I’m concerned that my client’s psychiatrist is prescribing the wrong medication. She’s taking an anti-depressant instead of an anti-anxiety medication, and she says her anxiety hasn’t improved. She signed a release giving me permission to contact the psychiatrist, so I plan to call him.
It’s often useful to talk with other professionals who are involved in your client’s health care, and preparing in advance makes the conversation more productive and collaborative. In this instance, you have formed an impression of the psychiatrist’s professional judgment based on your client’s report which you should reflect on before contacting him. I recommend approaching all conversations with other care providers with an assumption of competence and professionalism on their part. There are many reasons your client may be telling you her anxiety hasn’t improved on her current medication regimen. Before concluding that the psychiatrist has made a mistake, consider whether your client has been taking her medication as prescribed and for a sufficient length of time to be effective, whether she has tracked her anxiety symptoms on a regular basis to verify her subjective impression, and whether she has any history of addiction that could be related to her desire for and advisability of benzodiazepines for anxiety. In addition, reflect on the interpersonal meaning of the client’s report to you and the triangle she has created between you, the psychiatrist and herself. This may repeat an early family pattern related to conflict and loyalty that you want to handle differently than the client has experienced in the past.
Once you have checked your biases and can approach the conversation with an open, collaborative attitude, it’s good to take some time to prepare by writing down the questions you want to ask and a summary of information you want to share. Make sure your questions are neutral and will not put him in a defensive position. For example, it’s better to say “can you tell me how you made the decision to prescribe Zoloft?” than to say “do you think another medication would be more effective?”. An open-ended question like “what information can you share that will help in my treatment of her anxiety?” is a good way to foster collaboration and may broaden your perspective. When you write your summary or make notes about what you plan to share, remember to keep it brief, concise and relevant to the psychiatrist’s relationship with the client. The client’s authorization gives you permission to exchange information, but HIPAA still obligates you to share only the minimum necessary information. When you talk with the psychiatrist by phone, start by asking questions and giving him a chance to share his ideas. This will show you areas of agreement and consistency in your views of the client, and highlight what you may want to emphasize in your summary. In your first conversation, I recommend that your agenda be only to establish a collaborative working relationship. If you have areas of concern or disagreement, it is better to address those in a later conversation after some time has passed and you have had an opportunity to talk with a supervisor or colleague.
I hope you find these suggestions helpful in talking with a psychiatrist or other health care professional. Please email me with comments, questions or suggestions for future blog topics.