I’ve described my approach to psychiatric care throughout my web pages. In case you’ve missed those comments, I’ll briefly summarize them below. I’m writing this post primarily so that I will have a web address to give people who ask about my practice.

Some background for the goals I’ve set for my practice:

- There are times when medication is a Godsend for psychiatric illness and symptoms, for example in treating moderate to severe depression, REAL bipolar disorder (i.e. not the bipolar label that is tossed on to every teen who is acting out), psychotic disorders, and moderate to severe anxiety disorders. Children and adults with significant ADD also do much better with medication than with treatments that do not include medication.

- On the other hand, there are many cases of over-reliance on medications. Studies have established that the best treatments are those that combine medication with attempts to improve insight into problem behaviors. Recent studies suggest that antidepressant medications do little for mild depression, and that at least some of the benefit comes from the patient feeling understood, cared for, and reassured that things will ultimately be OK.

- I find the practice employed in some psychiatric offices to be utterly deplorable, where people are seen for very limited periods of time, diagnoses are assigned, and potent medications are prescribed– without taking the time to understand ALL of the factors involved in the patient’s symptoms, and to explain all options for treatment– including the risks of each option.

- People do well when they are treated well. People want to be ‘understood’ by their psychiatrist, and that cannot happen if an appointment begins with a 30-minute wait! How, in such cases, can the psychiatrist claim empathy for the patient’s feelings– right after demonstrating the opposite? And how can someone accurately assess the personality traits of a person who has just been forced to go through a dismissive, frustrating experience?

- It takes time to understand a person– for many reasons. When I begin treatment of a person seeking help, I want to know that person’s strengths; not just the strengths that the patient knows about and describes, but the strengths that I witness and hear about as the patient settles into a long discussion. I also need to know the things that threaten the patient; those that the patient is aware of, but more importantly, the things that the patient does not yet recognize. And again, that takes time. People have a way of acting when meeting a person for only 15 minutes, that disguises how that person truly feels inside. It takes time for a person to let go of that presentation, and settle into being him/herself.

My practice

- With these principles as background, my practice is designed create an environment where people feel relaxed, respected, and understood. I set aside at least 30 minutes for every appointment, allowing time for us to truly understand each other. My appointments start on time. My patients wait a couple minutes for a 30-minute appointment– rather than waiting 30 minutes for a 5-minute appointment!

- I provide formal psychotherapy, usually with hour-long appointments that are scheduled for a predefined period of time, in order to tackle a predefined problem. My approach is ‘psychodynamic,’ meaning that I assume that we all have an unconscious part of our minds, where we repress painful and frightening feelings.  I sometimes use tools from cognitive behavioral therapy as well, depending on the particular symptoms and on the patient’s style of interaction and comfort level.  Beyond formal psychotherapy, I use every visit as a chance to understand the person seeking help, and to help that person understand their symptoms and options. Having a full 30 minutes for a ‘medication visit’ allows us to get things right the first time, instead of random trials of medication after medication.

- I do not belong to insurance panels. I realize that by not contracting with insurers, some patients may pay more for care than they would from a participating doctor. Unfortunately, insurance is set up to pay for ten-minute med checks– a form of psychiatry that I find to be worthless, in cases where it is not actually harmful.  I wish that I could be flexible, and accept insurance in some cases, but the insurance industry does not allow that situation.   I encourage people to consider the ‘big picture.’  Recent articles in the Wall Street Journal and the New York Times have decried the loss of traditional psychiatry as a result of the pressure by insurance companies.  The articles describe the problems with the ’15 minute med check’ in a field as complex as psychiatry.

- I do submit to all insurers, and many do cover non-participating doctors, at least in part.  If you have a high deductible, my relationship with panels may have no relevance to your costs.  I do accept charge cards for payment.

- I ask that people consider a couple of factors when choosing a psychiatrist.  You will not wait more than a few minutes in the office when see me, meaning that your time away from work or from home is more predictable.  I answer e-mails, so that I can answer the short questions that invariably come up when starting any new treatment. But most of all, I believe that my approach is more likely to reduce your symptoms, and more likely to prevent recurrence of your symptoms.  Working together we will improve your insight into the causes of your symptoms, helping you become more proactive in maintaining good health.

- The kind comments that I hear most often from my patients is that they feel that they can ‘be themselves’ with me; that I do not judge them, and that I act as if I have been where they are.  Those comments are accurate;  I have been there.  Life is sometimes very difficult, and I have had times of great struggles, as well as times of success.  I make no secret of my own experiences, hoping that my own openness will help to reduce the stigma that people continue to feel and experience when dealing with psychiatric symptoms.

That is my practice, in a large nutshell!  If you have any questions about my practice, feel free to write to me drj@fdlpsych.com .

JJ

Another installment of the radio program.  For newcomers, this is a program that I do each Monday morning.  You can subscribe to this content on i-tunes;  just search for ‘Junig’ or ‘shrink zone’ in the podcast section.  I will be posting past programs every time I think of it– hopefully at a pace of 2 or 3 per week until I am caught up to the present.  Thank you very much for listening, and I welcome your comments– which can be made through my home page at fdlpsychiatry.com.  I also provide telepsychiatry for patients in distant locations, as described here.

I’m going to get caught up with this year’s ‘episodes’ of my radio show.  Once I get them listed here, they get picked up on i-tunes…  amazing how that works!  Enjoy the show, and if you live in the area (Fond du Lac Wisconsin) listen and call in during the show.  Or better yet, send me an e-mail and I will answer your question on the show. Just write to drj@fdlpsychiatry.com.  The show is on AM radio, 1450, from 10:00 to 11:00 every Monday morning.

There are a number of web sites devoted to medicine, and it can be difficult to sort out the information that is accurate and unbiased from information that is placed more prominently after ‘donations’ to support the site. I try to ‘tell it like it is’ when it comes to mental health information, and if there are topics where I am expressing an opinion i try my best to point that fact– so that people know what is supported by data, what is supported by experience, and what is not ‘supported’ at all– but is conjecture based on background knowledge and opinion influenced by family issues and other personal life experiences.

Visit the growing medical database at Medpedia, and if you are an expert, add your knowledge as well.

I like the approach of Wikipedia and now Medpedia. The information is collected by the contributions of experts in the field, and if a person drifts into conjecture there are ways for others to step in and edit the information. That information is then edited by other readers. The result is a growing database of information that represents the best of human knowledge. Since contributors know that their comments are subject to edit, they are careful to get the facts right. And the very complex topics come together from the collective knowledge of the group.

I have contributed information about opiate dependence to Medpedia, and my two main blogs will be featured on their site. I invite readers to check out their information– which is growing daily. Please look for my blog while you are there, and say ‘hi’!

Here is another psychiatry radio show from the archive featuring myself, Jeffrey T Junig MD PhD, interviewed by Bob Hoffmaster of KFIZ radio.  I do tele-psychiatry by the way– if you are interested in a different type of psychiatry– the ‘old fashioned’ kind where you have time to talk. Check out my practice if you have the time; I am taking new patients, and I ‘see’ patients from across the country.  I avoid prescribing controlled substances, so if you require Xanax-type medications, I am not the right person.  But I can prescribe the typical psychiatric medications that are not controlled by the DEA– pretty much anything except for stimulants, ‘benzos’, or narcotics. Please read about my philosophy, which includes ‘seeing’ no more than 2 patients per hour. I don’t ‘belong’ to panels but I do submit insurance claims, and many people who have significant deductibles have no difference in payment for out of network docs– if the person never reaches the deductible, it doesn’t make any difference!

Another show from the archives.  I should mention that the other person on the show with me is Bob Hoffmaster, who does the morning show at KFIZ Fond du Lac every day.  As you can hear, he makes the show a breeze;  he has a curiosity about everything, and all I have to do is come in and chat with him.  It is always the high point of my week– too bad it has to happen on a Monday!!

Continuing my efforts to get all of the episodes on i-tunes, here is the show from 4.13.2009.  If you like it, send me a question and I’ll discuss it on the air next week!  Send it to radioshow@fdlpsychiatry.com.