Finding a Doctor
The importance of finding a good mental health doctor, especially if you are taking PTSD medications, whether it be through the VA, DoD or private sector is a very important factor in getting your PTSD under control.
We want to emphasis that with PTSD non medication therapy should be your first line of defense if and whenever possible, good old fashioned talking and this should be the first thing you think about. This section will hopefully give you some insight and information that we feel is really important when you are looking for someone to help you or your loved one in dealing with PTSD.
We have focused on the "psychiatrist" in this informational web page for this reason: for the majority of veterans or service members dealing with PTSD or TBI's, this particular doctor, your "psychiatrist", will be your most important allie in your PTSD care if you are on medications. Their job is to help monitor and watch for any adverse side effects during treatment being medication is usually the first line of treatment currently being used to assist getting symptoms under control. This is not saying a psychiatrist is more important then a therapist or psychologist or counselor, just that they do not directly deal with medication and if your asked to take medication your psychiatrist will be the one to do so.
We also feel it is extremely important to include someone you trust and is close to you to be your "advocate" and assist with monitoring your medications. This could mean having that person come with you to appointments and asking questions, or helping make sure that you are taking them as prescribed, at the appropriate times and monitoring for adverse side effects that you may not notice but your loved one might.
Having someone to assist you in this is important because not all doctors communicate with each other and may not be aware of the medications you are currently taking, whether you have addiction issues or allergies and can not take certain medications. Having an advocate helps ensure that your health, safety and needs come first and are being met.
Why a Psychiatrist? In almost all cases involving military psychiatric issues, it is valuable for members or veterans to obtain an independent civilian evaluation, preferably when you first suspect you maybe suffering from PTSD.Because the majority of veterans or soldiers diagnosed with PTSD will most likely see a Psychiatrist either through the VA or DoD medical care system, having a private evaluation to begin with can be quite beneficial later on, especially if medications will be used to help manage PTSD symptoms.
Below are a few things we feel are most important in finding and working with a good Psychiatrist either outside the VA or DoD or within. The increased use of anti-depressants and other medications for psychiatric conditions has affected the military and VA handling of care. Service members and veterans are frequently given medication (not always accompanied by therapy) in an effort to stabilize or improve the condition and permit retention in the service or to function within the civilian community. This is not the best answer but it is the least expensive treatment and is probably the biggest reason why medication is being prescribed more frequently.
Sometimes refusing psychiatric medication can be very difficult, as a practical matter, and may affect entitlement to disability benefits or even be the reason for discharge for active duty members. Under current wartime conditions, monitoring of medication use is often sporadic at best, making it difficult to determine whether there is really sufficient improvement to retain a service member, or whether side-effects may exacerbate the psychiatric condition or create other medical or mental health problems. This is why it is extremely important to work with your family, loved ones and psychiatrist closely to assist you in monitoring your care.
Adding to the mix is the fact that people offering mental health and counseling services to the public identify themselves by a confusingly wide array of titles, including psychologist, licensed clinical social worker, marriage and family therapist, psychiatrist, psychoanalyst, counselor, hypnotist, hypnotherapist and psychotherapist. How can you make sense out of all of these confusing choices?
A psychiatrist we feel is the best in terms of diagnosing the problem and evaluating you. Psychiatrists are medical doctors, who, after completing medical school, receive an additional four years of specialized mental-health training. Psychiatrists treat the full range of emotional and mental disorders, and are licensed to prescribe medication. Psychiatrists sometimes use (psychotropic) medication in conjunction with therapy.
A good psychiatrist will not just want to prescribe you medications but want you to be receiving therapy. If the doctor is not recommending or referring you to this, you need to seriously question the quality of care you are receiving. If the doctor is wanting to increase medications or keeps adding more, again you need to question this type of care.
Psychologists have earned a doctorate degree in psychology. Their training may have been focused on theory and research methods, or they may have concentrated in clinical therapy and counseling. Psychologists are required to complete several years of supervised practice before becoming licensed and they do not prescribe medications.
Clinical Social Work/Therapist
Clinical social workers commonly hold a master's degree in social work (or the equivalent) and have completed two years of supervised practice to obtain a clinical license. They may use a variety of therapeutic techniques, including psychodynamic therapy or cognitive-behavioral therapy. They as well do not prescribe medications.
Licensed Counselors have a master's or a doctoral degree in counseling or a related area and complete two years of supervised practice. They are licensed as independent providers of mental health services, including the diagnosis and treatment of mental and emotional issues, and use a variety of therapeutic techniques. They as well do notprescribe medications
What should you look for in a good doctor or therapist?
Our own personal experience as to PTSD care and treatment is of the mind-set that this is not just your problem, but it also becomes the problem of the people you love, care about, live with or who care for you day to day.
A good psychiatrist must incorporate the family in recovery because they are the first line of defense in making sure you or your veteran or soldier is getting the care they need. You must be their advocate if you can, especially when they are dealing with a system that can get both frustrating or confusing at times. Doing this can make a world of difference and could even save a life.
Do not be afraid to ask questions either as a patient or family member!
You have a right to "interview" your doctor as you would for anyone providing a service to you. You might want to ask questions such as"
Do you treat other veterans, soldiers?"
What is your experience?
What things do you suggest besides medication?
What would be the treatment plan?
Do not be afraid to ask about your medications!
What is it for?
Outcomes or studies that are evidence literature based?
Where can I get more information?
A good doctor will take the time to answer you or your loved ones questions and may even make suggestions as to specific literature to read, or things you should avoid to help lessen your symptoms. A good doctor does not mind questions.
Also keep in mind when you are testing the waters of psychiatry, don't assume that every psychiatrist is a well trained expert who knows how to make an accurate diagnosis. Also, don't assume that all psychiatrists are clueless fruitcakes who don't know what they're talking about. While those two statements appear conflicting, after you visit a couple of psychiatrists, or have been shuffled around through the VA system for a while, you'll quickly recognize why this advice is important to understand.
FIVE BASIC SIGNS OF A GOOD PSYCHIATRIST
1. Listening Skills: A good psychiatrist will sit, facing you, and listen intently as you describe how you're feeling. You have to be able to trust your psychiatrist and having a doctor that you both feel comfortable with and who's personality works for you allows for you to build that trust.
2. Good communication: A psychiatrist who is well trained has an excellent "bedside manner." This means that you feel comfortable and relaxed when talking to them. They are often soft-spoken and gentle, and they allow you the time to express what you're feeling emotionally as well as physically. They also take the time to describe a course of therapy that they believe will help you, and they will outline what you can expect over the coming months, in a fair and honest way. Finding a good psychiatrist that has a personality that "jives" with yours is important and they need to be a person who you feel comfortable asking difficult questions, and who shows sincere concern for your well-being, your happiness, and your health.
3. Tweaking medication in moderation: Instead of massive medicine changes every month, a good psychiatrist will change one medicine at a time, and only very slightly. Each visit, the psychiatrist should ask you about any changes in mood, physical symptoms, and any general improvement or decline in your overall sense of well-being and happiness. The goal of every good psychiatrist is to, in time, bring you to a stable level where you are mostly content, and can cope with difficult feelings in a healthy way.
4. Family knows best: A good psychiatrist will ask for the feedback of any immediate family members who may be providing many of your care-giving while you are working on your PTSD. A good psychiatrist may prefer to get input from your spouse or even your parents before making medication changes. You family is your advocate and their observations sometimes may not reflect what you can not see yourself, so their input is highly important as well as having questions them self that your doctor can explain.
5. Collaboration: Psychiatrists who are well established within the mental health community understand the importance of a well rounded and holistic therapy. This means that talk counseling, support groups and group therapy are just as important as medicine when dealing with PTSD. People who are struggling PTSD often feel isolated, hopeless, and powerless. A good psychiatrist will promote the idea that talk counseling, support groups or group therapy can help with learning better coping mechanisms that can help with establishing a feeling that there is, in fact, hope for the future.
Lastly, know your HIPPA laws. HIPPA are the privacy laws that are there to protect you and your private medical information. You might want to seriously think about choosing someone to even be your medical advocate. You can write up a request or Medical Power of Attorney that designates that person to be allowed to call or ask questions about your medical/mental health care on your behalf. You can be specific as to what information you want shared or not. A release form and medical POA though has been a great help for us in dealing with the VA medical system. With a release plus POA in your file that advocate can make or cancel and reschedule appointments, speak with VA staff directly, check on medications or just follow up on your care for you if you are unable to do so.
Please speak with your doctor about this. Also this link gives some good information of being your loved ones medical advocate.
All information is from our own personal experience and should be used only as a basic guideline in helping you or your loved one to maneuver through your PTSD care and treatment whether through the DoD, VA or civilian health care system.