While Dr. Melfi from the Sopranos may give the impression that a day in the life of a psychiatrist involves seeing high profile clients and constantly wrestling with ethical dilemmas, working with interesting patients is only one small aspect in a psychiatrist's day. In addition to being adept at the diagnoses and treatment of mental disorders and substance abuse problems, the daily tasks of a psychiatrist include the more mundane activities of juggling phone calls, writing reports and following up on clients.
First and foremost, a psychiatrist is a medical doctor, so a large part of her day is spent ruling out medical conditions, unless, of course medical issues have already been ruled out by another physician. Although it may seem less than glamorous, a psychiatrist spends time with each new patient they see in an average day simply obtaining a thorough medical history and ordering medical tests or specialized evaluations. Diagnosing a patient comes administrative work, too. A portion of a psychiatrist's day is spent on the phone, coordinating care with other medical professionals and in writing case notes and evaluations for her patients' medical charts.
Once a medical cause for symptoms is ruled out, a psychiatrist uses information collected from the patient and her family to make a psychiatric diagnosis. According to the Child Development Institute "a list of symptoms and signs are elicited by the patient... [and] these sets of symptoms are correlated with disorders that are found in the Diagnostic and Statistical Manual, also known as the DSM.” What this means is that, in a typical psychiatrist's day, she will play Colombo, sorting through a mess of clues to solve the diagnostic mystery of what is causing the patient's symptoms.
Once a definitive psychiatric diagnosis is given, the psychiatrist prescribes the appropriate medication. While television psychiatrists conduct psychotherapy sessions with patients who lounge on couches, few actual psychiatrists conduct therapy today. Most of a psychiatrist's "couch time" with a patient involves introducing the patient to a psychotropic medication and following up with patients to assess the benefit of the prescribed pharmacotherapy. Over time a patient's response to a psychotropic medication can change, so ongoing psychiatric checkups are essential.
When not engaged in "couch time" with her patients, a psychiatrist spends a portion of her day making sure her office is running well. While most psychiatrists rely on an office manager to complete clerical and accounting tasks, the psychiatrist herself must keep her "finger on the pulse" of the office as she is ultimately responsible for all payments to employees, treatment codes sent to insurance offices and even such totally uninteresting but important activities such as making sure the light bill is paid as she cannot, after all, see patients in the dark.
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