Not all psychiatrists are great at what they do and it is okay to switch doctors or get a second opinion if you are unhappy with him or her. As a person with schizophrenia who has gone to different psychiatrists, here are some things I would look for in a psychiatrist:

1. Warning patients to not go off cold-turkey

This should be a golden-rule for psychiatrists to first talk about with you. This is very important, because often times patients will likely want to go off medication. It is the doctor’s duty to warn you up-front of not stopping medication abruptly, because there are withdrawal effects. The best way is to reduce incrementally if you want to go off medication. All of this should be clearly stated–and it’s suprising how many do not mention this in the beginning.

2. Focus on how you feel and sleep, not just symptoms

Too often a psychiatrist might ask questions on only symptoms, but a good psychiatrist will ask you about how you feel and sleep. As it is “their goal to reduce symptoms,” the more important questions are knowing how those symptoms affect you. Do you feel distressed? Are you not sleeping well? Those are the key questions to understand how you are doing.

3. Discuss a ‘cost-benefit’ approach

The key to discussing medications is recognizing the positives and negatives and realizing it is going to differ between people. You might have to do some trial-and-error to figure out the best medication for yourself. Often best practice is to think of it as a balancing act of the benefits with costs to your quality of life, comfort, or health. There really is a holistic perspective and trade-offs to be considered. And often time the best goal is to find “the most minimal effective dose.”

Key things to consider in finding the most minimal dose is looking at whether you are experiencing distress with your current level of symptoms. If you are coping fine, it is okay to incrementally lower to find the most minimal dose for you.

4. Understanding your personal goals

As patient, you may prefer to experience a little more symptoms with an exchange of reduced side effects, like lethargy or sedative effect, from the medication. It really comes down to the individual level’s preferences and how the drugs affect you. If working is very important, but the medication makes you sleep for half of the day, then this is huge effect towards your goals–which should be seen as a high priority for the doctor to make better. Quality of living and your preferences should be key to achieve.

5. Do medical check-ups for side-effects

Many of these medications can affect your health, especially in the long-term. It is important for your doctor to discuss potentially long-term effects as well as actively monitor your physical health. Blood tests should be done every 6 to 12 months.

6. Willingness to make changes when needed

Even if currently doing well with a medication, a person’s preferences may change and ultimately its the patient’s preferences that form the basis of medication choices. For example you may of decided on a particular medication where you noticed no side-effects except sexual dysfunction. That side effect might not have mattered to you at first, because you had no interest to be in a relationship at that time. Later on that may matter more due to changes in circumstances or desire, and you should feel comfortable discussing changes to address side effects that are a hindrance to anything personal or to do any activity.

7. Not funded or given money by drug companies

In the US in particular, there are surprisingly no laws restricting drug companies paying doctors. The Affordable Care Act (ACA), which may go away soon, did add a new mandate for drug companies to disclose in a public database the physicians they have given money to. While your physician may not be affected by the financial incentive, it does show a potential conflict of interest that you should be aware of. You can look up whether your doctor has been given money by any drug company through this government site, here.

8. Tries to avoid the ‘drug cocktails’ mess

Some doctors, if a medication isn’t working, might keep adding, not switching medications. While there are circumstances where it makes sense to take more than one medication for your benefit and different concerns, a doctor should be vigilant in not having you take too much medication. It’s okay to seek a second opinion or try another doctor if you feel this is the case.

9. No pessimism, giving you a “grave” prognosis

With a diagnosis like schizophrenia, there is no definitive prognoses. For some, the symptoms can be a passing ship with the diagnosis and for others it could be more chronic, but exists with a variety degrees of severity. As a general rule, however, symptoms tend to abate with age. If you feel your doctor is discouraging, that is definitely not helpful for your well-being. It is important to remember things can improve and you’ll learn what’s best for you with time.

10. No “casting off” concerns

If you feel not being listen to, that is a pertinent concern that should not go unnoticed. Your concerns, whether not being able to achieve your personal goals, preferences, or side effects warrant discussion. Also, especially if you feel you have a medical problem, it is important that your doctor addresses it.

Some people diagnosed with schizophrenia have reported a medical problem, but say it gets dismissed by their doctor as part of their “mental health” symptoms. A NAMI study revealed “Nearly half (49%) say that doctors took their medical problems less seriously once they learned of their diagnosis; 39% say the diagnosis made it more difficult to get access to other physical healthcare.”

This can be quite serious if a medical problem can get worse when ignored. It is possible for doctors to unfortunately have their own biases and can fail to follow proper protocol of ruling out all other causes when patients describe physical symptoms. Be careful and know there is proper procedures where they should be ruling out all other causes and your concerns need to be considered.

It can still be hard sometimes to communicate with a doctor your preferences to find the best options for you, especially if you experienced psychosis. There is no reason that you should being taking the “back-seat” and it is okay to challenge your psychiatrist, because their tendency is to look at reducing symptoms, but may not focus on the negative side effects if not brought up by you or stressed as a hindrance. Especially if not in the acute phase, they should only be there to help you know the best options based on your personal goals and preferences.

My general tips are to bring up some of the topics above yourself if not initiated by them. Discuss side effects you would especially like to avoid, balancing the costs with the benefits of medication, finding the most minimal effective dose, and goals you want to achieve can be a good starting point and a continuous way to make sure you are maximizing your well-being, health, and happiness. Sometimes the psychiatrist needs to be reminded of best practices, which could be neglected by certain tendencies in the profession. “The most minimal effective dose,” for example, is a known term, but often left out in the conversations even though it is commonly seen as a good common sense approach.

There are of course other qualities or matters you may discover you highly prefer with regards to your doctor that you could specifically want. These are just good things to look for. And if you think the doctor is an impudent asshole, it is really okay to leave him or her. No need to deal with that.

Psychiatrist appointments tend to be really short and not that informative. Hopefully this gives you useful tips in possible things to bring up during your appointments and not fall into the trap of being stuck with a horrible doctor. You can decide at any point to look for a second opinion or switch doctors if you feel like you are in that trap.

It is important to feel empowered and having a good doctor can help that progress.

Note medication, even for a diagnosis of schizophrenia, is not needed for everyone and/or there are other options you can look into. Some prefer talk therapy instead or in addition to medication. Also some people are not distressed by their symptoms and can manage without support. You can look at my resource list, which provides links to find affordable mental health services.

Hopefully these points help, but whatever you do, make sure you feel empowered by any professional you seek help from and know all your options.