An Interview with Psychiatrist Evelyn Nelson
Evelyn Nelson, MD is psychiatrist at Seattle Anxiety Specialists, PLLC. Dr. Nelson specializes in the treatment and medication management of anxiety related disorders.
Jennifer Ghahari: Hey, thanks for joining us today for this installment of The Seattle Psychiatrist Interview Series. I'm Dr. Jennifer Ghahari, Research Director at Seattle Anxiety Specialists. I'd like to welcome with us psychiatrist Evelyn Nelson who's one of the psychiatric providers at Seattle Anxiety Specialists.
Evelyn specializes in the medication management of anxiety related disorders and utilizes a holistic approach in her patients' care. Before we get started today, can you tell our listeners a little bit about yourself?
Evelyn Nelson: Yeah, sure. Thank you for the introduction. I'm Dr. Evelyn Nelson, I am an adult psychiatrist. I live in Seattle, and I live with my husband and two-year-old daughter, Emmi. And so, we just moved into the area about a year ago, so we're just kind of getting used to the area, loving exploring, being outdoors. And originally I'm from California and so, it's a very different climate, very different environment, but yeah - just getting used to the area.
Jennifer Ghahari: Nice. What are your favorite parts of the Seattle area, or Washington as a whole?
Evelyn Nelson: Oh, I love being outdoors, and I love the greenery. I've always lived around water, so that's really important to me. So, being around the water, being around greenery, taking ferries just seeing the islands just is my absolute favorite, and was a big reason why I wanted to move into the area. And so, just the outdoors scene, and the greenery is just the best part honestly.
Jennifer Ghahari: Do you have a favorite outdoor activity, or is it like everything?
Evelyn Nelson: I love hiking with my daughter just because we're starting to get into hiking with her. And so, there are a lot of new things, and seeing her just kind of explore the trees, and slugs, and different animals is very cool and exciting.
Jennifer Ghahari: Wow, that's awesome. Great. Thank you for sharing that.
Going back a little bit and a few years back now, what is it that got you interested in becoming a psychiatrist?
Evelyn Nelson: Yeah so, it originally started with just an interest in, at baseline, “What motivates people? What drives people to do what they do?” And so, that interest started with my majoring in religious studies as an undergrad. So, that's kind of where this theme started. And over time, as I started to study religion and psychology, my interest expanded into more of an interest in being more active in that study, and being more active in the role of helping people. And then, so that's kind of how that developed into psychiatry.
There was a point where I was considering becoming a therapist. But I also was very interested in medication management. And so, that's why I went down the psychiatry route.
Jennifer Ghahari: It's like the best of both worlds in your case.
Evelyn Nelson: Exactly. And I wanted to make sure that I had the full realm of ability to help people. And I wanted to make sure that I wasn't kind of ruling anything out. And so, going into medical school, I actually knew that I wanted to be a psychiatrist. I was kind of one of those rare cases where I went into medical school to do psychiatry. Whereas, I think, a lot of people go in with an open mind, see what is interesting to them. And I always knew.
Jennifer Ghahari: Wow, that's great. It was kind of a long-term calling for you.
Evelyn Nelson: Exactly, yeah.
Jennifer Ghahari: Can you speak to the reasons why a person may see, or should see a psychiatrist?
Evelyn Nelson: Yeah, of course. So, I mean, the reasons that people see a psychiatrist are just so expansive. I think there's a misconception that you have to be really struggling, or really not functioning, or just things have to be dire to see a psychiatrist. And that's just not true.
I see a full range of people. So, people who have been engaged in mental health care for years and are very involved in the system. But then, I also see people who don't really know what psychiatry is, don't even know if they want to take medications. They tell me their struggles, and sometimes we decide maybe medication isn't appropriate. So, I see a full range.
And so, what I hope for people is that they're not scared out of a misconception that we're going to push medication on you. Or you have to be at a certain point in your life to see a psychiatrist. It's a huge range. And really it's not harmful to just have a conversation to be able to just see what's going on, and see how I could potentially help. And sometimes it's not medication, sometimes it's therapy. Sometimes there's just kind of a natural transition in life, but it's hard to know without that initial conversation. So, the reasons are just huge.
Jennifer Ghahari: Great. And at its core you are, as you said, a doctor, you went to medical school. And so, I think what might be helpful for people to know too is that they shouldn't be afraid to see a psychiatrist. It's really akin to going to any doctor in many regards.
Evelyn Nelson: Exactly right. And you don't have to have an established diagnosis. You don't have to know that you want to take medication. That's part of our job to see if medication is even appropriate. In an intake and follow up appointments that's part of the conversation. People don't go into visits 100% needing medication. That's just not the reality. And so, it's important for people to know that.
Jennifer Ghahari: Thank you.
Are there any disorders that you specialize in?
Evelyn Nelson: Yeah, so I specialize in anxiety disorders, PTSD, mood disorders, so including bipolar disorder and depression, and ADHD. Those are the multiple things that I specialize in, but I see a huge range of diagnoses.
Jennifer Ghahari: And can you talk a little bit about your treatment approach?
Evelyn Nelson: Yeah. So, the most important thing is that the person coming to me is on board with whatever plan that we have. So, the way that I approach medication management is just getting input from my patient, and just making sure I have an understanding of what's going on with them, and what is really bothersome for them. And then, understanding what they're feelings about medication is.
And then, from there, getting a sense of comfort level. Are they afraid of a certain type of medication? Are they afraid of a certain type of side effect? And it's really important for me to know these things before I even suggest a medication just because there are so many things that are avoidable, or things that we can kind of work around. Or if someone's really afraid of something, it's just so important for me to know. So, that's kind of my approach is just taking a team approach with my patient. And then, going from there.
I also tend to be pretty conservative in terms of starting medication slowly, monitoring for side effects. And that's just always been my approach. And I think it's helpful for people, especially who are afraid of taking medication to have that approach.
Jennifer Ghahari: And, from my point of view anyway, it's really nice to hear that things are very customizable. It's not a one size fits all type of treatment where everybody just gets the same type of thing. So, that's great that you really take the time, and trust people's fears and concerns.
Evelyn Nelson: Yeah, exactly.
Jennifer Ghahari: So, let's say, that I sign up for an appointment with you. And right now, I have no idea what to expect from the process. I presume that there's some type of paperwork to fill out, like when I go to any doctor.
Evelyn Nelson: Yeah.
Jennifer Ghahari: Can you explain what the process actually is, and what I can expect in a first session with you?
Evelyn Nelson: Yeah. So, initially, if somebody signs up for an appointment with me there's some paperwork, just getting some basic medical history, getting information about the medications they're on. And then, basic assessments in terms of mood, and anxiety, and other kind of psychiatric symptoms, just so I can get a sense of what the person can be potentially coming in with so I can prepare for the visit. So that's initially. And once the visit comes, the intake is usually scheduled for 60 minutes. And our interaction would be like 45 to 60 minutes is usually standard. And then, so initially what we talk about is just what's bringing them into the visit? What's been bothersome? What concerns do they have? So kind of getting a sense of current symptoms. And naturally, that can kind of go into some history. But then, we talk about any history with mental health, any medical history.
And then, after that, I get a sense of who they are as a person. Like what is day-to-day life for them? How is their life affected by what's been going on in terms of their current symptoms? What it was like for them growing up? Just to kind of get to know who they are as a whole person 'cause it all relates. It all comes together. And then, toward the end of the visit I take a pause and I say, "Is there anything that we didn't talk about or you feel like is important for me to know to kind of move forward?" And a lot of times people do bring things up because it's hard for me to know what's going on in the person's mind without taking that pause. And sometimes things are hard to bring up, or things can be scary, or embarrassing. And I just, I like to give that space and that option for people.
And then, after that, we just talk about if I can get a sense of diagnosis... Sometimes I can't there are a lot of times where in a intake appointment, I just got a lot of general information. But I do give some ideas. And then, I talk about how I could potentially help in terms of the plan. And, again, that can include changes to medication, starting a medication, or even not starting medication at all, or just referral to therapy. So, the ways that we can kind of go toward the end of the visit are pretty varied.
Jennifer Ghahari: Great.
And you actually bring up a good point. So, if someone is receiving psychiatric care somewhere else, and it's maybe been a while, they're on certain medications, and they're maybe wondering, "Is this the right path for me?" They could always come to you for an intake maybe to see if they are on the right track, right path, or maybe there's another option?
Evelyn Nelson: Yeah, exactly. And so, just because we have an intake appointment doesn't mean that we necessarily have to continue. I can always throw out options, and my kind of opinion and recommendations. And they can see if that sits well with them.
Even if they have another psychiatrist that is managing their medications, I can throw out ideas. A lot of times I validate what their other psychiatrist is doing. But then, ultimately, we like to have people just have one psychiatrist managing medication, just so it's less confusion, and more safe. But there are a lot of times where I can kind of give my recommendation. And then, I give them the space to think about it, and they can always let me know. There's never any pressure to go down a certain route, or continue with me.
Jennifer Ghahari: Fantastic.
At our practice, we have a form of psychiatric concierge care. Can you explain what that is and how it differs from a traditional practice?
Evelyn Nelson: Yeah. So, that's a really good question. So, with the concierge model, people pay a monthly fee. And with that monthly fee it includes any follow up appointments. It includes any contact with me, so emails, or messaging, or phone calls. And follow up appointments we just charge a dollar, meaning that it's a really low fee. So, we can follow up as many times as we need to. And a lot of times people need a good amount of follow up, especially if they're kind of in this really acute phase, and maybe things are really difficult.
And so, in that way, people won't have to worry about paying for each follow up visit. And I can just follow up with them as many times as I feel like I need to with taking out that financial aspect. Whereas with other kind of private practices, they tend to charge per visit.
And so, this can work for a lot of people. But I think, for me, I prefer the concierge model because I think what dictates follow up is just based on clinical need, and not if they can pay for this next follow up visit or not, or if they want to pay for the next follow up visit. So, it's nice to just have this kind of catch all. All services are just kind of available with me without having to think about that financial aspect.
Jennifer Ghahari:
Great. And you brought up a good point before that some people can have some trepidation, or nervousness about starting a new medication, or there might be side effects that... With any pill, you wonder, "Wait a minute, is this normal? Is this okay?" And so with our practice, patients would be able to reach out to you at any point, like you said, through an email, or a call, and that's all included there's no extra charges, right?
Evelyn Nelson: Exactly.
Jennifer Ghahari: That would provide some peace of mind, and also help get the right dosage, right?
Evelyn Nelson: Yeah, exactly. And so, the most common way that I communicate with my patients is through secure messaging. And I always encourage, especially if we're making a medication change, or if we're starting a medication for them to message me. I always counsel about side effects, but things can come up and people have questions about it. And so, a lot of times we don't need to have a follow up appointment. They can just ask me like, "This is going on. Is this normal? Will this go away? What do you think?" And it's really easy for me to just message back. And so, I love having that ability to communicate with my patients without thinking about charging an extra fee. It puts the patient at ease. And I think, for me, it's nice to be helpful in that kind of quick way.
Jennifer Ghahari: That's great. It sounds like there's peace of mind on both ends. That sounds really helpful.
Evelyn Nelson: Yeah, absolutely.
Jennifer Ghahari: Wow.
Well, this has been flying by. So, for our final question, do you have any final words of advice, or anything else that you would like to say to our listeners today?
Evelyn Nelson: Yeah. So, a couple of things. So, number one, is that no matter what provider you have, whether it's me, or anybody else, it's really important that you feel heard, and you feel like your concerns are being taken seriously. That is extremely important. And you deserve that relationship with your mental health provider. You just do. And so, for anybody pursuing care in mental health, I know it's really hard to even find a provider, but just know that you deserve that trust, and that kind of relationship.
The other thing too, is that if you are feeling apprehensive or afraid, it's okay to voice that to your provider. I think it's really helpful to be able to say that so that we can take a little bit more time into talking about the concerns, because a lot of times that's just as important as the symptoms that are going on. That can be a huge barrier to care. And so, I just encourage people to kind of advocate for themselves, and speak up to any fears, or concerns that they have because, again, they deserve to be open with their mental health provider. If you can be vulnerable and open with anybody, it should be your mental health provider.
So, I think those are the biggest things. And it's really important for my patients to know that and my future patients to know that.
Jennifer Ghahari: Dr. Nelson, thank you so much for finding this time in your schedule to speak with us today...
If anyone is interested in scheduling an appointment with Dr. Nelson to discuss psychiatric care, any concerns that they may have, or medication management you can do so at seattleanxiety.com and we will be happy to set you up.
Thanks so much.
Evelyn Nelson: Thank you.
Editor: Jennifer (Ghahari) Smith, Ph.D.