I was playing house until…


I love seeing patients. And I know this is true because as I was working on this video, I kept saying "This is my favorite case" or "my favorite patient said..."

Can they all be my favorites?

I mean, probably not, but what a great way to feel about work!

Which is strange because 2 years ago I was pretty unhappy in my contract position and I didn't have a private practice at all!

I had spent months dancing around the idea of my own virtual private practice and set the whole thing up as if I was just playing house and never expected to actually have anyone over for tea.

Until I had to, quick, throw on some Vivaldi (or maybe Taylor Swift?) and grab the nice china because, SHITE! I have a patient booked! In the clinic that only existed in theory. (But also had a bank account, a PLLC, and an EIN so not exactly made up.)

And now, almost 2 years later I don't dance around anything anymore. I put on some Taj Mahal and groove through my clinic knowing I'm doing it in a way that aligns AND putting good out into the world.

And yeah, pretty much all of my patients are my favorite!

So this video, about 3 of my favorite patients who came to me with anxiety, discusses presentation, some things that could have gone wrong (or actually did!), and the medication choices and changes we made and why!

It's a little longer than usual, 21min, but that's because I love talking about my favorite cases!

If you don't wanna watch the whole thing that's cool too (hopefully you have to do something more important like chill on a raft in a pool avoiding burn out and a sunburn).

But these are the most important take aways!! Commit these to memory and become an anxiety med whisperer!

The 4 questions to always ask before starting a medication discussion with a client (this is specific for anxiety):

  1. What kind of anxiety is it? i.e. physical, mental, constant, triggered, all this from anxiety video 1
  2. What's the time frame? i.e. is there an end point or is this going on for a while
  3. What feelings does your client have about meds? i.e. love 'em? Hate 'em? Can't remember to take them?
  4. What's the family history or any contraindications? i.e. fam does well on Prozac? Substance use disorders a problem?

Then always address these too:

  • Don't say THAT!: "Just ask the prescriber"
    • Please don't just pass the entire med conversation off onto a prescriber. They likely won't have the same impact because they don't know your client as well and may not have as much time
  • Say THIS instead: "Here's what I can tell you about treating your kind of anxiety with meds"
    • Really! And then proceed to tell them what you know and feel comfortable with about meds: PRNs vs. daily meds, common side effects, how long it takes to start working. It's the prescriber's responsibility to consent the patient before actually giving them a medication but you can give the client as much info as you feel is helpful!
  • Always as questions!
    • I mean you already do this. But finding out why they think meds will or won't help or they can or can't take a daily medication could help them when they do talk to their prescriber
  • Instill hope!
    • Always. This is imperative. I instill hope and that helps people feel better. I'm honest about what meds can do for them but always give them that half full glass of optimism by the end of our visit!

And that's really what it all comes down to!

But I'm really serious about you talking to your clients about medications. There's no way your conversation can be worse than going down that Google rabbit hole and reading about how Prozac has caused people to get their appendix out or breast cancer or for their partner to leave them.

You don't actually prescribe the medications so even if you say something not quite right it's still always the prescriber's responsibility to explain and consent the patient for every medication and choose the dosing that makes sense. You are off the hook!

And there's nothing better than when a patient tells me their therapist suggested they see me about starting Lexapro and then that's exactly the right thing for them! No one is surprised, and the client has faith in both of us AND their new medication!

Now go forth and be awesome!

Cheers to healthy brains,

Dr. B

Jessica Beachkofsky, MD

Your friendly online psychiatrist!

p.s. This is the best thing ever! I made Thera Blanks (even though I copied it from Mad Libs) and it’s digital so only requires your phone (or computer) which is always glued to your person anyway. Wanna show how clever you are with esoteric vocabulary or obscure names? This is the place to do it! And after you list your impressive words you'll read your even more impressive story that you created! Congrats on making an incredible new medication! Now you just need to work on that FDA approval.

p.p.s. the video link for anxiety cases!

Welcome to Brain Bites with Dr. B!

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