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My psychiatrist sees 50 patients a day. How is this possible?

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The question: I suffer from depression – at times quite severe – brought on by combat-stress injuries and post-traumatic stress disorder from about 20 years ago. I receive satisfactory treatment from a psychiatrist at a major teaching hospital, though my appointments are not the same depth I had from years of psychotherapy elsewhere. My depression has gone from crippling to functioning around 70 per cent of normal. Recently, when I tried to change an appointment, staff told me he booked up to 50 patients a day and, using a manual system, they couldn't change it. Can my psychiatrist see that many patients a day? Should I think about another referral?

The Answer: Post-traumatic stress disorder – an anxiety condition caused by a life-threatening traumatic event – is treated by specific forms of psychotherapy. Exploratory psychotherapy, in which patients attempt to open and therapeutically close a wound, can do more harm than good for patients with PTSD.

Janet McCulloch, a Kingston psychiatrist who treats a large number of patients with PTSD, noted you have felt mostly satisfied with the treatment, which is good, and that sometimes, less can be more when treating your condition.

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"Often people do not want long appointment times as they don't want to get into things that may be destabilizing," Dr. McCulloch said. "They just need to touch base with someone who knows them well, knows when they are slipping and knows when the meds need to be adjusted."

Your condition, which can cause flashbacks, nightmares and depression, is a lifelong one. Some patients choose supportive care – brief sessions, medication checks – knowing the risk of going deep could trigger a relapse. For some, that form of supportive care is enough.

Given your relapses with depression, you may want to find a psychiatrist or psychologist with experience in PTSD who could explore the newer therapies of Eye Movement Desensitization and Reprocessing [EMDR] which can help process distressing memories and allow more adaptive coping mechanisms. Another is Electroencephalographic [EEG]neurofeedback , a direct training of brain function, with the aim of making the central nervous system work more efficiently.

According to Dr. McCulloch, if you have a pensioned condition with Veterans Affairs Canada, the psychologist and psychiatrist would be funded through that body and you could apply for this through your area counsellor or case manager.

As for the 50 patients a day, it sounds high but if this is the day where a psychiatrist does medication rechecks, which take five or 10 minutes per patient, it may not be terribly unusual.

Columnist's note: In my last column, about the doctor who would not refer a patient with cataracts to an ophthalmologist, readers brought to my attention another solution: Go to an optometrist who can make that referral.

The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to

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