[shygirl2101]

A few days ago I went to my gp to get referred to a t, but my gp said I first have to go through a pdoc and then he will refer me to a t. Now I know the basic differences between pdoc’s and t’s ,but are there any different approaches on the first appointment with either of them. What should I expect on both of the first appointments? What kind of questions will they ask me? What kind of questions should I ask them? How can I know if the referred pdoc or t is right for me? It will be a while before either of my appointments, since I will be going to a public hospital, but I was thinking that I should get prepared.

[avlady]

tell the doc your symptoms, then they will be able to put you on a med if needed

[pegasus]

Hello shygirl2010,

Here in the UK, the GP would refer you to the mental health services, there you would see a psychiatrist. A psychiatrist is trained in diagnosis and treatment through medication. The psychiatrist would then decide if you need to see a therapist. There are many different levels of therapists from CPN's, social workers, counsellors, up to a clinical psychologist. It can take a long time to get to see a clinical psychologist and there is usually a waiting list.

So, essentially the meeting with the psychiatrist will be the important one as he/she is the one that then refers you for therapy. That's how it works in the NHS. There may be a different system where you live.

Some mental health services use a general form of questions to determine what your issues are, so the questions will be about how you feel, how well you sleep/eat etc. You can ask any questions you want but I strongly recommend writing your questions down to jog your memory and help you feel more in control.

[shygirl2101]

tell the doc your symptoms, then they will be able to put you on a med if needed

Thank you for your reply, avlady. Yes, I will do that. My symptoms are less intense, than they used to be, so I'm hoping that the pdoc will refer me to a t.

Hello shygirl2010,

Here in the UK, the GP would refer you to the mental health services, there you would see a psychiatrist. A psychiatrist is trained in diagnosis and treatment through medication. The psychiatrist would then decide if you need to see a therapist. There are many different levels of therapists from CPN's, social workers, counsellors, up to a clinical psychologist. It can take a long time to get to see a clinical psychologist and there is usually a waiting list.

So, essentially the meeting with the psychiatrist will be the important one as he/she is the one that then refers you for therapy. That's how it works in the NHS. There may be a different system where you live.

Some mental health services use a general form of questions to determine what your issues are, so the questions will be about how you feel, how well you sleep/eat etc. You can ask any questions you want but I strongly recommend writing your questions down to jog your memory and help you feel more in control.

Thanks for the reply, pegasus. The way the NHS works in the UK is very similar to how the system works in my country. I hope that they use general form of questions, it would be much easier for me to answer them. And I'll think about questions to ask the pdoc. There should be a possibility that the pdoc would refer me to a t, almost all of my issues are related to communication.

[thecrankyone]

a psychologist can be a therapist, as can a counselor. But a psychiatrist is an MD with a specialty in mental health and can write prescriptions.

[Crazy Hitch]

This is a great question shygirl because so many of us will face this scenario.

I read a cool Blog here on PsychCentral that gives some suggestions of what you can do / ask / look for when deciding this.

My wish for you is that you might find something meaningful that you will be able to use whilst working on this.

Let us know how it goes.

Choosing the Therapy That?s Right For You | Psych Central

[llleeelllaaannneee]

Just making sure you ask questions is good. I've noticed I tend to just answer their questions and evaluate them based on how they respond to me but if I ever see a pdoc again (I've sworn to myself I won't because I believe they've caused more harm than good for me) I'll be asking alot more questions.

For example:
Even if they mention side effects to a med I'll press them with more questions like how often they've prescribed it to their patients, what issues others have had with it, what might happen, when and how should I contact them if I believe I'm having side effects. Many pdocs don't seem to like the side effects conversation, I don't know if they assume everyone is a potential hypochondriac or what...

I'd also ask what happens if you are not having any sort of emergency but are not doing well and would like a sooner appointment or if they cancel an appointment and become unavailable in a timely manner (say within 48 hrs m-f). I say this because my last pdoc had a personal crisis and just jumped ship. To make matters worse he didn't even communicate his crisis until I politely asked him why his availability had so dramatically changed overnight (to not available, canceling appointments, delaying for weeks making new one). I won't see a pdoc now that doesn't have a back up plan. Ask if they have a dr that covers them.

Go ahead and ask their impression of something you said, something that came up or for any type of clarification. You are placing trust in this person, working with them and it's kinda weird to tell a stranger personal stuff even if they are a pdoc. It can feel intimidating but it needn't be and ambiguity isn't necessary. Pdocs that act like their's is the word of God are not a "good fit" for most.

Also, if they want to put you on a med ask what your options are. I really liked it when my dr gave me a few options, told me his impressions of how each may work for me and then let me go home and consider my options before emailing him a reply.
Some pdocs are heavy prescribers and if you go to a clinic type setting (low income, not private practice) they tend to prescribe higher dosages. You can ask how they approach starting a med and ask to taper up slowly. I had one pdoc tell me he prefered higher dosages because he thought they saturated the brain and would produce better results. I'm not ok with the saturation idea, I ask for the lowest possible dose and to taper up slowly.

Finally, you could encounter a weirdo that tries to pressure you with the notion you "should" be on meds without even seeing a therapist. If you feel in a tight spot where you feel like they might not give you a referral to a therapist unless you let them put you on or make changes to meds go ahead and pretend you're fine with whatever they say. This is a worst case scenario and I doubt it will happen but it happened once to me. Instead of letting their ego have control over you accessing help just play along.

You're likely to have a fairly comfortable experience with a decent person, I gave you worst case scenarios.
Good luck!

[shygirl2101]

Yesterday I made the appointment for the pdoc on June 23. I'm a little anxious because on the same day is my cousin's birthday also I'm thinking of the possibility that someone will see me go to the psychiatrist.

a psychologist can be a therapist, as can a counselor. But a psychiatrist is an MD with a specialty in mental health and can write prescriptions.

This is a great question shygirl because so many of us will face this scenario.

I read a cool Blog here on PsychCentral that gives some suggestions of what you can do / ask / look for when deciding this.

My wish for you is that you might find something meaningful that you will be able to use whilst working on this.

thecrankyone and Hooligan, thank you both for your replies. I'll keep all of that in mind.

Just making sure you ask questions is good. I've noticed I tend to just answer their questions and evaluate them based on how they respond to me but if I ever see a pdoc again (I've sworn to myself I won't because I believe they've caused more harm than good for me) I'll be asking alot more questions.

For example:
Even if they mention side effects to a med I'll press them with more questions like how often they've prescribed it to their patients, what issues others have had with it, what might happen, when and how should I contact them if I believe I'm having side effects. Many pdocs don't seem to like the side effects conversation, I don't know if they assume everyone is a potential hypochondriac or what...

I'd also ask what happens if you are not having any sort of emergency but are not doing well and would like a sooner appointment or if they cancel an appointment and become unavailable in a timely manner (say within 48 hrs m-f). I say this because my last pdoc had a personal crisis and just jumped ship. To make matters worse he didn't even communicate his crisis until I politely asked him why his availability had so dramatically changed overnight (to not available, canceling appointments, delaying for weeks making new one). I won't see a pdoc now that doesn't have a back up plan. Ask if they have a dr that covers them.

Go ahead and ask their impression of something you said, something that came up or for any type of clarification. You are placing trust in this person, working with them and it's kinda weird to tell a stranger personal stuff even if they are a pdoc. It can feel intimidating but it needn't be and ambiguity isn't necessary. Pdocs that act like their's is the word of God are not a "good fit" for most.

Also, if they want to put you on a med ask what your options are. I really liked it when my dr gave me a few options, told me his impressions of how each may work for me and then let me go home and consider my options before emailing him a reply.
Some pdocs are heavy prescribers and if you go to a clinic type setting (low income, not private practice) they tend to prescribe higher dosages. You can ask how they approach starting a med and ask to taper up slowly. I had one pdoc tell me he prefered higher dosages because he thought they saturated the brain and would produce better results. I'm not ok with the saturation idea, I ask for the lowest possible dose and to taper up slowly.

Finally, you could encounter a weirdo that tries to pressure you with the notion you "should" be on meds without even seeing a therapist. If you feel in a tight spot where you feel like they might not give you a referral to a therapist unless you let them put you on or make changes to meds go ahead and pretend you're fine with whatever they say. This is a worst case scenario and I doubt it will happen but it happened once to me. Instead of letting their ego have control over you accessing help just play along.

You're likely to have a fairly comfortable experience with a decent person, I gave you worst case scenarios.
Good luck!

llleeelllaaannneee, your post started OK and the were good bits of advice. However I didn't have to know about your experiences with pdocs. I'm sure you had good intentions, but for future reference don't tell a person with social anxiety what could go wrong in a social situations . I can imagine all the worst scenarios about the appointment all by myself. I hope that you don't find this rude and insulting , but that spiked my anxiety. I'm still hoping that I won't be prescribed with any meds.

[Perna]

We have some major medical clinics in the United States that reminded me of your going to your GP first for referral, etc. Here's how that would go in the United States:

Social anxiety disorder (social phobia) - Mayo Clinic