After making the decision to see a psychiatrist, the next challenge is often uncertainty about what will happen during the appointment.
“What if I don’t know what to say?
“Will I be judged?
“Will I be forced to take medication?
“What if I cry?”
Just like how people might make assumptions about medicine from shows like Grey’s Anatomy or House, much of what people know about psychiatric consultations comes from film and television, where they are often shown as intimidating or dramatic.
In real life, a psychiatric consultation is essentially a structured conversation.
Its purpose is to understand what you are experiencing and to work out the best way to help.
Here is what that process generally involves.
Before your appointment
Before your first psychiatric appointment, it may be helpful to prepare some information that can make the consultation more productive.
You can write down your main concerns, the symptoms you have been experiencing, when they started, and how they have affected your daily life, work, studies or relationships.
Bringing along a list of your current medications and any relevant medical records can also be useful.
If you feel comfortable doing so, you may consider bringing a trusted family member or friend who can provide additional information about changes they have noticed in you, or offer support during the appointment.
One of the most common things patients say when they walk into my consultation room is: “I don’t really know how to explain this” or “I don’t know where to start”.
If this sounds familiar, you are not alone.
Most consultations begin with a simple question: “What brought you in today?”
Many people worry that they need to organise their thoughts perfectly before seeing a psychiatrist.
That is not necessary – you do not need to prepare a rehearsed answer.
Some patients come in with symptoms in mind, such as poor sleep or ongoing anxiety.
Others are less certain and only know that something feels wrong.
Both are acceptable starting points.
Organising your thoughts into a clear account is not something you need to do beforehand.
It is part of the psychiatrist’s role to guide that process.
The first consultation
Today is your clinic appointment, what can you expect?
Although every consultation is different, the first appointment usually focuses on understanding your concerns and gathering information about your overall well-being.
Information regarding your symptoms, severity, duration and daily functioning might be gathered, and it may include more than what you have experienced.
For example, someone with anxiety may be asked about panic attacks, sleep, appetite or alcohol use.
You may also be asked about your family medical history, past psychiatric history and personal background, including childhood experiences and any traumatic events.
The reason is that mental health symptoms may overlap across different disorders, and it is important to identify the underlying cause rather than treating the symptoms in isolation.
Furthermore, mental health conditions are known to run in families, and the answers to these questions can assist in diagnosis and treatment planning.
Similarly, questions about childhood or past experiences are vital to understand patterns that may be relevant to what a person is currently experiencing.
Imaging and tests
In some cases, further investigation is needed.
Physical health conditions can produce symptoms that closely resemble mental health conditions.
A low thyroid level, for example, can cause fatigue and low mood that looks like depression.
A psychiatrist may recommend blood tests, such as a thyroid function test, a full blood count or screening for vitamin deficiencies such as vitamin B12 or folate.
In select cases where symptoms appear suddenly or are accompanied by neurological signs, a brain imaging such as a magnetic resonance imaging (MRI) or computed tomography (CT) may also be recommended to rule out a structural cause.
Other investigations that may be ordered are an electrocardiogram (ECG) or electroencephalogram (EEG).
This is a standard part of clinical practice to ensure that treatment is based on an accurate understanding of what is happening.
Diagnosis and treatment
This is usually the part people are most anxious about.
Whether a diagnosis is given at the end of the first session depends on the individual case.
In some instances, the condition becomes clear during the first consultation.
In others, further sessions or additional information are needed before a conclusion can be reached.
Mental health conditions can overlap, and symptoms do not always fit neatly into a single category.
This is a normal part of the process rather than a delay in care.
It is also worth noting that a diagnosis is a clinical tool used to guide treatment, and it may change when new information arises or when symptoms change.
Rushing to put a label on the condition is usually worse than taking the time to get it right, hence a few follow-up sessions may be required.
Following the diagnosis, your psychiatrist will discuss the treatment plan with you.
Depending on the assessment, your psychiatrist may recommend lifestyle modifications, psychotherapy, medications or referral to another healthcare professional.
In many cases, more than one of these is prescribed together, as medication and therapy are often complementary, rather than alternatives, to each other.
Where medication is recommended, the decision typically involves a discussion of the expected benefits, possible side effects and alternative options.
Before deciding on the treatment plan, you are encouraged to ask your psychiatrist questions.
Common concerns
A repeating phrase I’ve heard from my patients is: “I have never told this to anyone until now. Please don’t tell anyone this.”
It is valid to worry about things before your first consultation, such as being judged, not knowing what to say and becoming emotional.
Another common concern is confidentiality.
Firstly, judgment isn’t part of a psychiatrist’s job; if anything, the opposite is true.
Psychiatrists are trained to listen without judgment.
It is also common not to know what to say, and this does not affect the quality of the assessment.
The psychiatrist’s role is to help guide the conversation, and to allow you to share your thoughts and feelings.
You may cry when speaking about what you’re going through.
Rest assured that crying or showing distress during a consultation is normal and does not need to be apologised for.
It is a safe setting for discussing difficult experiences.
Confidentiality is one of the foundations of psychiatric practice.
Information shared during a consultation is generally kept confidential and is not disclosed without the patient’s consent.
The exceptions are in specific circumstances where there is a serious risk of harm or where disclosure is required by law.
Where possible, this would be discussed with the patient beforehand.
Taking the first step
Seeking an assessment does not necessarily mean that a mental health condition will be found.
Some patients learn that what they are experiencing is a normal response to a difficult period and that they require no treatment.
In other cases, a condition is identified early, allowing treatment to begin before symptoms become more severe.
Either outcome represents useful information, not wasted effort.
For many people, the consultation itself turns out to be more manageable than expected.
The more difficult step is usually deciding to make the appointment in the first place.
In the next article in this series, we look at a common area of concern following a diagnosis: psychiatric medication, including questions about medications, treatment duration and side effects.
Dr Lim Poh Khuen is a consultant psychiatrist. This is the third in a five-part weekly series on mental health treatment and practical guidance in Malaysia. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
