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What is a Psychiatrist?

People come to see a psychiatrist for many reasons. But, quite often, when patients come to my office, they aren't completely sure what a psychiatrist does.

Maybe your family doctor suggested that you visit a psychiatrist. Or maybe another doctor told you that that you need to see a psychiatrist because of a particular medication you are on. Perhaps you felt that therapy might do you some good, but aren't quite sure what the difference is between a psychiatrist, psychologist, or one of the many kinds of therapists available.

So, in a nutshell, a psychiatrist is a physician – that is, a medical doctor. And that is very important. The psychiatrist is always thinking from a medical point of view. Physical problems and medical factors affect your mental health. All the therapy in the world will not fix your depression if your depression is being caused by a thyroid problem!

The psychiatrist always keeps in mind first the physical, and then the psychological, emotional, and spiritual.

After medical school and general medical training, a psychiatrist undergoes very specific post-graduate training in psychiatric diseases, conditions, and treatments.

This includes specific training in the use of psychotropic drugs such as antidepressants, sleep aids, and many others.

It includes training in various kinds of therapy, including psychotherapy, cognitive behavioral therapy, and others.

Beyond that, psychiatrists are trained in other kinds of treatment such a Electroconvulsive therapy (ECT), biofeedback, Quantitative Electroencephalogram (qEEG).

General psychiatric training takes three or four years. Some psychiatrists choose to take further, more specific, training in fields such as Child Psychiatry, Forensic Psychiatry, or pain Medicine.

During general training, the doctor who is studying to become a psychiatrist sees different kinds of patients in a variety of settings.

Emergency Room

Obviously, the ER is for emergencies! So, here the psychiatrist sees patients who are having some kind of crisis. The psychiatrist might prescribe medication, speak with people who are upset or angry or even violent, or just have a chat for a few minutes. These crises can be almost anything:

  • a teenager who is having a late-night personal crisis, and really just only needs someone to lend a sympathetic ear.
  • someone who is very mentally ill, needs medication, is a danger to themselves or others, and is brought in by the police.
  • and all sorts of things in between; family crises; problems with, or side effects from, medications; people who feel that life isn't worth living; people who are intoxicated; and even someone who just broke their leg, and is really upset about it.

 

General medical hospital wards

Here the psychiatrist is a consultant, and is called in by the main medical team to assist with some problem. For example, perhaps the patient is in the hospital for pneumonia, but also takes a psychiatric medication. The Internal Medicine doctor, who doesn't usually prescribe psychiatric medication, will call the psychiatrist for advice on how to manage the medication during the patient's hospital stay.

Or maybe the patient comes out of surgery and begins to hallucinate or see things that aren't there. The surgeon will call the psychiatrist to speak with the patient, and determine if this is because of the surgery, or maybe a side effect of a medication, or if there is something else going on.

Sometimes, if there is a conflict or misunderstanding, the psychiatrist is called in to be a liaison, or diplomat. Perhaps the family is upset with the main doctor, maybe the patient is angry about something, or maybe a nurse feels that there is a conflict with a patient, but no one knows why. That's when a psychiatrist is called in to help figure out how to find the best solution.

Psychiatric hospital ward

This can be a ward in a general hospital, or a free-standing purely psychiatric hospital. Here the patients can stay for just a day or two because of a crisis that passes. Or, patients who have very severe psychiatric illnesses may stay for many years.

The main advantage of a psychiatric ward or hospital is that the patient can be observed 24/7. So, a doctor can start a medication, and very quickly adjust the dose up to the correct therapeutic dose. Some medication may have serious side effects, or may just have unpleasant side effects. So, very often, the doctor will start a medication at a very low dose, and very slowly go up over days or weeks. In a psychiatric ward or hospital, the doctor can go up on the dose much more quickly because problems will be noticed almost immediately, and can be treated right away, or the medication stopped.

Outpatient clinic

Here the doctor sees patient for a relatively short period of time, often a hour or less, on a regular basis anywhere from daily, to once every four to six months.

In the clinic the psychiatrist may simply prescribe medication, and have very brief visits with the patient. Or, the psychiatrist may sit with the patient for an hour or more, ond perform traditional long-term psychotherapy.