August 18, 2022
Carlene MacMillan, MD
In her series, The Practice Playbook, psychiatrist Dr. Carlene MacMillan shares insights & best practices designed to help clinicians grow and run their mental health practice.
When working as a trainee at a hospital or as an employee at a clinic, new patients likely appeared on your schedule and you saw them without a lot of flexibility as to whether or not they were a good clinical fit. Fast forward to owning your own practice and you suddenly have the opportunity to decide what types of patients you want to work with.
In our “Building Your Private Practice” series, The Practice Playbook we are following along with adult and child psychiatrist, Dr. Robert Dugger, as he opens his brand new practice, Sarasota Minds. Not surprisingly, Dr. Dugger has put a lot of thought into the types of psychiatric concerns he is best suited to handle in his practice.
In part one, we covered setting your foundation from a legal, business, and web-design perspective. In this article, we'll dive into best practices around screening new potential patients.
This could include specific diagnoses as well as types of appointments like second opinion consultations for complex cases. Some psychiatrists only see patients for medication management if they are also seeing them for psychotherapy. Other psychiatrists are comfortable with patients either not being in regular psychotherapy or working with an external therapist they can collaborate with. You should state which approach you're planning to take since it can vary so much.
This could be an embedded brief screening form (although make sure it is HIPAA compliant if storing protected health information), an email, or even a phone number. Keep in mind a form is likely going to be easiest for most patients and for you as you can collect some structured information. Dr.Dugger also uses this form as an opportunity for prospective patents to indicate they understand practice policies around things like fees, availability outside of sessions, and prescribing of controlled substances. This form should be quite basic and is not meant to take a full history because it's a negative experience if a patient fills out a lengthy form on their personal and medical history only to be turned away because of a logistical barrier like not living in a state where the clinician is licensed or wanting a type of service not offered.
After reviewing the brief screening form, voicemail or email and determining the patient may be a good fit for your practice, the next step is scheduling an initial appointment and sending paperwork to be filled out electronically ahead of time. This includes things like detailed practice and privacy policies, the Good Faith Estimate to comply with the No Surprises Act and a comprehensive intake form that asks questions about the patient’s medical, psychiatric and social history.
As an Osmind user, Dr.Dugger has access to an online form patients can complete on their phone, their computer or even on a clinic iPad in the office. As it consists of different modules, he can select how detailed of a history he would like to obtain ahead of time. Keep in mind that this intake form helps to set the tone for your work with a patient, so things like making sure patients can select their pronoun and their name to use if different from their legal name are important. Osmind’s form is designed to do this, along with multi-select options for things like race, relationship and employment status—so patients can convey nuanced information about their background if that is important to them.
Once the patient has returned their intake form and scheduled their appointment, you'll have gathered a lot of information to make that initial assessment efficient and focused on areas warranting an in-depth exploration. By collecting more information prior to the appointment, you can focus more on connecting with the patient and helping them to feel understood and less on being a scribe jotting down minutiae about dates of past medication trials and surgeries!
In Part 3 of the Building Your Private Psychiatry Practice series, I’ll discuss collecting payments from patients and setting fees, a subject many clinicians feel awkward about but is essential to address in a thoughtful manner.
Dr. Carlene MacMillan is Vice President of Clinical Innovation at Osmind. She is the founder of Brooklyn Minds Psychiatry, a multidisciplinary team-based, multi-site practice in New York City. Her practice was one of the first to offer deep TMS for OCD and esketamine for severe depression and suicidal thinking. Dr. MacMillan is an expert in mental health communities, with a large following on platforms including Clubhouse (@psychiatrist), where she champions awareness of evidence-based and innovative approaches in psychiatry. She is a member of the Ketamine Taskforce for Access to Safe Care and Insurance Coverage. She is the Co-Chair of the Clinical TMS Society Insurance Committee and of the American Academy of Child and Adolescent Psychiatry Consumer Issues Committee.
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