Office Psychotherapy

When he introduces himself, at first I don’t realize that he’s a doctor: he offers his first and last name only, without the title. Perhaps this is because, for the present, he regards me as next of kin—in the kinship of medicine—as evidenced by my bowtie and stethoscope draped around my neck. In any case, I offer him my hand and introduce myself in the same fashion—first name, last name; no title.

He has come to our office with his small entourage: two pharmaceutical representatives, both female, both strikingly glamorous. They are sponsoring the luncheon; he is the guest speaker. The doctor is chic himself—full head of thick wavy hair, parted in the middle, designer glasses, clean-shaven, wearing a pinstripe suit and dress shirt, open at the collar, no tie. The absence of the tie suggests a certain informality of youth and freedom. When he speaks, his accent betrays a southern origin.

He is, we learn, a psychiatrist. Currently he practices at a large mental health facility in Maryland. There are over seventy mental health providers in this agency: a fanfare of psychiatrists, psychologists, psychiatric social workers, family therapists, psychiatric nurses, as well as the usual gamut of support personnel needed to run a huge enterprise.

He tells us that he is also involved in psychopharmacologic research: he and his colleagues have published a number of studies in the medical literature, studies which lend credence to his professional standing.

We sit and listen to him talk, quietly munching our deli designer sandwiches and sipping bowls of hearty soup. The topic today is pharmacologic treatment of ADHD—specifically, the use of a newer non-stimulant medication. We learn that the doctor uses this medication routinely in all of his ADHD patients. In fact, it is the only FDA approved medication that achieves a steady state in the body to keep symptoms at bay twenty-four hours a day. What’s more, it’s safe: in his practice, he’s used much higher doses than recommended in the package insert with no toxic effects. Minor side effects such as drowsiness or abdominal discomfort can be lessened by dosing with dinner or in the evening hours. What’s the bottom line? Excellent drug: efficacious, easy to titrate, minimal adverse effects.

I ask about his clinical practice: what sort of patients does he see routinely? The gamut of child and adolescent psychiatric problems, he says: ADHD, oppositional defiant disorder, conduct disorder, bipolar disorder, panic disorder, anxiety and depression—in short everything except personality disorders: they don’t respond well to medication.

I inquire about his schedule: how many patients does he see a day? Forty to forty-five, he answers, matter-of-factly. I look surprised; my face has betrayed me. But, he’s quick to add, he’s got lots of support personnel available. If a patient needs counseling or talk therapy, there’s always a mental health provider on site to touch base with the family. He handles titrating the medications—after all, that’s his job; that’s what he was trained to do.

He encourages us to consider prescribing the drug: we won’t regret it, and our parents will thank us after we’ve helped their children get back on track. He winds up the session and slings his travel bag over his shoulder.

“Next stop, Springfield,” one of the glamorous pharmaceutical representatives says, glancing at her watch. “It’s just up the road. You’re scheduled for one o’clock.”

They disappear out the front door. We clean up the remnants of the lunch, and discover a box of designer cookies on the table: oatmeal raisin, white chocolate chip, chocolate chocolate chip, sugar cookies coated with vanilla icing.

I make my selection and savor the first bite, chewing thoughtfully. It leaves a slightly bitter taste on the back of my tongue as I swallow hard to force it down.

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