With the huge shortage of psychiatrists and the high cost of seeing a private psychiatrist, IMHO psychiatrists should not make patients come “just because”.
We would all agree that treatments must be customized to each patient and there is no “one size fits all”. Similarly, we need to be thoughtful about how frequent follow up needs to be–in different patients and in the same patient at different times. This is an important skill that clinicians need to learn. I see some people twice a week (rare) and some once a year (also only a few). I propose for your consideration the following principles that may help us to decide how often the patient needs to be seen:
1. The frequency of visits should be least that will produce full benefit. How can we be more efficient? What can patients do on their own or with the help of other resources?
2. Many factors will determine the frequency of the visits. These may include whether active medication changes are planned, the degree of insight, do we think the person can be relied upon to call if there is a problem, are others (family, friends, therapist, etc.) monitoring the patient as well, is the medication regimen such that there is a high risk of serious side effects, and so on.
3. If we ask the patient to come after a certain number of weeks, we should be able to explain to ourselves why that is needed. Is it a decision point for possibly changing the medication? It shouldn’t just be that we’ll ask the patient if the depression came back and if there are any side effects because in that case we can tell the patient to call us right away if the depression comes back or there any side effects, or whatever we think the criteria for needing a visit are.
4. If patients don’t need to be seen more than every six to twelve months, should we ask them to follow up with their primary care physician rather than with us? This may not be better than asking them to follow up with us every six to twelve months. The primary care physicians’ monitoring and management is likely to be less detailed than ours because they have other things to do during their visit and their visits are usually briefer. So, asking them to follow up with their primary care physician may amount to just passing the buck.
But, in some cases, patients who have been completely well and are on medications that don’t require complicated monitoring may prefer to get refills from their primary care physician to reduce cost and the number of clinical visits.
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