Treatments
Selecting a Doctor
Introduction
To achieve successful management of any serious or chronic illness, we need the best medical care available. The clinicians who care for us constitute an essential component of that care. For people with schizophrenia, the selection of those treatment team members may be particularly important. This is related to issues that to some extent are unique to mental illnesses, especially Schizophrenia. They include the issue of trust and those that relate to certain symptoms such as social isolation, anxiety, and paranoia.
Before you make a final decision about a doctor, consider these suggestions:
Shop Around
Whether we are looking for a new winter coat, an apartment, or a girlfriend or boyfriend; we generally don’t settle for the first one we come across. Unless of course it is clear that we couldn’t possibly do better.
The same principles should apply when we are shopping for a doctor. Do your homework to narrow the field, and then make an appointment and check them out. If you have any doubts, try another "store".
It is common for patients with mental illness to explore their options to ensure that they find the best “fit” for them when it comes to a doctor. Most doctors are familiar and comfortable with this practice.
Unless you live in an area with a relative shortage of qualified doctors; those areas do exist; you likely have some choices.
Think About Experience
Consider their experience, but don’t let this factor overshadow other concerns that may in the big picture be more important to you. Does the doctor have adequate experience and acceptable credentials? Ratings for residency training programs are available on the internet, but remember that neither training, nor the age of a clinician, are reliable indicators of clinical expertise. Check them out yourself. You are the ultimate authority when it comes to quality.
If possible, find a clinician who has some reasonable degree of comfort monitoring your other medical problems. This doesn’t mean that they will assume primary responsibility for the diagnosis and management of your medical illnesses, but they should be aware of them and what to look for if they are not in good control.
Patients with mental illness often have other co-morbid illnesses and sometimes develop illnesses as a complication of their psychiatric treatment. The doctor who prescribes those medications should be well versed in the diagnosis and treatment of any disorders that might arise as a complication of your treatment.
Patients with schizophrenia often do not access other types of medical care as frequently or regularly as they should. Your psychiatrist may need to function in that capacity in a pinch, or at least be quick to refer you to the necessary resource.
Reputation
This may be more important than credentials. What do people you know think about this doctor? What does your primary care physician know about them and what is their opinion? What has been the experience of other clinicians in your community?
These clinicians include psychologists and other therapists, and other professionals, such as social workers.
Remember, while this is not the most important strength for a doctor, an ability to get along with your social worker and families members could be valuable over the long haul.
Most importantly, have other patients been satisfied with this doctor?
Accessibility
How close is their office to where you live? This may be particularly important if you do not drive or have access to convenient or affordable transportation. How much time do they allow for your visits? Are they willing to bend the rules a bit, and extend your appointment for a few minutes, if you clearly need the extra time?
Do they answer your phone calls promptly? Does a nurse or other person who isn’t a physician screen their calls? Can they squeeze you in if you have an urgent need to be seen sooner than your next appointment?
Continuity of Care
Do they provide both inpatient and outpatient services so that they can care for you in the event that you require hospitalization? The ability to receive medical care from a doctor who knows you well may be especially important if you have a complicated history and difficult to manage symptoms.
You want someone who knows this history. This may be essential if your symptoms are severe or your illness has been refractory to treatment in the past. How well do they work with the other doctors who provide care for your other medical problems?
Are They Personable?
Do you feel at ease when you see them? Are you relaxed when you are in their office? Do you ever feel threatened or intimidated by them? Do you believe that you can share everything about your symptoms with them; confident that they will not be offended and will address your issues in a straightforward fashion?
Can you be critical about your treatment, especially as it relates to the choice of medications and their side effects? If you can’t, it will be difficult to form the type of partnership that is necessary for effective communication and optimal care.
Do They Seem Rushed?
Do you feel as though you might as well stand for the duration of you appointment, rather than relaxing in a comfortable chair in their office? Are they so busy that they can’t move up an appointment if that’s what you need? Are they frequently interrupted by their pager, the phone, or office personnel? Do other issues frequently distract them? If they do, they may not be able to give you the undivided attention that you deserve and require for the best possible management of your illness.
Performance
In the time that they have cared for you, have you improved? Have they addressed all of your concerns, both with respect to your symptoms and medication side effects? Do they communicate clearly and take the time to explain issues until you understand them completely? Do you feel that you are on the same team?
Conclusion
If you are pleased with the answers to most of these questions, you have probably found a doctor that represents a good fit for you. Now go out and shop for that new coat, apartment, or girlfriend or boyfriend!
(Sources: The author's knowledge base, unless otherwise noted.)
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