For Medical Providers

I am a physician before I am a psychiatrist, and I am comfortable with a patient whose psychiatric picture is tangled up with a medical one: renal or hepatic impairment that constrains prescribing, an oncology or autoimmune course that reshapes mood, delirium risk in an older adult, interactions across a list you are already managing.

My master's training at Stanford focused on clinical research and epidemiology. That training informs how I assess research findings and apply them to an individual patient's care.

That also covers the patient whose somatic symptoms have outrun the workup. Being able to read the chart, and to say plainly when I think the remaining question is not psychiatric, is usually more useful to you than another referral onward.

A patient who has accumulated psychiatric medications across several prescribers, none of whom owns the list, is a common and awkward referral. It is one of the more satisfying things I do.

Deprescribing is a named part of my work and it is planned: which agent moves first, over what interval, what withdrawal looks like against relapse, and what has to be in place psychotherapeutically before a taper starts. Benzodiazepine and sedative-hypnotic tapers in particular go better when CBT for insomnia or exposure work is carrying the load the drug was carrying.

When a patient sees a psychiatrist and a therapist who have never spoken, the coordination usually falls back on you. Here psychiatric medication management and the psychotherapy sit with one person. I finished my adult psychiatry residency at the University of Washington with distinctions in Psychotherapy and Psychopharmacology, so there is a single clinician accountable for the plan and a single number to call about it.

For your patient that means the first appointment produces a formulation and a set of recommendations covering medication, psychotherapeutic approach and behavioral change, rather than a prescription and a referral onward.

A note through the contact form or a call comes to me, with no intake coordinator in between. After I have seen your patient, and with their permission, the formulation and the recommendations come back to you. A small panel and longer appointments also leave room to answer a colleague, so expect a reply about a shared patient, and expect me to tell you when I think the psychiatric contribution is small and the problem is mostly yours to manage.

Second opinions are a normal request and do not require moving the patient's care. If what you want is an assessment and a written recommendation handed back to you, that is a complete piece of work and I am glad to do it that way.

This is outpatient, scheduled, cash-pay care. It is not an emergency service and not a substitute for a higher level of care: acute suicidality, psychosis needing urgent stabilization, or anything requiring inpatient admission should route through emergency services, not a booking here.

I see adults, so a child needs a different referral; teenagers I take case by case. I do not bill commercial insurance. I see patients with Original Medicare (Part B) on a case-by-case basis; contact me before referring to discuss availability and expected charges. The private-pay fees are published – $695 for the 85-minute initial evaluation, $495 for a 55-minute combined appointment after it – so the affordability question can be settled before a referral rather than after.