The Good Med Check II: Getting to Know You

(Continued from The Good Med Check I: Checking the Med)

Critics of the now nearly ubiquitous medication management encounter frequently recite the mantra that psychiatrists who use this procedure  do not "get to know" their patients. They would have us believe that spending 45'-50' for psychotherapy once or twice a week in an artificial setting subject to numerous restrictions on verbal and other interactions allows the physician to really know the patient. They would also have us believe that only psychiatrists need to know their patients. They rarely complain that endocrinologists don't know their diabetic patients or gastroenterologists the patients on whom they perform colonoscopy.

I believe the better any physician knows his patient the better care she can provide. But don't equate psychotherapy with getting to know the patient. Many psychotherapies probably interfere with really knowing the person in treatment. One of the first things a psychiatrist should do when embarking on a medication management practice: Dump all the psychoanalytic dogma about blank slates, boundaries (no, maybe not all of those), and self revelation, and relate to your patient like any other physician, like a human being.

You can get to know your patient even in a 10' med check. Here are some ideas:

• Ask the patient about new developments in his life since the last encounter.
• Talk about an interest or concern you share with the patient, something the two of you have in common.
• Establish an interest in a matter you know is a priority in the patient's life.
• Discuss sports, hobbies, entertainment.
• Follow up on the patient's evolving relationships with significant others.
• Ask the patient what has changed most in her life since the medication started to work.
• Inquire about the patient's pets. Even encourage them to bring one to a visit.
• Chat about current events, religion, politics
• Encourage dialog about health care reform.
• When (if) you conduct encounters via video-conference you may see the patient at home, at the office, or even in a vacation spot. You may see a family member, pet or other element of the patient's life you would never see in your office. Ask about what you see.
• Google your patient and tell them what you discovered.

Look for a subject that will evolve over time. Make a note in the patient's record to remind you to inquire about change in that subject during every encounter. Even one or two minutes devoted to such dialog will enhance the effectiveness of your services.

(Continued in The Good Med Check III: Time Is Money)