If your question isn’t answered below or elsewhere in this site, please contact me directly.

1. How do I know if I should come see you?
2. How do I schedule an appointment?
3. What happens at my initial consultation?
4. What should I expect after my initial consultation?
5. How do I get medication & refills?
6. What about fees and payment?
7. What if I have an Emergency?
8. How do you keep my records?
9. What If I’m concerned about someone else?
10. What is your treatment philosophy?
11. What about a brain scan?
12. What about psychological testing?
13. What questions do you ask?

1.  How do I know if I should come see you?

The simple answer is: Come see me if your life isn’t working the way it should, or if you feel terrible all the time for no reason.  The fictional examples below may help.

“Is there something wrong?  You don’t seem like yourself lately.”

These are not words that a high function/high potential individual ever wants to hear, but this may be your first clue that other people have started to notice.

Even if no one seems to have noticed, see if any of the following scenarios sound familiar:

• You don’t have fun anymore and nothing brings you pleasure.  You feel irritable all the time.
• You can’t fall asleep or stay asleep; or you feel like sleeping all the time.
• Your weight and appetite fluctuate more than usual.
• Your normal energy is gone.  The mere thought of a task is overwhelming.
• Your mind is dominated by worry and anxiety.  You obsess about things you shouldn’t.
• You have unreasonable fears of loss or failure.  You feel guilty for no reason.
• You find troubling significance in ordinary things.  It feels like people are out to get you.
• It’s impossible to get things perfect, so you never feel like you’ve finished anything.
• You find it difficult, almost painful, to get rid of stuff, even useless stuff.
• Easily distracted, you can’t pay attention or stay on track.  People joke about your “A-D-D”.
• You feel totally enthusiastic about everything!  Execution and follow through don’t always happen.
• People question your judgment or make comments about your behavior.

Regardless of what the problem looks like, if life isn’t working for you or you just feel terrible all the time, you probably need help to get back to being yourself.

2.  How do I schedule an appointment?

Via Phone (425-646-1141)

When you call my office you’ll connect to self-explanatory voice mail. I don’t have a nurse or a secretary (no staff confidentiality issues).

At the “Leave a Message” prompt, be sure to leave your name, your contact number(s), and best time to reach you.  Also, leave any special instructions (for example, “Don’t tell my secretary you are a doctor.  Just give your name, and say I am expecting your call.”).

Via Email

Please include name, contact info, as well as special instructions.

My goal is to call you back within 24 hours.  I can usually see you within a few days of your call, if not sooner.

Once we have connected, we can work out an appointment time that fits best with your schedule.

3.  What happens at my initial consultation?

My office is located in a quiet, wooded business park, not a busy medical center or clinic. There’s lots of free (and anonymous) parking.

I have a private waiting room, so please come in.  If my office door isn’t open, please have a seat, and I’ll be out shortly.  I space appointments, so there shouldn’t be anyone else in the waiting room.

Your first appointment will be a thorough and detailed evaluation.  I’ll work with you to understand the issues that brought you in to see me.

Once I have an idea about the main problems, I’ll ask more specific questions, starting with allergies, habits, medical & surgical history, and eventually moving into other areas of your life that may be relevant.

When both of us think the issues have been clarified, I’ll then discuss my ideas about what the problems may be, and how best to deal with them.

Metabolic problems, which can mimic any known symptom, can usually be ruled out with a few well chosen lab tests.  I have my lab orders processed at Meridian Valley Labs (MLV), a private medical lab that will process specimens anonymously. No names are used.

Treatment often involves medication.  I carefully choose medication that will not interfere with your thinking or reasoning.  (Remember, we are all individuals, so the medication that worked for your friend’s brother may not be right for you).  I work with a private pharmacy.

Psychotherapy may be recommended.  There are different approaches, and I will discuss each with you so that you can make an informed decision.

We will end our meeting by arranging follow up plans, which may include scheduling our next appointment.  In general, the first follow up appointment is about 3 to 5 weeks after the initial evaluation, and then about 3 to 6 months thereafter, if needed.  If we decide on a course of psychotherapy, frequency and expected duration will be discussed at that time.

As you exit through the “back door” specially built into my office, no one in the waiting room will see you leave

4.  What should I expect after my initial consultation?

If you are prescribed medication for sleep or anxiety, you should notice results in as little as one or two days. If you are prescribed antidepressant medication, it could take a week or two before you notice significant effects, with continued improvement over several months.  That’s why it’s important to continue taking medication as prescribed.

Although statistical predictions about various treatment outcomes are known, your individual response to a specific medication will vary.  I will tell you about the most common possibilities before prescribing the medication.

Most people experience minor or no side effects from psychiatric medication. If you do experience minor side effects when first starting a new medication, they usually diminish or disappear after a week or two.

In any case, I encourage patients to check in by email after a few days to let me know how they are doing.

If you experience persistent or major ill effects from medication I have prescribed, stop taking the medication and contact me for an appointment ASAP.  Although my practice isn’t designed for 24/7 operation, I respond to calls as quickly I can.  However, please do not think of this as emergency care.  Please see Emergency instructions further down this page.

5.  How do I get medication & refills?

I work with a private pharmacist.

6.  What about fees and payment?

Fee structure will be discussed when you call for an appointment.  My fees are reasonable and consistent with community standard.

I accept payment in cash at the time of your appointment.  Please be prepared.

At your discretion, checks from a local bank are acceptable (checks verify your payment and may raise privacy issues).

I don’t take credit cards at this time.

I do not bill insurance or take insurance assignment.  If requested, I can provide you with a properly coded bill to submit to your insurance company yourself.

My philosophy is simple:  You pay me directly, you direct your care, with no outside influence or interference.

7.  What if I have an EMERGENCY?

I do not have 24/7 coverage, however, I respond quickly to calls and emails.  For serious problems, please do as follows:

If you have an emergency, do not hesitate.  Immediately call 9-1-1 or go to the nearest Hospital Emergency Department.

8.  How do you keep my records?

I keep a standard electronic medical chart on a non-networked, non-shared computer.

A paper record is kept for accounting purposes in a fireproof locked file cabinet.

I keep back ups to protect against data loss.

ALL records are kept locked in a fireproof locking file cabinet for safe keeping.

Although I go to great lengths to keep your records private, please understand that the purpose of what I do and how I do it is not to break or evade any law or statute, nor deceive any regulating authority.

9.  What if I am concerned about someone else?

What should you do? Suggest they look over this web site. People are naturally more motivated when they make their own decisions, so it’s best if they do their own investigations.  Don’t push.  It may take a little time for them to get used to the idea of consulting a psychiatrist.

Although some people will see the need right away, others may not like the idea at first.  If the person you are concerned about seems hesitant or resistant, be gentle.  No one likes to feel pushed into anything.  Remember, their objections probably conceal their real objection, and only they know what that is, so repeated attempts at persuasion almost never work.

If “I don’t have time” comes up, you might mention that my office is very easy to get to, with lots of free parking, and appointments scheduled to suit the individual, not the other way around.

If someone wants information or is unsure about some part of the process, exploring this web site may help.

If possible disclosure of treatment is a deterrent; please let them know about my services!

10.  What is your treatment philosophy?

This is a question that has several answers, depending on one’s perspective.

Most basic:

• I always tell you the truth.  To be perfectly frank, that is what you pay me for.
• I do my best to leave out the jargon and mumbo jumbo.  Most of my patients don’t have years and years of professional training in this field, so big complicated words usually don’t help people understand any better.  Anyway, if I can’t explain something in plain English, I probably don’t understand it myself.
• I don’t know everything about anything, so if you come across information you think may be helpful, on the web or elsewhere, by all means, bring it in with you so we can discuss it.

Most specific:

• My work is patient centered, but more importantly, patient directed.  I am your trained and experienced navigator, but you are at the wheel.  In every case, I’ll present you with what I think are the most reasonable choices.  That includes the choice to do nothing.  I’m a big fan of the Lewis Carroll line from Alice in Wonderland, “Don’t just do something, stand there!”  Sometimes doing nothing is hardest, but sometimes it’s also the best.
• I use a traditional, medical based approach, with innovative and creative techniques using the latest information from around the world, tempered with my 16+ years of experience.  I am not afraid to try new things, or even unorthodox approaches to problems, but neither do I chase rainbows or promise you the moon.

To summarize:  My goal is to provide you with highest quality care possible, delivered in the most ethical manner, with great attention devoted to maintaining your privacy.

11.  What about a brain scan (CAT, MRI, etc.)?

Although beautiful to look at, metabolic brain scans are still primarily research tools. I anticipate scans in the future being very helpful in directing treatment, but at this time there are too many variables for functional scanning to be clinically useful. However, use of imaging is mandatory if a structural lesion is suspected (tumor, stroke, etc.). If after initial evaluation, it appears that imaging might be helpful, we can discuss your options.

12.  What about psychological testing?

Psychological testing can be helpful in certain cases. In general medical psychiatric evaluation, testing doesn't often add a great deal of additional information. If it appears that testing will be useful in your situation, we have several options. However, I routinely use rating scales to measure progress in a number of different situations.

13.  What questions do you ask?

I ask as many questions as it takes for me to get to know you, and understand your issues.  Although each person is different, these are the basic areas covered in every evaluation:

• Chief complaint; why you've come to see me
• Course and history of problem
• Life changes, losses and stresses

• Prior mental health and family history
• Medical and surgical history, and personal habits
• Current medications (bring a list of meds & doses)
• Vitamins and OTC supplements
• Lifestyle, social and family of origin history
• Neurovegetative signs and symptoms
• Mental Status Examination
• Additional tests as indicated