What will happen at the first appointment?
The first appointment will last approximately 1.5 to 2 hours.
My primary aim during the first appointment is to consider all possible diagnoses and, together with the family, determine the best treatment pathway. In order to do this, I have to take a careful and detailed patient history, hence I apologise for the rather lengthy and costly process that is involved.
The structure of the first appointment depends on the age of the young person. Less parental involvement is required for young adults, whilst younger children may require significant parental input. Some young adults require virtually no parental involvement at all.
For an ‘average’ 15-year-old adolescent, I will usually spend the first 30 minutes with the parents and young person together with me in the assessment room. During this time, I often construct a family tree. This process serves to introduce me to the family, and it also allows me to interact with your child and gauge his or her views on coming to see me, how much he or she wants to participate in the interview, and assess his or her body language and general demeanour. I understand and expect, that sometimes I may have reluctant or wary patients. I am trained to deal with this, so don’t be worried if this is the case.
If I feel the young person is comfortable and ready to talk confidentially with me, I will ask to spend about 30 minutes alone with them. During this time, I will explain to them that unless I feel they are in immediate and life threatening danger, whatever they say to me is confidential, and I shall not, share the information with their parents, or routinely with any other clinicians involved in their care. Information will only be shared with the explicit consent of the young person.
After this individual confidential session with the young person, I like to swap and have a confidential session with parents in the assessment room. If you would prefer that your child be accompanied at this time whilst you are with me, please bring along a relative or friend to accompany your child in the waiting room. Having parent-only time allows you to discuss any difficult or possibly sensitive issues that you prefer not to discuss directly in front of your child, such as family psychiatric history or financial or marital strains.
In the case of older adolescents and young adults, this approach will be modified, and there will be greater emphasis on time alone with the young person. However, it will still be useful to start with the young person alongside one or both parents, and to have less time alone with the parent/s.
Very occasionally, a young person is reluctant to be left alone with me. I am happy to adapt to whatever feels appropriate at the time and would never force a child to speak to me alone.
After the various interview sessions, I will usually bring your child back into the assessment room so that we can debrief and finish our consultation together. I will summarise my views on the main points and discuss them with you as parents and in age-appropriate language for the young person. I will explain what I feel the issue may be, and we will discuss various options in terms of treatment plans. At that point, I will convey my professional advice and views, and listen to you as a family, including your views on medication, inpatient care, psychotherapy, and lifestyle variables. Together we will build a treatment plan in order to give your child the best possible care.
I may need to request a school report, but I would never contact your child’s school without your explicit permission. I may need to undertake simple physical examinations such as height, weight or blood pressure. Sometimes I will request routine blood tests or an ECG which may be arranged via your GP, and on rare occasions, I may request that a child have a brain scan via a separate hospital arrangement.
Occasionally parents cannot persuade a young person to come and see me. If that’s the case, booking a parental advisory consultation of 30 or 60 minutes would be the best initial course of action.
I will write a medical report detailing my assessment to the referring Doctor or Clinician.
If the patient needs ongoing talking therapy, I may refer on to a Clinical Psychologist, or a Psychotherapist. However, in some cases it may be that I am the best person handle the care, particularly those relating to addictions or personality issues where a specific psychological approach is required, (such as Solution-Focused Therapy or Motivational Interviewing) as I have much experience and training in those approaches. In such scenarios, I will offer follow up sessions for your child.
Medication may be part of a holistic treatment plan, in which case I can prescribe directly, or in conjunction with an NHS or provide GP. In cases where the GP continues my prescribing recommendations, I will require regular ongoing specialist reviews.