It took some time, but another person I saw was more like a refill nurse and I saw her twice a year. It just takes time to figure it out.
I more or less just met this person and I am trying to get used to him. I am used to responding to questions, not offering information out of the blue which someone mentioned before. I did not realize this before. That is why I asked how often did the P-doc ask you to come in before you started to "open up"? and How did you find out what to share? I just come in when they ask. I feel like I have to catch up. It took almost two years to discover ADHD is a mental health issue. You would think someone would have mentioned that right? Thank goodness for the interweb.

I was only asked once (between two people in almost two years) the question "tell me about yourself". Which prompted me to ask him the next time to introduce himself. I thought that was fair. How can you just plop down and "open up" to someone you don’t know or what they do. That’s a reason to ask here and find out. Especially from the veterans. What may seem obvious to some people, is certainly not obvious to others.
If you have never met a p-doc before and didn’t know they were a p-doc, how would you know how to respond? So far I know who he is now and that I am supposed to share more than usual (thanks to this post). But how did anyone else know?

And I did have a second question before: Do you feel that the p-doc offers just as good shared-medical-decision-making as your regular doctor?
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Old 04-24-18, 08:57 PM
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Re: What has been your typical experience with a Psychiatrist for an ADHD follow-up v

The auto-mechanic might greet us and say, "How you doing today?" ... He doesn't mean that literally. He is simply saying hi and waiting for us to tell him what problems or issues we want him to address with our car. "How you doing today?" is simply his way of saying, "Hello, how can I help you."

And we get right to the point of why we're bringing our car. And if private info is relevant, we disclose it ... Look, I have a budget of X amount of money right now.

Same with when I visit my psychiatric nurse practitioner (or my therapist) ...

My np is basically like the auto-mechanic ... She wants me to reveal the key information in her area of specialty (my mental health) ... so that she can figure out how to advise and treat me. She isn't my friend or trying to be my friend ... and any barrier I put up to disclosing--and I speak from experience here--is a waste of her time and my time. In order to treat me and make recommendations and write prescriptions, she wants an update on my depression, on my mood ... on my ADHD ... on my concentration and focus ... on any sleep issues ... how I'm doing at work ... and so on.

What's a little odd (until you get used to it), is that you can skip the small talk with a mental health professional ... and get to the issues we are concerned about ... But that's true for every health visit. I went to the dentist today. He said hello ... I said hello. Pause for about 1 second ... Then I explained why I was there ...

Same thing if we visit a dermatologist or cardiac doctor ... or whatever. You disclose IMMEDIATELY why you're there, what you want, what you're unhappy about, what questions you have, whatever.

These are not social visits ... and what was confusing to me for a long time ... is I sorta thought they were social visits ... until a therapist once gave me hell for not disclosing some important info to a doctor ... She explained that I'm not there to please the doctor ... or be liked by the doctor ... in fact, I was misinterpreting the whole encounter. Visiting my doctor is basically like visiting the auto-mechanic.

Or think google search ... the search is only as good as the search words you enter, right? ... Well health providers need specific and detailed description of our symptoms in order to find in their knowledge and experience ... a good form of treatment for us.

Sure there can be small talk around the edges ... But therapists and doctors are people (lawyers too btw) ... you disclose to ... immediately. Took me some time to get to this, but now it's the most normal thing in the world to get to the point right away.

The clock is ticking when we visit any health specialist or any lawyer ... or accountant or whoever ... The goal is to tell our provider the the key information they need in order for them to use their knowledge and experience to think about how best to help us.
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Old 04-26-18, 11:42 PM
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Re: What has been your typical experience with a Psychiatrist for an ADHD follow-up v

To answer the OP, when I was seeing a psychiatrist for medication management, our appointments were usually very brief and he mostly wanted to find out how well the medication (IR Ritalin) was working in reducing the symptoms of my ADHD and whether there were any side effects. It's been a while, so I don't remember it clearly, but I don't remember there being much small talk of any sort. We usually got right down to business.

I'm now getting my ADHD med (Vyvanse) through my primary care physician (PCP) and my discussion with him when we get to the ADHD is not much different than what it was with the psychiatrist (although my PCP is much more knowledgeable about ADHD than what the psychiatrist was). He usually wants to know about my ADHD symptoms at the dose I'm on and whether they've improved, whether there are any side effects and sometimes he suggests that I might want to raise the dose.

Quote:
Originally Posted by ToneTone View Post
The auto-mechanic might greet us and say, "How you doing today?" ... He doesn't mean that literally. He is simply saying hi and waiting for us to tell him what problems or issues we want him to address with our car. "How you doing today?" is simply his way of saying, "Hello, how can I help you."

And we get right to the point of why we're bringing our car. And if private info is relevant, we disclose it ... Look, I have a budget of X amount of money right now.

Same with when I visit my psychiatric nurse practitioner (or my therapist) ...

My np is basically like the auto-mechanic ... She wants me to reveal the key information in her area of specialty (my mental health) ... so that she can figure out how to advise and treat me.....

These are not social visits ... and what was confusing to me for a long time ... is I sorta thought they were social visits ... until a therapist once gave me hell for not disclosing some important info to a doctor ... She explained that I'm not there to please the doctor ... or be liked by the doctor ... in fact, I was misinterpreting the whole encounter. Visiting my doctor is basically like visiting the auto-mechanic.
I mostly agree with what you're saying in that it's important to get right to the point with your doctor and tell him or her what's going on and whether there are any issues that need to be addressed. It's even more true now because doctors usually have much less time to spend with each patient than they used to.

Nevertheless, at least for me, the relationship I have with most of my doctors are much more important to me than my relationships with my auto-mechanic or even my dentist. This is especially true of my relationship with my primary care physician who provides most of my medical care and is also the one who is treating my ADHD. It's very important for me to like my doctors and trust that they know what they're doing and to feel that they are listening to my concerns and taking them seriously or I'm unlikely to be as forthcoming when I talk to them or as willing to trust their judgement as I would be otherwise.

I've always seen my relationships with my doctors as being a kind of partnership where it's important for my doctor and I to reach mutual decisions about my healthcare, not my doctor just telling me what to do.

And although I haven't always gotten it, I sometimes want more than just a clinical discussion of my medical condition or my lab results from my doctor. Sometimes I need a little empathy!
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Old 05-06-18, 04:48 AM
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Re: What has been your typical experience with a Psychiatrist for an ADHD follow-up v

My experience has also been that I see my p-doc every month when trying to get stable on new meds.. that could be as little as a month or as many as three months of seeing her once a month for med changes but once a med is working and no changes are needed I see her every three months.
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