[archipelago]

This may sound like a stupid question but I actually don't know about it. People here refer to their "pdoc" which I assume means "prescribing doctor"? or could it stand for "psychiatric doctor"?

The reason I don't know and I mentioned this to my shrink as well who also hadn't heard the term, is that my shrink is both an MD and a therapist. And several of his colleagues are as well. While they do prescribe their primary purpose is to provide therapy. And I chose mine because he is an analyst, not because he is a psychiatrist.

So I'm wondering how people interact with their "pdoc"? Is it like every month for a brief check in about meds? Or is it longer? Is there also therapy involved? Is there consultation between the therapist and the doctor?

I just don't know how it works for people because my situation has been different. I've always seen analysts who happen to also be psychiatrists.

[Nightlight]

I never check in with mine unless there is a problem with medication (and even then he tends not to listen). He's very anti long term therapy, so prescibing medication and talking me out of going to therapy are the only things he does.

[SingDanceRunLife]

Generally here on PC, when someone says Pdoc they are referring to their psychiatrist.

I have a Licensed Clinical Psychologist as my therapist, and an MD as my psychiatrist.

Depending on how things are going, I see my pdoc every 1-3 months. Our appointments generally run about 45 minutes as we talk about things that are going on in my life as well as meds, but she leaves the actual therapy up to my T, but of course, likes to stay in the loop.

Whenever either my T or pdoc feels that there is something important for the other to know, they [with my consent] will give them a call. This actually just happened to me today. During my session, my T thought she should call my pdoc to get some insight on my situation since it involves my meds.

[sweepy62]

I see my pdoc every 1 to 2 months depending or sooner she manages my meds, I see her for 40 minutes we talk about meds, stressors and moods. I also have a t, and they are both part of my health team, so they interact via email.

[ShrinkPatient]

My PDoc is a psychiatrist. I usually see her about every two months but lately more often because of a recent breakdown. She prescribes my meds and spends about 20-30 mins discussing my meds, how I am doing, and how therapy is going.
My T is a Licensed Mental Health Counselor (LMHC). She is actually part of the same practice as my PDoc and they read each other's notes. I see my T twice a week. About every other week, she also asks how my meds are going.

[archipelago]

Thanks. I knew that "pdoc" meant psychiatrist but I wasn't sure if the "p" meant "prescribing" or "psychiatric" and still am not certain. I guess I would find it a bit confusing given that I've not done it that way before to have two people to go to. Here in my community lots of psychiatrists are primarily interested in in depth therapy and do meds of course as well, but prefer not to only do meds if they can manage that. I guess that is somewhat unusual. It sounds that way anyway from what I am noticing.

[BlessedRhiannon]

When I use pdoc, I'm referring to my psychiatrist. In my area, it is rare for a psychiatrist to do talk therapy as well...and obscenely expensive if they do. For talk therapy, I see a psychologist. The psychiatrist prescribes my medication, and right now, I'm seeing him for about 20 minutes every 3 months. My first appointment with him was an hour, and then we had weekly 20 minute appointments for the first month, then once a month for a few months, and now I'm at every 3 months. I see my psychologist weekly for an hour.

I do not do any therapy with my pdoc - he's more interested in how the meds are working for me. My T and pdoc do consult with each other and I've given them permission to talk about me as they need to.

[Daeva]

Is psychiatric, when people have pdocs those are the ones prescribing meds, and not giving them therapy so when they say pdoc it's just a psychiatrist who prescribes them meds and nothng more

[gayleggg]

Yeah, my pdoc is a psychiatrist. I've been seeing him about every three weeks since my depression has been so bad. He spends about 15 minutes with me and adjust my meds. I'm limited on what I can take since I have no insurance, so he has to work with the older meds that have generics. We discuss my current feelings and circumstances. I really like him he has helped helped me through many touch patch.

[LoneWolfie]

I too see a psychiatrist for talk therapy and she is the one that prescribes my meds. In Canada with our national healthcare, pdocs are the only ones that are covered and I don't pay out of pocket to see her.

I have been seeing her almost two years, I have weekly hour long sessions.

[Lauliza]

I use pdoc to refer to my psychiatrist. He is more than a meds dispenser and does some general therapy. But He does not do weekly sessions so when I needed someone more intense (I self harmed) he referred me to a DBT t in his office and I saw them both for 3 years. She is gone now and I'm back to the "lighter" T with him for 20 or 40 minute once a month. In my area it's next to impossible to find a psychiatrist who does intense therapy and med management. They always refer u to a social worker or LMHC. Standard pdoc appt's are short -15-20 minutes. It's weird but insurance reimburses them less for long 50 minute appointments than they do for 20 minute med checks.

[healingme4me]

My pdocs, title is psychopharmacologist, he's a psychiatrist, MD. I see him, every 6-8 Weeks, for 15 minutes. Yes, he's checking up on meds, but still I can bring up anything new, going on in my life. He's been more than helpful, in my therapy process. I don't just see him, as 'prescribing doctor,' that, to me, minimizes his role, in my overall, wellbeing.

Sent from my LG-MS910 using Tapatalk 2

My pdoc is a psychiatrist. I have a separate therapist. My psychiatrist mainly prescribes and manages my medications. I generally see him every month or so depending on how I'm doing. Our visits are scheduled to be 20 minutes, but he goes over if needed. Very few psychiatrist in our area do therapy. It would be horrendously expensive and I doubt insurance would cover it. My pdoc takes charge of my care especially during a bipolar depressive or manic episode, and if I require hospitalization, he manages my care in the hospital where he is the director. I love him dearly, and he is highly skilled with medication management. I was very fortunate to stumble across him. He does consult with my therapist from time to time, usually when things are not going well and hospitalization is under consideration.

Originally Posted by LoneWolfie

I too see a psychiatrist for talk therapy and she is the one that prescribes my meds. In Canada with our national healthcare, pdocs are the only ones that are covered and I don't pay out of pocket to see her.

That's pretty much the same as in Sweden. Almost all psychiatrists are covered, whether they do therapy or not, and most non-MD therapists are not covered. It is possible to get therapy through the system but that would usually be short term, and it's not easy to get.

I first saw my T as a pdoc, when I needed to discuss the medication my GP had prescribed. The appointments were the same length when I went to him as a pdoc as they are now (45 minutes).

[wotchermuggle]

My Pdoc is a psychiatrist that I see for meds. Sometimes I'm in and out. Other times she wants to chit chat more about things and will give me suggestions or strategies. We talk a bit about my therapy (who is with someone else). I see my Pdoc roughly every 6-8 weeks. If I'm doing really well, it might be longer. If I'm doing poorly, it's a shorter time.

[archipelago]

Thanks I learned a lot about how others use a psychiatrist. It's so different from my experience so now I feel different about things.

It is interesting that in different countries that a psychiatrist is the one who is covered not any other mental health care provider. I see why, but it is interesting. I wonder if that will ever happen in the US. Probably not, but there was probably a time when psychiatrists did more than mainly meds. Perhaps there is a historical shift in the role of psychiatrist? That might explain why in my area there are a number of psychiatrists who specialize in intensive therapy alongside meds. They are all colleagues in reading groups together and interact regularly. Now I see how unusual that is.

My last T was a psychiatrist. I think it helped at that time since I was taking medications. This issue was irrelevant after a certain point because I grew to love and adore him...

My current T is not a psychiatrist, but since I am not taking medications, I think it is better for me at this point in my life. The way I look at it, psychiatrists have to spend years learning general medicine while non-MDs spend those same years learning about psychology. Both before getting psychoanalyst certifications. That's not a big deal, but it makes sense to see a psychologist for therapy unless meds are needed.

There are psychiatrists practicing psychotherapy in the various places I've lived, but I agree with you that it is not the same everywhere. I think it's less common outside of the Northeast for those who live in the US. I noticed they seem to be more prevalent in more liberal cities (although I've never counted).

my shrink is both an MD and a therapist

I wonder if this has any other meaning for you? If you don't mind my asking...it's just I've noticed that you have mentioned this is several of your posts here.

Did you ever see this article about psychiatry from the NY Times? Warning-some of the comments might be for those who swear by psychodynamic therapy.

http://well.blogs.nytimes.com/2011/0...more-medicine/

[Lauliza]

I read that NYT article and I think it does explain the shift in psychiatry in this country. Regarding insurance, my psychiatrist bills $265 for a 40 minute session ( the longest his office offers), but gets reimbursed about 1/2. Now for a 20 minute appt, he bills $165 and gets reimbursed about 80%. So he actually loses money on the longer appointments. The insurance companies essentially force them to do med checks only. I do know there are many in the city who do psychotherapy but they don't accept any insurance. At $250-350/ hour, only the most affluent can afford them.

There are more Psychiatric nurses popping up. My former t left the practice to go back to school for a masters in psych nursing. Then she can prescribe meds, do therapy, accept insurance and be reimbursed well. I bet psychiatry as a profession will be obsolete in 20 years.

Sent from my iPhone using Tapatalk

[archipelago]

I use the term "shrink" because I really mean "analyst" as opposed to either "pdoc" or "therapist." So I define the term in posts just to be clear because I know it is not the typical situation here. I am just trying to match the community with its own habits like using just "T" when I always spell out "therapist." I have differences that I have to respect as well as bend to fit in.

I have read an article like that, perhaps the same one. I asked my shrink today about the history of psychiatry on this issue of whether it's changed into just giving out meds and away from therapy.

There are studies that show that psychotherapy has an effect size almost double to anti-depressants as just one example. So I don't think meds are completely the answer in many if not most situations.

I do use meds for anxiety so mild benzos so my shrink does provide me with that and occasionally I've needed something for depression, but his primary focus is therapy whether or not it is analysis.

There are lots of people who have put down psychoanalysis. It is an easy target. But not all psychoanalytic approaches are the same. And contemporary approaches have be shown to be as or more effective that so-called empirically validated approaches such as CBT. There are longer lasting effects and more depth change so even in something like borderline psychoanalytic approaches have more effects that something as commonly assumed as DBT. It really depends on what research you read and what your beliefs are as to what you pick out for a "warning."

[Lauliza]

Archipelago- I forget where you said you live, but in Boston, NYC and much of the northeast, insurance seems to dictate how psychiatrists can run their practice. Even if it doesn't fit with their own preferences, if a psychiatrist wants to be accessible to a large population and make a good living, they need to follow the insurance company guidelines. I too believe that it makes more sense to receive your whole treatment from one provider- if you take psych meds but need therapy I'd prefer to get it from the same person, and I'm sure many others would too. I think thats why psychiatric nursing has picked up as a profession in my area, because that is precisely what they do- meds and therapy. And its cheaper for the insurace co's...

I think everyone's success in therapy will depend on what they want to get out of therapy and what is a good fit for them. I think oftentimes the practical issues of time, cost and provider availability make psychoanalysis less appealing to some people (especially today when everyone wants such fast results). I don't think people doubt the effectiveness, but with the other factors I mentioned, many patients and providers just don't have the time or patience to really commit to intense analysis. With the availability of therapies like CBT and DBT that work for so many people, then it seems natural to go with it. It makes even more sense with all the demand we have on us with work, family, social obligations, etc.,.

I also think many T's, analysts or psychiatrists, whatever we want to call them, combine approaches according to their clients needs and wants. So unless there is a pathology that responds very strongly to one approach- such as DBT for borderlines, I think many practitioners are flexible in their approach. I realize true psychoanalysis is intense and therapists/doctors need training in it. But for the most part, I think many in the field don't want to commit to just one style of therapy since their client's needs can vary so widely.

[archipelago]

I agree with everything you said. I know that there are pressures from insurance and managed care. That's why I feel that my situation is so different because there are many in my community who offer intensive therapy as psychiatrists and lower their fees for clients who have either no insurance or have reached the limit. So my shrink doesn't ask more than an MFT or psychologist. It is still a factor in that I can't really afford it, but it is so important to me that I figure out how. That means that I can't do full analysis which would mean at least 3 times a week. I have done that when I could, and it was amazing the amount we got done. It made a huge difference. I sorta miss it, but am happy with the work we do and am busier now so can't take on that intensity because it's not just in the session but all the stuff that comes up alongside it. It is still intensive, but with more space around it. I just don't think I would work well as you sorta say with two different people. I like that my shrink is both my MD and therapist. And I have seen 3 of his colleagues; they do the same type of thing. I don't think they are interested in their earning power, but in the challenges of treating patients. They are all in reading groups together and constantly are challenging themselves as well as having to learn about all the new psych meds so they work really hard and don't make an obscene amount. In my community the median price for a house is more than $600,000. To even make a mortgage they have to work really hard. And the cost of living is high as well. I appreciate this group and feel that they are actually noble in how they have chosen to practice. Some even take patients for free. And most don't charge for phone calls. It is a generous and dedicated group.