Family Doctor or Psychiatrist?

Who wants to admit that they need to see a psychiatrist? There is often an inner sense of shame and disgrace when people seek psychiatric consultation, yet the pain of mental illness compels many people to seek help from family doctors or psychiatrists.

Most people who suspect mental illness initially go to their family doctors. However, it is valuable if the ill person knows the pro’s and con’s of consulting their family doctor about their mental symptoms as opposed to a psychiatrist or who specializes in diagnosing and treating mental illness.

Studies show that 74% of people seeking help for depression, for example, will first go to the family doctor. Of these cases, as many as 50% are misdiagnosed.(1) These general practitioners or internal medicine specialists are trained to recognize mental illness, but do not have the updated specialized education and expertise as do psychiatrists, to most correctly diagnose and treat mental illnesses.

There is a lot of depression diagnosed by family doctors, especially since depression has become more advertised on television and less stigmatized. If the family doctor chooses not to make a referral to a psychiatrist or psychologist, he or she will probably will treat it with an SSRI like Prozac. But the true diagnosis may turn out to be something different than depression. Not recognizing mania combined with depression, for example, is a risk because this is how many bipolar disorders are missed. Even of the depression cases that are correctly diagnosed by the family doctor, 80% are given too little medication for too short a time.(2) Starting with the family doctor might still be a good idea for anyone suspecting mental illness, however, because the doctor can rule out possible physical causes for mental symptoms. Some tests that are commonly done are EEG, MRI, or PET scans to rule out seizure disorders, and some lab tests to determine pituitary and thyroid function.

In mainstream mental health, medication is an important ingredient in treatment of mental illness. Although the family doctor can prescribe medications, a psychiatrist is more familiar with the wide range of psychiatric medications, how to use them in combination, and how to manage their side effects.(3)

A majority of people diagnosed with a mental illness by their family doctor are not referred to psychiatrists. The doctor probably chats with them for a few minutes, writes a prescription, and sends the individual home. If the individual is concerned that additional professional investigation is needed, they should insist on being referred to a psychiatrist. On the other hand, if the family doctor does suggest that an individual see a psychiatrist many people do not go at all and refuse additional treatment, because for the rest of their lives, when asked “have you ever been to a mental health professional”, they will have to say “yes”, risking jobs, relationships, insurance coverage, admission to schools, etc. due to stigmatization. They are afraid that a visit to a psychiatrist will label them as “nuts”. They may not have faith in the mental health system at all, or may not have confidence in psychiatric drugs. And, it might just seem easier to keep their illness secret if they consult with only their family doctor.

It is society’s discrimination against the mentally ill which puts a person seeking treatment in the predicament of risking the results of stigma just by trying to find the best treatment for an illness that deserves no more discrimination than any physical illness.

References

(1) “Understanding Depression Treatment“. WebMD Medical Reference. (2005).

(2) Ibid.

(3) “Choosing a Mental Health Provider: How to Find One Who Suits Your Needs”. Mayo Clinic Staff. (2005).