Why see a psychiatrist?
A psychiatrist is a physician who specializes in the diagnosis and treatment of psychiatric symptoms, disorders and psychological problems.
Psychiatrists are uniquely positioned as physicians to diagnose and manage all aspects of psychiatric disorders using medications and psychotherapy, but certain specializations within psychiatry require additional years of training and qualification beyond medical school, internship and residency. I am a psychopharmacologist, an expert among psychiatrists in the diagnosis and medical treatment of disorders involving moods, thoughts, and behaviors, and in the biological underpinnings that link the mind and the body.
As a psychiatrist, understanding and being able to explain to you the biological underpinnings that link the mind and body is a critical part of my responsibility as a physician, and allows me to offer you sophisticated genetic testing regarding brain enzymes and neurotransmitter functioning, laboratory testing, neuroimaging, select medication combinations, neuromodulatory therapies like Transcranial Magnetic Stimulation, and cutting-edge treatments for resistant depression like ketamine infusions — so that you have the most sophisticated and targeted medical approaches available that link your mind, brain, gut, environment and spirit in goal of restoring you to your best self.
What should I send in before my first appointment?
Once we schedule an appointment, we’ll send you an email so that you can provide us with information about your symptoms, previous treatment, medical problems, and family psychiatric history.
The more information that you can provide for me to review before and during your first appointment, the more quickly we can formulate a plan for your treatment.
If you are a new patient coming in for IV ketamine consultation and infusions, please complete and send in our Ketamine New Patient History. If you are seeing a PCP or psychiatrist, APRN, and/or a therapist, please ask them to fill in, sign and send in our brief referral form — it assures me that your treating doctors will follow you during and after your treatment with me.
If you are a new patient coming in for a consultation to see if TMS may be right for you, please complete and send in our TMS New Patient History.
Please get the following information to us, by fax or email, as well: your most recent labs, most recent office note from your PCP, most recent note from your psychiatrist/therapist. Collaboration among all of your doctors is important for your treatment success.
Our fax is 860.648.9756 and our office email is email@example.com.
What will happen during my first visit?
I will meet with you for an extensive interview and we will determine the best plan of action to move forward.
That plan may include comprehensive genetic testing in the office that day to determine if you would be a rapid responder to ketamine, and a number of other indications of response to psychiatric medications. We may order labwork, tox screens, and neuroimaging, and make recommendations for lifestyle changes, and/or medication, TMS or IV ketamine therapy.
If you are a new patient coming in specifically for ketamine consultation and treatment, and it is an appropriate treatment for you, you will be able have your first IV infusion immediately after your consultation.
If you are a new patient coming in specifically for a consultation about TMS, and it is an appropriate treatment for you, we can schedule TMS to begin the following day.
If you are a new patient for Suboxone, and it is appropriate treatment for you, you will be able to begin Suboxone immediately.
How long will I need treatment?
There are no precise determinations that I can make regarding the length of your treatment. Generally speaking, the longer your symptoms have persisted, the longer the treatment will take. Certain conditions do not require a lot of time to treat, while others require considerably more. Certain symptoms and disorders require just a couple of visits, while others require life-long maintenance. I believe that you should seek treatment as soon as possible for the best outcome.
What determines if my symptoms will come back?
There are a few components that play a part in the recurrence of psychiatric symptoms and psychiatric disorders:
Coexisting stresses in life: Your symptoms can recur if you experience additional life stressors (e.g., family or marital problems, starting a new job, or losing someone close to you). We offer genetic testing to determine if you are genetically at high risk for developing depression or PTSD in the setting of life stressors.
Age: If you are diagnosed with a psychiatric disorder early in life, there is a higher likelihood of symptoms recurring later.
Diagnosis: Some psychiatric disorders have symptoms which recur more often than others. These include depressive episodes, hypomanic and manic episodes, panic attacks, social anxiety, obsessions and compulsions, PTSD symptoms, binge eating, purging, restrictive eating, and alcohol and drug use.
How can I prevent that from happening?
Your treatment is a collaborative effort. I will give you guidance and recommendations to adhere to between visits, but they will only be effective if you follow the treatment regimen and plan of action that we agree upon. Make sure that you take your medications as prescribed, keep your follow-up office visits, attend psychotherapy sessions with your therapist if that is part of your treatment plan, and keep your life as balanced as you can. It is very important to eat well, exercise regularly, avoid stressful situations as best as you can, let your loved ones help you whenever possible, and seek help if you feel like your symptoms are coming back.
What if I have an emergency or an urgent situation?
In a life-threatening emergency, always call 911 or go to the nearest emergency room. If you are a current patient, and have an emergency, call my office immediately. My staff will get me the message as soon as possible and we will always offer you the first available appointment, or add on to the end of the day if possible. After hours, at night, and on the weekends, my answering service will page me for emergencies and urgent situations that can’t wait til the next day.
Will my treatment be confidential?
Every aspect of my practice is designed to maximize your privacy. Your treatment is confidential and will not be discussed with anyone without your written permission. We adhere to and go beyond standard HIPAA protections for privacy. Please see our HIPAA Notice of Privacy Practices in our office. I will not reveal any information regarding your care and treatment unless you have signed a HIPAA Authorization to Disclose Protected Health Information for me to share information.
Are there exceptions to confidentiality?
The only exception to confidentiality is in extreme cases where a patient may pose an imminent risk of harm to him/herself or others or where I am bound by law as a designated reporter to report child abuse, elder abuse or imminent risk of harm to another person.
What if my family wants to get involved?
You may always bring in a family member during your appointments. Let us know if you want to do this during a medication management visit so that we can schedule your appointment as a double visit if you will need extra time.
Your family members can always leave messages for me, or send me information by email or fax about you, how you’re doing, what’s happened recently, or about family history. They may want me to listen directly to their concerns. I’ll always inform you about any communication that I receive. However, I cannot discuss your diagnosis or any aspect of your treatment directly with your family or friends without your signed HIPAA authorization.
Can I email you?
I use an encrypted email program to safeguard your information and communicate securely.
Email is a great tool, but it is not appropriate for urgent or emergency situations and it should never be used in those circumstances.
Although I do my best to read and respond to email quickly, I focus first on in-office patient visits, phone calls, and coordination of care with other physicians, therapists and pharmacies.
You should know that there are limits to protecting patient confidentiality over the Internet because email can be copied, archived, and re-transmitted if you do not use an encrypted program. In addition, email is retained in the logs of Internet service providers and could potentially be read now or in the future by the system administrator(s) of the internet service provider or disclosed by the system administrator if safeguards are not in place. Feel free to call my office staff to learn more about our encryption and privacy.
Please call me or schedule an office visit or a telephone appointment to discuss sensitive information. It’s better for your peace of mind.
Is social media confidential?
Psychiatric care is best conducted within a safe setting with clear boundaries. Doctors are not permitted to diagnose, treat, or prescribe medications through social media channels. Our social media networking is for the sole purpose of providing additional education and resources to our patients and their loved ones.
What are your fees?
Our practice is on a fee-for-service basis and we require payment in full at the time of your visit by check, cash, or credit/debit card. We will provide a receipt which you may submit to insurance. For telepsychiatry appointments (appointments by phone or video), we require a credit card which we will keep securely on file.
We are committed to providing you with the finest psychiatric care, and we make every effort to keep our fees reasonable.
Do you accept insurance?
No. We do not bill insurance companies and we do not accept insurance payments. We expect that you will pay for your appointment at the time of your visit.
Our services may be fully or partly covered by your health insurance or employee benefit plan or may be fully or partly covered once you have met your deductible. Please check your coverage carefully and contact your insurance company for coverage questions before your first visit with us.
We will provide you with a statement/receipt which you may submit on your own to your insurance company if you are eligible to be reimbursed for your care.
Do you accept Medicare?
No. We have been opted-out of Medicare for the past decade, which means that we do not bill Medicare or accept Medicare payments. According to Medicare rules and regulations, if you are covered by Medicare, you cannot submit your statement/receipt from us to Medicare or your secondary insurance to receive reimbursement for your office visits with us.
If you are covered by Medicare, it is your responsibility to notify us immediately so that we can present you with the appropriate opt-out notification and agreement for you to review and sign before you begin or continue treatment with us. We cannot proceed without your signature and consent on this crucial document.
What is the cancellation policy?
We offer flexible, extended office hours and telemedicine so that we can offer you appointments that work with your schedule, and we appreciate your call if you have to cancel or reschedule. We love cancellations! They give someone else who might need to be seen that day an opportunity to come in.
However, in order to provide excellent service and remain available to all of our patients, we will charge your full visit fee for any missed appointment not cancelled by the previous day. Your missed appointment fee must be paid before your next scheduled appointment. If you have missed an appointment, you will not be given another or have your medications refilled until you have paid your missed appointment fee.
How do I request a refill?
We make every effort to accommodate your schedule and, if you are prescribed medication, to ensure that you have enough to last until your next appointment.
If you need a refill, please ask your pharmacy to send us a request. However, if we have changed your dose or directions collaboratively since your last appointment, don’t call the pharmacy–call us, and request a new Rx with the new dose and directions.
Certain psychiatric medications cannot be refilled without an office appointment.
If you request a refill before your next scheduled appointment, but need to be seen first, I will notify your pharmacy or ask our staff to contact you to come in for an office visit before your refill request will be approved. We’ll make every effort to see you–we don’t want you to run out! In certain cases, I may authorize the pharmacy to dispense a few days’ worth of medication until we can schedule you to be seen.
What if I am out of medication and need a refill?
Please call our office directly so that we can verify your last appointment, when you were due to return, and your medication dose and directions.
Given the complexities of life, psychiatric symptoms themselves, and the medications we use, it is critically important that we follow you closely and that you keep your follow-up appointments within the appointed time frames.
We take great pride in providing superb care, and we look forward to your collaboration.
How often do I need to be seen for medication visits?
Follow-up appointments are scheduled in 15 minute blocks at regular intervals. If you need a longer appointment to discuss the results of genetic testing, to bring in a family member, or because of stressors or symptoms, just let us know and we’ll schedule a double appointment for you.
The better you feel, the less often you need to be seen. It’s wonderful when you get to the point that you feel so well that we can stretch out the interval between appointments to every 3 or 4 months.
But life happens, and if you ever need or want to come in for an appointment because of a change in your thoughts, feelings or behaviors, a stressor, a loss, or a new issue in your life, just call. We’re happy to schedule an appointment for you when you need one. That’s why we’re here.
Can I return for booster Ketamine infusions or additional ketamine treatment?
Can I continue maintenance TMS treatments?
Yes. We will design a maintenance program to help you stay well.
How often do I need to be seen for Suboxone?
After you begin Suboxone, we will follow you closely and see you again within just a few days for a second visit, and then at monthly intervals and we’ll discuss additional supports and treatment that will help you truly break free from opiates.