How do we decide when it's time to consider medication?
A psychiatric diagnosis does not necessarily mean that medication is needed. Whether someone has depression, an anxiety disorder, ADHD, or another psychiatric condition, one of the most important considerations is the extent to which their symptoms interfere with everyday functioning.
This is often a nuanced clinical judgment, although sometimes the need for treatment is quite clear.
For example, when a student has such difficulty concentrating that schoolwork becomes nearly impossible, when anxiety makes it difficult to leave the house, or when depression produces such profound apathy and lethargy that work or ordinary household responsibilities become difficult to manage, it may be time to consider medication.
The question is not simply whether symptoms are present, but how significantly they affect a person's ability to function at school, at work, in relationships, and in daily life.
Medication is not always the appropriate answer, even when functioning is impaired. But when symptoms substantially interfere with someone's life, it becomes an important treatment option to consider, alongside psychotherapy and other approaches.
How frequently will we meet?
The frequency of appointments depends on the type of treatment and the individual patient's clinical needs.
Patients receiving psychotherapy are typically seen once a week.
For patients receiving medication management, appointments are generally scheduled about once a month. However, particularly at the beginning of treatment, when significant medication adjustments are being made, or when symptoms are especially troublesome, I may recommend weekly appointments until things have stabilized.
Patients who are doing very well on an established medication regimen may eventually be seen less frequently, sometimes as little as once every two months.
The guiding principle is that the frequency of appointments should reflect what is clinically appropriate for each patient, and this may change over the course of treatment.
Is telehealth as effective as an in-person appointment?
Whenever possible, I prefer to conduct the initial psychiatric evaluation and early follow-up appointments in person.
Meeting face to-face allows me to develop a fuller understanding of the individual and helps establish the rapport and trust that are so important to an effective therapeutic relationship.
Once that relationship has been established, however, telehealth can be an excellent option for ongoing care. I am happy to conduct appointments remotely when it is clinically appropriate and consistent with the patient's preferences.
My approach is to consider what works best for each individual rather than insist on one format for everyone. In-person and telehealth appointments each have their advantages, and we can decide together which is most appropriate as treatment progresses.
I already have a therapist. Can I see you for medication management alone?
Absolutely. This is a common arrangement in my practice.
I am happy to provide psychiatric evaluation and medication management for patients who already have an established relationship with a psychotherapist.
I believe that collaboration between clinicians can be an important part of effective psychiatric care. With the patient's permission, I am happy to communicate with their therapist when appropriate to help ensure that treatment is coordinated and that we are working toward the same goals.
There is no requirement that patients receiving medication management from me also participate in psychotherapy with me.
Why don't you accept insurance?
There are several reasons I have chosen not to participate in insurance networks.
The first, and most important, is clinical independence. I believe decisions about treatment — including how frequently we meet, how long appointments should last, and what kind of care is appropriate — should be made by the patient and physician together, rather than influenced by the requirements of an insurance company.
Confidentiality is another important consideration. When insurance is used to pay for psychiatric treatment, diagnostic and other clinical information must generally be shared with the insurer. Many patients are not fully aware of the extent to which their private medical information becomes part of the insurance process.
There are practical considerations as well. Insurance reimbursement rates can be low, and the administrative requirements can be considerable. I maintain a small, independent practice without a billing department, and I prefer to devote my time and attention to clinical care rather than insurance administration.
Ultimately, I often explain my decision to patients in very simple terms: I want to work for you, not for your insurance company.
Although I do not participate in insurance networks or bill insurance companies directly, I am happy to provide patients with receipts containing the information needed to submit claims for possible out-of-network reimbursement. Whether reimbursement is available, and in what amount, depends on the patient's individual insurance plan.
How do I arrange an initial appointment?
Email is generally the easiest and most reliable way to contact me, whether you are interested in scheduling an initial appointment or simply have questions about my practice before deciding how to proceed.
I am happy to answer questions about the services I provide and discuss whether an initial consultation might be appropriate.
What are your fees?
Fees vary depending on the nature of the treatment, the complexity of the clinical situation, the patient's age, and the frequency and duration of appointments.
For this reason, I do not have a single fee that applies to every patient or type of appointment.
I discuss fees with prospective patients before scheduling an initial appointment, so that the anticipated cost of evaluation and treatment is understood before we begin.
How do I pay for appointments?
Most patients pay by credit or debit card. Many flexible spending account (FSA) cards can also be used.
For convenience, payment cards are kept securely on file through the payment processing portal used by my practice. This allows payments to be handled efficiently without requiring patients to provide their card information at every appointment.