What can I expect when I consult Dr. Herbst?
My approach to helping my patients comes from my backround and training, first as a physician, and later as a psychiatrist. This means I want to work with you to acertain the correct diagnosis and develop a sucessfull plan for treatment. We will work together to do a through history, psychiatric evaluation and physical examination and testing as needed to develop a diagnosis and treatment plan that take into account psychiatric, physical, social, and environmental history to understand and treat your needs in a holistic, yet scientifically based treatment approach.
What will happen during my first appointment?
We will meet with you for an extensive interview and psychiatric evaluation in which we will gather some information such as your history, symptoms, health information and social and family situation. During the initial session we will work together to develop a treatment plan going forward.
What if I don't want to take medication? Medication can be a valuable tool in treating mental illness, but it is not the only one. Ultimately, the decision to take medication is yours. I can help to guide you in making a decision, keeping in mind that deciding not to treat the illness with medication may also have negative effects. We will evaluate the risks and benefits of using medications as well as the risks and benefits of not using medications.
What about controlled medications such as Adderall, Ritalin and Opiates? While the goal of treatment is to provide effective treatment of your condition without exposure to the potential risks of controlled, potentially habit forming medications, sometimes the use of controlled substances for conditions such as ADD and ADHD is necessary. For patients on controlled substances, Federal Law allows a maximum of 90 day supply to be prescribed and strictly prohibits refills of these medications. Therefore, by law all patients on controlled medications must be evaluated by their treating physician a minimum of every 90 days. Unfortunately, there are no exceptions allowed for in Federal Law, and even patients who have been stable on medication for years and have no sign of medication abuse or dependence must be seen every 90 days.
What about supplements and natural medications? My approach to supplements and "natural medications" is that their risks and benefits should be evaluated using the same evidence based approach as any medication. Just because a medication comes from a plant does not make it safe. Opium, Cocaine, Digitalis, Rauwolfa and Belladonna are just a few examples of plant based medications that can have theraputic uses, but certainly are not safe just because they are "natural". If there is good evidence that a "natural" medication is safe and effective in treating your condition, then we should certainly consider it as part of your treatment plan. However, we should keep in mind that supplement companies also make many claims about their products that are not as rigorously evaluated as FDA approved medications.
What about Medical Marajuana? My approach to medical marajuana is similar to that of other "natural medications". Where there is clear evidence that cannibis may be helpful in treating your case, it may be part of a treatment plan. However, at this time, there is little scientific evidence that cannibis is a theraputic treatment for most psychiatric disorders including Schizophrenia, Bipolar Disorder, Major Depression, Attention Deficit Disorder, or Obsessive Compulsive Disorder.
While cannibis is generally safe in low doses with occassional use, there is good scientific evidence that excessive use of cannibis can cause side effects including weight gain, poor attention/concentration, memory disturbance, endocrine abnormalities and, in some cases, increase anxiety or even cause paranoia.
With the changes in the legal status of cannibis I will often hear that "marajuana is safer than alcohol" This may be true, but there is little evidence that alcohol is beneficial in the treatment of mental illness, while the evidence that alcohol has substantial side effects is very well documented.
Will my treatment be kept confidential?
We will not reveal any information regarding what happens within the work that we do together unless you have signed the Authorization to Disclose Information form. In the instance that you are in imminent danger of harming yourself or another, then we are obligated both by law and ethics to take action to prevent harm.
Will the cost of my treatment be covered by my insurance plan?
Although payment is due at the time of services, Dr. Herbst is considered an out of network provider for most insurance plans. Most plans cover approximately 50% of the cost. Recent changes secondary to the Affordable Care Act mean that a psychiatric evaluation or follow up visit must, by law, be compensated at the same rate as any other physician visit and that insurance companies cannot deny a claim because it involves psychiatric treatment. We will provide you with all of the forms needed to file a claim with your insurance company.
How long will my treatment last?
Dr. Herbst belives in individualized approach to each patient and everyone's treatment length is different. Generally, patients may need to meet with Dr. Herbst more frequently while developing the initial treatment plan or if there is a crisis situation. Once the problem is properly diagnosed and treated we will meet less frequently to ensure the condition does not return.
How can I prevent mental illness coming back?
This is one of the key goals of any treatment plan. The vast majority of evidence shows that prompt, effective initial treatment, followed up with consistant adherence to a treatment plan markedly reduces the chance of relapse.
What if I have an emergency or an urgent situation come up?
If you find yourself in the midst of an emergency, please immediately call 9-1-1. If you have an urgent situation, call our office, and we will see you as soon as we can. I am generally quite available for urgent questions, but as a back up, I work with a team of experienced psychiatric nurses who provide support if I am away from the phone or with another patient.