ll sessions are one hour or more. Individual visits are sometimes longer. Success is most likely when each person has a sufficient period of time to tell their story, to feel that they have been listened to, and most importantly, understood. All patients wish to be treated with dignity and respect. Only with the experience of improvement can a person appreciate the value of a more thorough approach to gathering information.
This is an intensive process.
I employ measurement based care (MBC) For many years I have found that this method yields the most information in the shortest period of time at the outset of an evaluation. After obtaining the usual history, I ask each person to complete a variety of self-report forms which screen for general symptoms, depression, anxiety, social fears, mood disorders including bipolar illness, attention deficit disorder, fatigue, sleepiness, recent and past post traumatic stress disorders, (PTSD) and sexual abuse.
While the primary disorder is usually quite evident, additional conditions are screened for as they are often missed, and often submerged under the primary illness or concerns. It is my job to detect whatever is present to do a differential diagnosis for optimal treatment.
The standard brief insurance visits do not allow for a comprehensive, thoughtful understanding which often leads to one prescription after another till the correct fit is arrived at, if at all. Also, major psychological troubles such as child behavior, marital discord, substance abuse, or job stress cannot be evaluated, and specific recommendations cannot be made. There are hundreds of psychotherapies with multiple rationales, and generic counseling may be too non-specific.
I am dedicated to providing my patients with the best treatment options available. I have chosen to be an out of network doctor and do not accept insurance. Having a cash-based practice gives me the flexibility and freedom to tailor a treatment plan that best serves each individual patient.
Errors in medication usage
Is your doctor making these mistakes:
1. Continuing a treatment long after it is clear to you that it’s not working?
2. Amount of medicine is too much, or increased too rapidly?
3. Side effects are not addressed?
4. Dose is too low, and then switched to another medication? The medicine may have been valuable at an adequate dose, sometimes measured by blood levels.
5. Time between appointments are too long apart? This does not allow for adequate tracking. Prominent symptoms exist for longer than necessary.
6. No brief interim communications to insure that the medicine is doing what it is supposed to without major adverse events?
One study suggests that the accuracy of the diagnoses, and effectiveness are improved by 40% so it well worth the time to employ this approach, and is well within the scope of the primary care setting.
Reference: Neuropsycopharmacology, online publication, 4 April, 2007. Maximizing the Adequacy of Medication Treatment in Controlled Trials and Clinical Practice, STAR*D Measurement Based Care by Madukar H. Trivedi, A John Rush, et al
STAR*D ( The sequenced treatment Alternative to relieve depression
Measurement based care (MBC)
The more relevant information obtained in the shortest time period provides the platform for a successful intervention.
BASIC DEMOGRAPHIC INFORMATION
- History of current major concerns (signs and symptoms)
- Social history
- Adolescent experience
- Any substance abuse, past and present
- Child abuse
- Marital status
- Family structure and current support system
- Medical/psychiatric history
- Prior psychiatric treatment
- Prior and current medications: antidepressants, stimulants, mood stabilizers, anti-anxiety agents
- Current and past medical conditions
- Accidents, illnesses, surgeries, drug allergies
- Primary care physician, last MD visit
- See brochure – psycho-social attachment for more details