You’ve been told you should speak to someone. Your doctors cannot seem to find anything wrong with you. Your friends and family say you’re not acting like yourself. Should I have a psychiatric evaluation? Seeing a psychiatrist or mental health care provider can be quite a distressing experience.  A psychiatrist is often the last stop in a medical investigation of symptoms that have not revealed a diagnosis.  Perhaps this describes your situation.

Many physicians refer to psychiatry as a last resort for their patients complaining of vague symptoms consistent with depression, anxiety, fatigue, and insomnia.  These physicians throw up their hands saying, “I can’t figure out what is going on, it must all be in your head.”

Psychiatry and mental health are legitimate areas of evidence-based medicine which have serious impacts on your physical well-being.  However, it is bad medicine to label something as a mental illness when there is an actual medical ailment affecting you. To make a diagnosis, psychiatrists rely on medical records passed from one doctor to another. Assuming there has been proper work up. It is the psychiatrist’s job to discover if you are having a psychiatric manifestation of an underlying medical condition or if you are truly suffering from a primary psychiatric condition.

Some patients are fortunate enough to receive care from a dually qualified physician trained in internal medicine and psychiatry or a nurse practitioner dually certified in family practice and psychiatric mental health. Also, dual-certified clinicians have completed both training programs to achieve board certification in both specialties.  Because of this, the patient benefits because one clinician can get to know you very thoroughly from a mind and body perspective, and will be able to provide your care in a bio-psycho-social approach.

What can you expect in a psychiatric evaluation?

Why did your doctor refer you to a psychiatrist? During your first few visits I gather the following information:

• I conduct a complete history and physical exam based on your symptoms, including anything your primary care physician did not complete.
• I order lab work to evaluate any underlying conditions that may contribute to your present symptoms. Lab tests are repeated if necessary and also if results are not available or if validation is needed of previously reported values.
• On rare occasions, you may require some radiological studies to rule out suspicions of underlying conditions.
• I utilize Pharmacogenomic cheek swab tests if you have failed to get well on previous psychotropic medications. It’s also useful if you are taking multiple medications that may have interactions.
• Finally, you will need to allow the release of your past medical information and allow me to contact key people in your life discretely to formulate a more nuanced perspective of you.

“All of psychiatric diagnoses are done by excluding other medical conditions. There are no lab test results that confirm a psychiatric diagnosis.”

The consultative phase of a psychiatric evaluation can take up to 4 visits depending on test results; turnaround time, and accessibility of information.   Treatment begins after a diagnosis. It may include medications, talk therapy, exercises, or a combination of these three.

Lastly, patients may seek counseling services from another therapist or may choose to have counseling provided by their psychopharmacologist. Some patients may not need counseling beyond medication or may require only short-term therapy.  Your treatment should be individualized to your life circumstances.

Sometimes life happens and we need some assistance and wise counsel along the way.

About Metro Medical Direct

Dr. Raymond Zakhari is the owner and operator of Metro Medical Direct and provides Telehealth and in-home visits. He also provides in-home alcohol and drug rehabilitation. Book an appointment here and check out the rest of this site for more information about concierge medicine.

Also, check out Dr. Ray’s Podcast The Psychology of it All here. Also available on Apple Podcasts.