I never said psychiatrists pressure patients. I said they only treat patients on drugs. If the patient decides to go off drugs that's the natural end of the relationship.
You replied and said you saw a psychiatrist when you were still on a anxiety drug and the insurance paid for it. Well, of course they did, you were taking a drug.
You are correct that some patients could stop taking an SSRI and still see a psychiatrist.
I'm also correct that many patients who have gone off the drug to see if the sexual dysfunction stops will probably no longer be making appointments with the psychiatrist. What would be the point? If they want to talk to someone that's what therapists are for.
The insurance company doesn't know what you are discussing in your sessions and isn't going to let you see or not see a specialist just based on whether they prescribe you meds. That's not how it works - or not how it should be working if your insurer is acting appropriately. I also saw this psychiatrist a couple of times before taking anything. I didn't walk out of my first session with a prescription for buspirone.
> I never said psychiatrists pressure patients. I said they only treat patients on drugs. If the patient decides to go off drugs that's the natural end of the relationship.
It is, but that doesn't mean you just immediately stop seeing them and never communicate again. That's not how it works - with a good psychiatrist at a good practice. You taper off, verify the taper worked and you have no further issues, and then stop seeing them if you want.
> I'm also correct that many patients who have gone off the drug to see if the sexual dysfunction stops will probably no longer be making appointments with the psychiatrist. What would be the point? If they want to talk to someone that's what therapists are for.
You need to provide some data for this assertion if you are going to keep making it. The point is that the psychiatrist, as the person overseeing your care, is the person you would naturally tell about a problem you were having. I don't think "go off the drug and just stop talking to the doctor" is the normal behavior, I think it's more like "tell the doctor you're going off the drug, confirm you went off the drug, the doctor asks if you want to try another drug, you say no, and then you stop talking to the doctor."
I'm sure some people do just stop taking whatever they're taking and never speak to their doctor's office again - but most practices are set up to prevent that, because you'd have to actually cancel an appointment and ignore phone calls in order to get to that point. Doctors hate risk by and large, and letting patients randomly discontinue drugs with no supervision is not something they generally want to incentivize.
This is completely consistent with the patient never telling the doctor that, to their surprise, after waiting months the SSRI side effects never go away.
I feel like you are arguing against my choice of phrase but not the substance of what I had to say.
When a patient terminates treatment doctors do not tell their patients "be sure to make a followup with me in 6 months after going off the drugs in the event you are permenently injured by the drug side effects in a condition that has no cure. I won't be able to help you but please pay me to chat about it."
The article this thread links to indicates there is no cure, so any patient who has done research would know discussing it with a psychiatrist would be useless.
And of course I have no data, you told an anecdote and I responded with a comment along the same lines.
I made a pretty small claim, that your psychiatrist may (not did have, may have) had patients with a condition they didn't discuss with her, that only became known to the patient after treatment had concluded. If you think a minor claim like that requires "surveys" or data, believe what you want, I don't know what to tell you.
That's true, that could certainly happen. I'm more skeptical about the rate at which it happens -- but also, if it is happening, presumably a patient will eventually go back to someone in the medical system and mention it. Whether they connect the dots is a question, but one which can be studied.
> I made a pretty small claim, that your psychiatrist may (not did have, may have) had patients with a condition they didn't discuss with her, that only became known to the patient after treatment had concluded. If you think a minor claim like that requires "surveys" or data, believe what you want, I don't know what to tell you.
The claim that my psychiatrist might have done something or not isn't the claim I want data for. The claim I want data for is "I'm also correct that many patients who have gone off the drug to see if the sexual dysfunction stops will probably no longer be making appointments with the psychiatrist. What would be the point? If they want to talk to someone that's what therapists are for."
That's not an anecdote, that's a pretty bold claim.
> The article this thread links to indicates there is no cure, so any patient who has done research would know discussing it with a psychiatrist would be useless.
I don't think people think about things that way necessarily. I wouldn't read an article and conclude I shouldn't talk to my doctor because the article suggests the doctor can't help, because I don't necessarily put that much faith in a single article. And doctors will frequently ask these sorts of questions, so even if I had read the article, I don't think I'd lie about it to them.
In general, I think you are making a number of assumptions about how people - doctors, insurers, pharma companies, and patients - behave that aren't necessarily borne out in reality. If your assumptions are all correct, your conclusions are reasonable, but I am not sure they're correct.
That's not true. From what I understand, sessions are coded e.g. "Intake" or "Meds check" when billed to insurance. They know roughly what you're talking about.
> and isn't going to let you see or not see a specialist just based on whether they prescribe you meds.
You can't bill a meds check with no meds.
> That's not how it works - or not how it should be working if your insurer is acting appropriately. I also saw this psychiatrist a couple of times before taking anything. I didn't walk out of my first session with a prescription for buspirone.
And those sessions were probably billed as "intake", "evaluation" or the like. A psychiatrist cannot keep billing intakes and evaluations forever. Talk therapy is coded in its own way, and generally paid at a lower rate.
You are correct that CPT codes give some insight into what was provided, but you are wrong about what codes providers use in this case.
To check myself, I pulled my insurance provider's EOBs for my last two visit to a psychiatrist and my last visit to a psychotherapist. The codes were as follows:
Psychiatrist - CPT 99214 and 90833. Those are "office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history, a detailed examination and medical decision making of moderate complexity", and "Individual psychotherapy, insight oriented, behavior modifying and/or supportive, 30 minutes" respectively.
So I don't think from these you can assume "this person was prescribed meds", necessarily. These are very similar to a standard doctor's visit billing code, or a therapy billing code (as below).
Psychologist - CPT 90837, which is "60 Minute Individual Therapy"
Both of these EOBs indicate the insurance paid the provider for the codes as billed. This is one example, but I'd be surprised to find it wasn't representative (that is, that my providers are not billing in generally accepted ways).
> You can't bill a meds check with no meds.
As you can see above, there isn't necessarily such a thing as a "meds check" CPT code. The codes don't give the kind of information you're imagining.
> And those sessions were probably billed as "intake", "evaluation" or the like. A psychiatrist cannot keep billing intakes and evaluations forever. Talk therapy is coded in its own way, and generally paid at a lower rate.
It is true talk therapy is a separate CPT code; it isn't true that it's always paid at a lower rate. The negotiated rate depends on the insurance company and provider's agreement.
