Concerns

Why go to a psychiatrist in the first place?

Psychiatrists are medical doctors who are trained in both therapy and medication. If you go to your primary care physician, you may receive a basic psychiatric medication, even if what you need is therapy. If you go to a therapist, you may receive therapy, even if what you need is medication. Dr. Crane has expertise in both; so can offer treatment specific to your needs. You don't need to have a diagnosis to see a psychiatrist. People can benefit from the supportive care of a psychiatrist when experiencing stress, a change in career or schools, life transitions, relationship difficulties, learning difficulties, anxiety, and even positive life changes.

 

All I need is a prescription, so why not get it from my primary care physician?

Many people do receive psychiatric medications from their primary care physicians. If you are stable and doing well on a medication, having your primary care physician prescribe it may be a convenient option. However, Dr. Crane believes this to be a potential avenue of over-prescribing, because primary care physicians currently write approximately 80% of antidepressant prescriptions, and often do so without a diagnosis. If you need a diagnosis, have a medication that isn't working for you, or want to get off your medication, it may be time to consult a specialist. A psychiatrist has 4 to 6 more years of training in treatment of mental health than your primary care physician, who typically has a few months of psychiatry training at most. Thus, you'll receive a wider array of treatment options, support, and experience.

 

Don’t psychiatrists try to medicate everybody?

Unfortunately, the intrusion of insurers into medicine and the influence of pharmaceutical companies has eroded the quality of psychiatric care and contributes to over-prescribing. If your psychiatrist takes insurance, be aware that many insurers have “requirements” for psychiatrists to get paid, such as writing prescriptions, and not spending more than "allowable" amounts of time. If your psychiatrist takes insurance, be aware that most insurance plans will not cover time for "disallowed" items such as therapy, nutrition, and supplements, even though they can help you minimize psychiatric medication.

A psychiatrist can make a handsome living taking insurance and seeing patients quickly, double-booking, and writing numerous prescriptions, but obviously, this is not always in the best interest of patients. Dr. Crane strives to make her private practice free of bureaucratic interference. Most physicians have a minimum of 7 or 8 years of medical training, and Dr. Crane has more than twice that number, so does it make sense for a psychiatrist to ignore years of professional training and tailor your medical treatment according to what a clerk in an insurance office says to do? Dr. Crane believes patients trust and rely on physicians to give treatment advice best for them, not best for the physician's pocketbook. Dr. Crane's medical practice is about medicine.

 

Why see a child psychiatrist?

In general, all child psychiatrists are trained in adult psychiatry, but most adult psychiatrists aren’t trained in child psychiatry. Training in child psychiatry is often helpful in treatment of adults, as many people have  long-term or familial concerns which are a source of stress. 

If you are seeking psychiatric care for your child, avoid those adult psychiatrists who “dabble” in treating children without specialized child psychiatry training. Without this training, they aren’t fully qualified for what they are doing.  Look for a Child and Adolescent psychiatrist who is “board eligible or board certified.” This is important because it signifies a psychiatrist who has had one or two additional years of specialty training in Child and Adolescent Psychiatry after the 4 years of regular psychiatry training is completed. Specialized training in child psychiatry is done after 4 years of college, 4 years of medical school, a year of  internship, and 4 years of adult psychiatry. After all that.

Many psychiatrists prefer to finish training before they go completely grey, and don't choose to spend  additional years in a child psychiatry training. Most go on to treat adults. However, some will skip the child psychiatry training and go ahead and treat children anyway. Dr. Crane does not agree with this and believes it is not in the best interest of patients. So how do you avoid those that “dabble” in treating children without specialized child psychiatry training? It's actually simple. Ask if they did a child psychiatry fellowship. If yes, ask if it was one or two years. Call their office and ask, or check online at the California Medical Board website and look up physicians by name to see what their training has been. If your insurance gives you a list of "child" psychiatrists, be sure to verify that they've had actual child psychiatry training.


Why bother with holistic psychiatry?  Does it even work?

Holistic, also called integrative psychiatry, does work for many people. It doesn't mean abandoning accrued medical knowledge. It just means the physician doesn't ignore important treatment options to support your health if they take longer or don't involve a prescription pad. The patient is treated with respect and engaged in their own medical treatment, rather than just a prescription and a 5-minute visit. This may allow fewer medications, lower doses of medications, no medications, or simply finding the right medication for you. 

A holistic psychiatrist may spend time with you to address stress, nutrition, past trauma, relationship issues, health issues, spiritual issues, identity issues, toxins, supplements, or other areas of concern to you personally. You should be able to ask questions about your care and be involved in your own medical decisions.

For example, what if you have a question about food additives or intolerances? Your regular physician may not have time to address this issue, but an integrative practice will typically incorporate nutrition as part of your overall evaluation. Just because your doctor doesn't have time, doesn't mean it's not important. Our food supply has changed rapidly over the past several decades, and many of the changes aren't positive. These changes affect mood, health, memory, and even your weight. Though nutrition may be an overlooked part of your medical evaluation in an insurance-driven practice, an integrative medical practice will typically include, and not exclude, your nutrition. This is important, as nutrition is one part of your health you have some control over. 

You should feel free to tell your psychiatrist anything without fear of disapproval. Your psychiatrist should be comfortable discussing the use of appropriate supplements and proper nutrition for your mental and physical conditions, as well as any chronic health conditions or allergies. Your psychiatrist should treat you as a whole person; mind, body, and spirit. When you step into the office of your holistic psychiatrist, it should feel like a safe place.

© Dr. Shari J. Crane, M.D. 2012