What do you think about this psychiatrist?

[vaspap]

I'm not seeking medical advice here.

Patient is 21 years old tells the psychiatrist she has OCD. She explains symptoms "such as walking back and forth, repeating certain phrases, counting steps," etc. Patient said her OCD is becoming unmanageable and she needs medication. Doc asks checklist questions about OCD which you can only answer "yes" or "no" to such as "do you wash hands" "do you arrange objects" "do you have religious obsessions"? Doc asks a bunch of questions about the patient's history. Then he asks to speak to the patient's mother, who is in the waiting room. Patient says no but doc says he needs to ask a few questions. Doc asks questions about history such as marriage, pregnancy, young child, etc. Then mom starts complaining about patient sleeping all day, how her husband started yelling everywhere for something patient did last night, etc. Patient tells mom to be quiet but doc insists she let her mom speak. Doc asks "how old is she?" and patient answers 21 and the doc thought at 21 patient should be independent from parents. He recommends a residential facility because they will set a schedule and rules so patient can't sleep all day. He then says the residential facility might not accept the patient and suggested a supported apartment. He asks the patient about her career plans who she wants to become. He said to call a family service organization that offers a supported apartment and employment training. In the end patient asked doc why he didn't prescribe meds. Doc thought patient didn't need meds. Patient asks what is he going to do about the OCD and he answers with the dismissive gesture that he will treat the OCD.

If you were the patient, what would you do? If you were the psychiatrist, how would you respond to the patient?

[blondy2061h, MSN, RN]

Without actually knowing the patient none of us could possibly make a judgement call on this patient. If you aren't happy with this psychiatrist's recommendations you can always get another opinion from a different doctor.

[Oldmahubbard]

Asking for a friend?

A question : Are the alleged OCD symptoms so severe that the patient cannot attend (or finish) school, or work?

A thought: Residential treatment programs are few and far between, not typically used in OCD, if that is the real issue.

I would seek a second opinion.

[KelRN215, BSN, RN]

Patient is 21 years old tells the psychiatrist she has OCD.

Has the patient ever actually been diagnosed with OCD or did she self-diagnose?

[Oldmahubbard]

Could be more to it. I have had RN's approach me to say "a patient has OCD" and really they don't.

[klone, MSN, RN]

I can only assume you are the patient. This is outside our terms of service.

[amoLucia]

I think we're being snookered here.

Patient? Family? Friend? Homework?

Or else my cynicism is sneaking thru again.

Popcorn?

[hppygr8ful, ASN, RN, EMT-I]

Sounds a bit like a homework question! That being said medication is often a last resort. Supported living is not the same as residential treatment. A group home or supported living apartment allows a person to have a degree of independence while also having structure. I don't think the Psychiatrist needs to go to meds immediately. Seeing how the patient does in a supported environment is entirely appropriate.

Hppy

[Jolie, BSN]

The first thing I noticed about this post was: "Patient is 21 years old tells the psychiatrist she has OCD."

My thought: Starting off an initial visit with a new healthcare provider by informing the provider what one's diagnosis should be will probably not end the way the patient had planned.

Secondly: Young adult psychiatric patients are often poor historians. I'm not being judgmental, just stating an observation. Including the patient's mother in the discussion was necessary for the physician to gain information as well as perspective. As a legal adult, the patient did not have to allow this, but without the mother's information, the physician may have chosen not to treat the patient, rather than attempt to do so with inadequate information.

Thirdly: I find psychiatrists who don't automatically reach for prescription pads to be worth their weight in gold.

[KelRN215, BSN, RN]

Thirdly: I find psychiatrists who don't automatically reach for prescription pads to be worth their weight in gold.

Yes, this. I quit seeing any kind of mental health practictioner with prescriptive authority for good when, within 5 minutes of walking into a Psych CNS's office in 2005, she offered me Wellbutrin and Prozac without any sort of counseling when A) I had never indicated my willingness to take any sort of psychotropic medication and B) my medical history involved severe, medically intractable epilepsy and Wellbutrin is contraindicated in anyone with a history of seizures.

[Alex_RN, BSN]

Why the rush to drugs? It is not like they are going to run out. I am impressed by any Psych that does more than pushes pills.

I sense a lot of red flags in the OP. New member, first and only post. Does not sound like someone who works in healthcare.

[Oldmahubbard]

It has made us all think, no?