An Insight into Adult and Geriatric Psychiatry with Ashok Bharucha of Transformations Psychiatry.

Transformations Psychiatry

In this interview with TechBullion, Ashok Bharucha will be telling us more about Adult and Geriatric Psychiatry, who needs a psychiatrist, and when, also the services he provides at Transformations Psychiatry.

Q: Please tell us about yourself and your journey so far as a psychiatrist?

A: I was a chemistry and German major during my undergraduate studies. Even though I always knew I wanted to pursue medicine, I’ve had a deep and abiding interest in storytelling and narratives. Not surprisingly, when the time came to choose a medical specialty, psychiatry seemed like an optimal fit. One of the great joys of psychiatry is that it offers so many different pathways to personal fulfillment. Not only are there multiple subspecialties, but also multiple treatment orientations, as well as a range of treatment settings within which one could work. Geriatric psychiatry appealed to me given that it straddles the borders of internal medicine, neurology, and psychiatry. I am now completing nearly 30 years of work as a psychiatrist – I have been a researcher, clinician, and teacher, all roles that I have highly valued. In addition to deepening my own experience and wisdom, the field has offered me ample opportunities to positively influence the lives of my clients and trainees. 

Q: What do you do at Transformations Psychiatry?

A: I am a solo private practitioner, operating as an adult and geriatric psychiatrist. I manage all aspects of the business and clinical care. The advantage of this approach is that clients need not navigate complicated bureaucratic mazes to have their questions and concerns promptly addressed.

Q: What is Adult and Geriatric Psychiatry, please explain this to us a little more? 

A: Adult psychiatry involves the assessment and management of a diverse range of mental health disorders. A psychiatrist typically performs a medical, cognitive, behavioral, and psychosocial evaluation of problems to obtain the clearest possible picture of the situation. Geriatric psychiatry involves the assessment and management of late-life mental disorders as well as dementia and its complications. Geriatric psychiatry requires fluency in internal medicine, neurology, and psychiatry.

Q: When we hear psychiatry, we often assume serious mental health issues. Could you throw more light onto when someone needs a psychiatrist? 

A: Psychiatrists see individuals ranging from those who are highly functioning to those with more serious mental health problems. For example, it would not be unusual to evaluate a very successful professional whose work and home life is being adversely affected by attention deficit hyperactivity disorder. On the other hand, psychiatrists must also manage serious mental disorders such as schizophrenia, bipolar disorder, depression, anxiety, trauma- and stressor-related disorders, substance use disorders, and personality disorders.

Q: What are the prevalent causes of psychiatric issues and how can we avoid or mitigate them? 

A: There is no single “cause” of psychiatric disorders. Every condition is an interaction between genetics, environment, and other biological or developmental factors. Much neuroscience research currently focuses on the underlying genetic, neuroscientific, and molecular mechanisms of psychopathology, and how these are impacted by environmental factors.

Q: Please tell us more about the services you provide and the conditions you treat. How does it work? 

A: As a psychiatrist, the most important service I provide would be a medical and psychiatric evaluation, diagnostic assessment, and treatment planning. I review my impressions and recommendations with the client and seek their input into the treatment plan, recognizing that best outcomes are possible only when the client feels s/he is a full collaborative partner in the plan. As a geriatrically trained psychiatrist, I am also trained to evaluate cognitive/behavioral disturbances of late-life, particularly dementia syndromes, but also other conditions that may result in cognitive/behavioral changes. The dementia assessment and management work is much more time and labor intensive in that active participation of significant others is often key. There is no substitute for competent communication skills in my line of work.

Q: What measures do you have in place to guarantee a better collaborative therapeutic relationship with your patients? 

A: Prior to each new consultation request, I ask my prospective client to submit a range of standardized rating scales that are commonly used in the field, along with forms that I have personally developed to gather as much of the past medical and psychiatric history as possible. Every new consult is allotted at least 90 minutes to make sure the client has a chance to convey everything that is on their mind, and still provide us with sufficient time to review my diagnostic impressions and suggested treatment plan. Before the client departs from the visit, I make sure they have my cell phone number as well as email so that they know I am truly invested in their care, and do not wish for them to experience any impediments in their treatment process.

Q: Oftentimes, the cost of treatment prevents patients from seeking help, tell us more about your costs and insurance coverage? 

A: I am in-network for Highmark BCBS products, commercial Aetna products, and traditional Medicare. In addition, I offer sliding-scale out-of-pocket payment arrangements to those who may not be able to afford my standard fees which while high are still below those charged in major metropolitan areas.

Q: What other support and resources do you provide to help your patients after psychiatric care treatment? 

A: My personal website has an Educational Resources page with links to many prominent national organizations that offer very valuable resources. On that same page, I have also posted a pdf file of suggested readings, organized by mental health condition, that could also serve to better inform the client. Dropout rates from treatment tend to be in the mental health field, especially when the treatment has led to significant functional and quality-of-life improvements. I always leave the door open for every client who wishes to return at a future point, though my preference is always that they engage in periodic maintenance treatment since relapse rates with most major psychiatric conditions are quite high. 

Q: Do you have more information for our readers? 

A: I imagine it’s very difficult as a prospective client to determine who would be an excellent, competent provider. Often, the best source of information might be someone else who has had experience with a particular provider. While Internet-based information can be helpful, I would not rely solely on that source of information – like any other source, it is prone to many forms of biases. I think it’s incredibly critical to learn what one may expect by way of length of visits, availability between visits, timeliness in responding to issues/concerns, and what the provider’s treatment philosophy might be. For example, some psychiatrists operate a purely pharmacologically based service with little to no interest in the individual’s life. 

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