What makes a good, competent psychiatrist?

A reader recently asked, how does someone find a good psychiatrist?

Stated another way, the questions are:

  1. What qualities make a good, competent psychiatrist?
  2. How do I find a good, competent psychiatrist?
  3. How do I get my concerns heard about the direction of my treatment?

I typed the question “How do I find a good psychiatrist?” in Google and got almost half a million results from around the world. I find it hard to believe that I can come up with the final word on this question where so many have been unable to. So, what follows is not the definitive, final answer, but my answer.

I will try to only answer the question – what makes a good, competent psychiatrist? In my view, the following qualities are key:

  • good listening & observation skills
  • empathy
  • willingness to spend time educating patient & family about diagnosis and recommended treatments
  • breadth of knowledge
  • depth of knowledge
  • humility – professional & personal

The first 3 of these qualities need no explanation. Most people know what they mean. These 3 make any person a good human being (substitute ‘willingness to spend time educating patient and families’ with ‘willingness to spend time with friends and family’). It is the addition of the next 3 that makes a good human being into a good, competent psychiatrist. Let me explain.

Breadth of knowledge. There is considerable overlapping symptoms between psychiatric diagnoses within and across diagnostic categories. For example, distractibility could be a sign of ADHD, a developmental disorder, hypomania, mania, depression, psychosis, substance abuse, multiple anxiety disorders, certain personality disorders, or could exist without a person having any psychiatric disorder at all. A psychiatrist with a breadth of knowledge, even when instinctively knowing what might be going on with a patient, will consider an adequately broad range diagnostic possibilities before settling on one.

The same applies to treatments. Breadth of knowledge means the doctor will have a variety of treatment solutions (medications, psychotherapy, referrals) in his bag, and will use different ones for different patients depending upon their illnesses. He won’t remind you of the saying, “When you all you have is a hammer, everything looks like a nail.”

Depth of knowledge. By depth of knowledge, I mean that with regards to conditions he chooses to treat himself (rather than refer out), a competent psychiatrist will know almost all clinically relevant stuff there is to know. If he doesn’t know, he will be willing to find out. For example, such a psychiatrist will have an idea, not only about the potential benefits and risks, but also about the limits of treatment with medication, psychotherapy, alternative medicine, and lifestyle adjustment in the treatment of various conditions he treats. He would know when fewer treatments or no treatment would be indicated.

Humility. A professionally humble psychiatrist would have constant awareness that psychiatric diagnosis is still a very subjective enterprise, i.e. there is no definitive diagnostic blood or imaging (CT scan, MRI, etc) test that can confirm a diagnosis. This awareness would shape his behavior in the form of a belief that no matter how confident he is of his initial diagnosis of a patient, until he has followed the patient through for some period of time, the diagnosis will be provisional, and subject to change based on new data. A professionally humble psychiatrist would be willing to consider the possibility that many common treatment don’t really suit a particular patient.

Personal humility on the part of this psychiatrist would be reflected in how he approaches patient with the constant awareness that the patient, even in the worst phases of mental illness, is an equal to him as a human being. That but for an accident of birth in a family with different genetic risks, and different social, economic or cultural background, he could very well be suffering from any of the illnesses that afflict his patients.

Dheeraj Raina is a psychiatrist who practices at the Depression Clinic of Chicago.

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  • http://natickpediatrics.net Rob Lindeman

    Don’t forget refusal to coerce patients into ‘treatments’ they don’t want; AND don’t forget refusal to excuse bad behavior on account of ‘mental illness’

  • http://offwhitecoat.wordpress.com The Scrivener

    Excellent article, and it could apply to any physician. I especially like the multiple treatment modalities and acknowledgment that two people with the same disease may require different (or varying) treatments. Any good, competent physician must be willing to meet the patient where they are.

  • http://thoughtbroadcast.com SteveBMD

    I agree entirely with Rob Lindeman’s comment, but must also point out that the competent psychiatrist must be able to do the exact opposite at times, too. In other words, to be able to say “no” to a patient, and to refuse to diagnose or treat when the patient does not have a clear disorder or condition that is amenable to psychiatric treatment.

    Just because a patient comes to a psychiatrist’s office does not mean that he or she is a candidate for treatment or needs medication. Sometimes the most therapeutic intervention I can take is to tell a person they don’t need my help and remind them of their own strengths, abilities, and resources, even if they get upset or angry because they expect a diagnosis or a medication (for whatever reason).

  • http://drpullen.com medical blog

    In our community the question is more how to find a psychiatrist at all. In family practice we have to stretch our comfort zone a lot to manage patients we’d rather refer to psychiatry because there just are so few around, and some of the ones we have meet zero of the three criterion above.

  • http://natickpediatrics.net Rob Lindeman

    SteveBDM, of course! Don’t BE coerced! Good advice for us pediatricians as well…

  • anonymous

    Ability to speak English is a plus.

    BTW I’m not trying to be snarky here. I know lots of psychiatrists who have a poor command of the English language… The ability to converse with patients in their own language is just as important as (if not more important than) breadth of knowledge or humility.

    Just ask any patient.

  • IndiePsychNP

    In addition to all of the above, a patient must find a psychiatrist or psychiatric nurse practitioner who will take their insurance. Here in Seattle, a psychiatrist has “arrived” when he or she moves to a cash only basis–$200 for a 20 minute medication check and $330 and up for an hour of psychotherapy. This is over triple in network contracted rates (with the best reimbursing insurance companies) without the billing hassles or fees to billing services. And, of course, these patients are not likely to have a lot of paperwork that needs to be done. And out the door goes Medicare patients.
    This is the actual value of psychiatric care, however, knowing what to look for in a psychiatrist is cold comfort to those with cut rate plans who pay basically $80-90 per hour for psychotherapy and I don’t know how much for medication management because I don’t take those plans. I’m a nurse practitioner, not a martyr.