Cold psychiatrist

Dear Maigler: After years of thinking about it I finally got up the courage to go and see a psychiatrist to see if I should go on medication for depression. The whole experience was so cold. I felt like he was not really listening to me and that he had made up his mind in the first 5 minutes he knew me. He gave me a prescription and told me to come back in two weeks. I don’t know if I will. How can a psychiatrist make a decision about something this important without really knowing me?

Disappointed WithDoctors

Dear Disappointed,

I’m sorry to hear you had a negative experience with your psychiatrist. Unfortunately many doctors have poor people skills. You would think that psychiatrists, who are supposed to be experts in people, would be more warm and outgoing. Some are, many are not, but that does not mean that their clinical judgment is poor.

Most psychiatrists have worked with literally thousands of patients. While each patient is different the psychiatrist has relatively few treatment options. Within seconds of meeting you a good psychiatrist has picked up hundreds of things about you and your treatment needs before you have even opened your mouth.

If you show up to the office and you are clean, groomed, and have decent posture there is a good chance that you are not psychotic. Body language and the intensity with which a person makes or avoids eye contact tells the psychiatrist a great deal.

When you made your appointment and filled out the forms in the office the doctor was informed that you thought you might be dealing with depression. Once the doctor has met you, heard how you are functioning in many basic ways, and even heard the tone and rate of your speech all he or she has to determine is if depression is an accurate diagnosis or if there is a better explanation for the way you are feeling, if medication might help, and which medication to try first.

For a person who has done this thousands of times they could probably make an accurate diagnosis in 10 minutes 90% of the time. Most of them will take 40 minutes to an hour so that they don’t miss anything. The really good ones take 90 minutes or more to explore the person in depth, but even they probably had a pretty good idea of what they were going prescribe in that 10 minute window.

Always remember, however, that you don’t work for the doctor she /he works for you!

If you would like them to slow down and explain to you how they made their decision, most will do so happily, they might just forget from time to time how new this is for you.
I would highly recommend you go back to your doctor. Tell her/him that you are looking for more of a personal touch and if that is not her/his style ask them for a referral to a psychiatrist who will be a better fit. Please don’t stop here, you’ve already taken the hardest step.