[certified]

Unfortunately a year ago my most excellent psychiatrist retired. I had been with him for 15 years since diagnosed Bipolar II. My appointments had always been 1 hour with psycotherapy.
Now I find that no psychiatrists in my area do psychoytherapy, they all do this infamous 15 minute "Med Checks". Can someone tell me how, in 15 minutes, a doctor can tell if my meds are working, if I need an adjustment in meds, or a new med?
The doctor I was referred to actually told me to use what I had learned in the past 15 years to cope. He will not do psychotherapy. In other words - be your own doctor!! Unbelivable!! I have checked for psychologists and none of them work with Bipolar patients.
Haven't seen a psychiatrist since May despite rapid cycling periods of the entire spectrum of Bipolar II. I've been tweaking my current meds of Seroquel, Lexapro, clonazepam and Wellbutrin as needed.
And for me, fortunately, suicide is not an option. 20+ years ago my husband suicided and I will never do that to my family and friends.
Any help or suggestions would be greatly appreciated.

[Berries]

Where and how have you looked for a therapist? Do you have insurance? Are you willing to accept someone with a masters instead of a PsyD? Social Workers Masters degree's psychologists can be good therapists too.
I hear you on the 15 med check thing. It's ok if all you are stable and just checking in. But, if you are in crisis or just having a hard time, it sucks!
But, if you can find a non MD for a therapist, they will help prepare you with what to say in the 15 minutes that will get you what you need out of the appointment.
There is a way to look for therapists in your area right here in PsychCentral.
Go to the home page and in the top right hand corner there is a link that says: looking for a therapist?
It will ask you your zip code, what you are looking for help with and what insurance you have.
Good Luck!!

[Josie55]

It's hard to get everything communicated in 15 or 20 minutes, but if you do a little preperation it can at least help. Try listing out what symptoms you are experiencing that are bothering you that are most important, or if there are meds that are giving you problems, the biggest problems you are having.

Put the important things on note cards and bring them in.
Also write down anything that you think is vital information for them to know. [like oh, hey, I felt manic for about four days last week and slept about an hour each night]

Anyway, notecards might be helpful with specific points to share.
I do it every once in a while when I can manage it.

[Martina]

Sadly, this is what the profession has become. That's all they do is 15 minutes, but they charge you a friggin' fortune. It's insane (pun intended).

One suggestion - look into a Psychiatric Nurse. Most do both meds and therapy in one visit - and it's an hour, not 15 minutes. And they are generally less expensive than a psychiatrist. Since you already have a good diagnosis with 15 years history - you don't necessarily need a psychiatrist, just someone who can titrate the meds you are already on.

At least get in to see SOMEONE before your meds run out. Don't go off cold-turkey, trust me, it's hell!

I see a psychiatric nurse practictioner & highly recommend this option. I have been seeing her for 10 yrs. In our state she can prescribe meds. She works "under" a psychiatrist she consults with if she feels the need to, but she is on top of the newest reseach & everything & has gone over & above the call of duty for me. Calling my ins. co. when they refused to pay for the Provigil (she started me on it 10 yrs. ago) & sent them all the literature showing it was useful for bipolar 1 & they reversed their decision & paid for it (very expensive med) & it has been a lifesaver medication for me.

She has accompanied me to an appt. w/ my internal med doc that was causing me all sorts of anxiety to the point that I kept cancelling the appt. (she took the afternoon off & did not charge me for this & just told me my physical health is just as important as my mental health).

She has given me her cell phone # to call if I need to just check in or to get motivation from her if I need it to do my exercise as she is a big believer that exercise is as important as medication.

My appts. with her are 1 hr. for $115.00, but if I need to stay longer she stays without rushing me out (she always allows a "buffer" between appts. for this purpose) & does not charge me extra. 15 min. med check--you have got to be kidding me!! She asks me about how I am spending my time, what I am thinking about, etc. She needs to know ME to be able to tell if I am not in my normal state & to have a collaborative relationship with me. I am sorry. I would not put up wit 15 min. I don't even think that is medically safe if they are working with psych meds.--Suzy

[multipixie9]

the prices for the so-called med checks are too big and the time spent is too small - and that is wrong and should be against the hippocratic oath. when bucks and time pressure rules how can anyone be considered a true healer, that barely qualifies for a mechanic!!!

i'm not bi-polar, but have run into the same sort of treatment as someone with ptsd, mpd/did, fibromyalgia and a bunch of other junk - i actually get treated by my general practioner whom i've seen for 12 years physically. he actually listens to me and does his best to do what is really in my interests.

there are good suggestions on here , like writing notes to keep important points in mind. you do deserve real and competent care - keep looking for it and fighting for your real needs!!! you matter as much as anyone on earth!!!

leslie and her pixies

[madisgram]

i'd run not walk away from that psychiatrist!! he/she gives many good doctors a bad name in the profession.
i'm sorry that you are having to go through this change. when i moved to another state i had to leave behind my awesome psychiatrist and phd psychologist. they had worked with me for over 12 years. when i arrived in sc i found that psych.docs did psychotherapy as well as med checks. however in the past i was strongly advised to use a phd psychol. for my therapy and a psychiatrist for my meds. this was a successful plan for me. i had to research phd psychol. in sc to find a suitable (but lacking) therapist until i moved to another state.
as long as you are stable a 15 minute med check is ok. i believe the law requires this 3 month med check on all patients on medications for mental disorders. however there was often the time in early treatment that i requested and got a longer appointment with my psychiatrist because it was needed. i hope you can find the same arrangement with a psychiatrist. you could use it as a question in an "interview" appointment which i strongly also reccomend. (i actually do the interviewing -when i move around- not the doctor, to assure myself of a good match for me.) i believe we need to state our needs at the time or our needs will probably not be met. in other words communication with our doctors is important for our treatment.
i have never heard of psychologists that do not work with bipolar patients! how odd. i would continue to research psychologists in your area that are trained cognitive behavioral therapists. this area of treatment works well with bipolar people like us.
i wish you well on your search. it is very important to have caring, trained professionals in our lives. it has enabled me to have a much more balanced recovery with my bouts of bipolar episodes.

[kim_johnson]

other doctors do 15 minute med checks for such things as pain management, diabetes, cancer etc. it isn't unheard of, and it certainly isn't against the hippocratic oath. psychiatry is mostly about medication prescribing these days and it doesn't take that long to see how the medication is working out (e.g., assess side effects, look at the results of blood tests, write a script).

there are some psychiatrists who offer therapy... you might have more luck with checking out your local psychoanalytic training institute (if you have one). the cost of a 15 minute medication check up... well... you can expect to pay considerably more than that for a 50 minute psychotherapy session from a psychiatrist. many prefer not to see psychiatrists for therapy, anyway. maybe have a think about what qualities you would like in a therapist and might be that you can save yourself some money by seeing a counselor or a clinical psychologist or a social worker or something...

I still think 15 min. is not long enough for a medication check (at least for me) for bipolar 1. In my case, most of my symptoms are my THOUGHTS & these need to be talked about. They cannot be measured by a blood test or a quick overview of physical symptoms. Sleeping, energy, etc. is important, but for me, it is really important to assess my THINKING. Am I starting to get paranoid, grandiose, excessively enegetic in my plans, etc. How are my relationships going? How am I feeling about myself? All my daily activities need to be evaluated to see if I am on a normal keel or going up or down. And if I'm needing help, my meds may need to an adjustment or I may need my provider (psychiatric nurse pracitioner) to talk with me for awhile, recommend a book , etc. to help me with my thinking & coping skills--or contact my therapist (doing indiv. therapy & DBT).--Suzy