What to Ask the Doctor

World Fellowship for Schizophrenia

and Allied Disorders

What to Ask the Doctor (Pamphlet No.13)

A Checklist for Families of People with Schizophrenia and Other Serious Mental Illness

INTRODUCTION:

Families are often unsure whether the psychiatrist to whom they have been referred is right for their relative. They wonder whether the doctor is up to date with current research and treatment methods; whether he/she is ready to do more than prescribe medications, for example, give counselling or arrange for a support worker. They also want to be sure that the clinician will be helpful to the family.

Here is a list of questions that families may feel appropriate to ask. We recognize that cultural differences and the variability of services make some of the questions less relevant for some families.

Don’t imagine that you will impart all of your knowledge or ask all these questions during the same interview.

HAVING A GOOD RELATIONSHIP WITH THE DOCTOR/ PSYCHIATRIST:

s We would like to be included in discussions concerning the treatment and management of our relative's illness in order to provide good care at home.

s We know that intimate clinical matters are private between you and your patient.

s We would like to have access to those apart from the doctor who are providing treatment (social workers, etc.)

s When are the best times, and what are the most dependable ways, for getting in touch with you?

s Who will be able to answer our questions at times when you are not available?

ABOUT DIAGNOSIS:

s Are you able to give a diagnosis at this time?

s If your current evaluation is a preliminary one, how soon will it be before you will be able to provide a more definite evaluation of the person's illness?

s If you have been able to give a diagnosis, what will this mean to our relative and the family?

s If you are not certain of the diagnosis, what other possibilities do you consider most likely, and why?

s Have you been able to rule out any organic diseases through neurological tests?

s Would you advise an independent opinion from another psychiatrist?

ABOUT TREATMENT & CARE:

Management Program

s Are you currently treating other patients with this illness? (Psychiatrists often have sub-specialties, that is, some treat only depression, others only schizophrenia, and others only neuroses rather than psychosis.

s What program of treatment do you think would be most helpful and how will it work?

s Is the treatment time-limited? What do you hope to accomplish in, say, the next six months?

s How frequently will you see the patient?

s How effective will the treatment be for our relative’s functioning?

s Will this treatment reduce all the symptoms and illness behaviours that our relative is exhibiting at present?

s What will be the best evidence that the patient is responding to the program, and how soon will these signs appear?

Medications

s What medication do you propose to use? (Ask for name and dosage level.)

s How will this treatment affect the patient as regards side effects?

s What are the risks associated with the medication?

s How soon will we be able to tell if the medication is effective, and how will we know?

s Are there other medications that might be appropriate? If so, why do you prefer the one you have chosen?

s How do you monitor medications and what symptoms indicate that they should be raised, lowered or changed?

ON HOSPITALIZATION:

s If our relative is hospitalized, which hospital will it be?

s Are there special psychiatric staff and wards?

s What are the options if our relative refuses treatment?

s Will provision be made for continuing care and monitoring after discharge from hospital?

ON OUTCOME:

s Can you give us some idea of what we can expect for the future?

s How can I as a family member contribute to a favourable outcome?

QUESTIONS FOR SPECIAL SITUATIONS:

If your relative has manic or depressive symptoms:

s Did you do a thyroid screening? If so, what was the result? If not, would it be appropriate to do one?

If your relative has been taking lithium for more than six months:

s Have you performed an assessment of the kidney function?

s How frequently do you think there should be reassessments of thyroid and kidney functions in connection with the ongoing lithium treatment?

If your relative is over 45 years old:

s What effect will the medication have on cardiac functions?

s Do you think it useful to perform a cardiogram?

A FINAL WORD:

You may find it helpful to write down the questions that you want to ask beforehand. The time for your consultation with the psychiatrist is likely to be limited, and having notes to work from will help ensure that you get the information you need before your appointment time is over. Some people also find it helpful to write down the answers to their questions to help them remember the information accurately, particularly if it involves details about test results or medications.

Pamphlet Revised 2008.