An Interview with Psychiatrist Peter Reiss
Peter Reiss, M.D. is psychiatrist at Seattle Anxiety Specialists, PLLC. Dr. Reiss specializes in the treatment and medication management of anxiety related disorders.
Jennifer Smith: Hi, thanks for joining us today for this installment of The Seattle Psychiatrist Interview Series. I'm Dr. Jennifer Smith, Research Director at Seattle Anxiety Specialists. We're a Seattle-based psychiatry, psychology, and psychotherapy practice specializing in anxiety disorders.
I'd like to welcome with us Dr. Peter Reiss, who is one of the psychiatric providers at our practice. Peter has extensive experience with psychiatric medication management and has worked in multiple levels of care in the Seattle area, including inpatient, outpatient, partial hospitalization, and residential treatment programs, as well as in the psychiatric emergency room.
Before we get started today, can you tell our listeners a little bit about yourself?
Peter Reiss: Yeah. Hi, Jennifer. Thanks for having me, and inviting me for this interview series. As you said, I worked in quite a few places before I started working as an outpatient psychiatrist here. I took a slightly different route than the traditional way of, "What do you do when you start working after residency?"
I initially started working as a locum tenens, which includes more short-term contracts. I was doing six months to a year at different kinds of levels of psychiatric care. It just gave me a way to see what kind of psychiatric jobs I like, and it gave me an opportunity to see what the mental health resources are in the area. And, just gave me a chance to see what I could see myself doing in the long run.
Jennifer Smith: That's great. I think, like you said, to have all that different exposure probably makes you a really well-rounded psychiatrist. I think that's fantastic. Great.
Peter Reiss: I did think that. It just gave me a little bit more opportunities to really see what different acuities look like on different levels of care.
I wouldn't change a thing, so I'm very happy I did it this way.
Jennifer Smith: Fantastic. Just to let our listeners know a little bit more about yourself as well, what are your favorite parts of the Seattle area or Washington as a whole?
Peter Reiss: So, the first time we came to Seattle, I just immediately loved the area. I do think that it has this very special kind of culture. I love how it combines the urban and the nature, and just the fact that there's so much to do. Especially in the summer, with festivals going on. And, even the winter, I mean, people do complain about, or some people say we have particularly bad winters, but, in the middle of winter, it's 55 degrees, and you can go hiking or do whatever if you're okay with a little bit of rain.
Jennifer Smith: The saying is "It's not bad weather, it's bad clothing," or something like that. Right?
Peter Reiss: Well, I think our weather is our best kept secret.
Jennifer Smith: Yes.
Peter Reiss: Not as bad as people say.
Jennifer Smith: Exactly.
Peter Reiss: Or, have the reputation.
Jennifer Smith: Right?
Peter Reiss: Yeah.
Jennifer Smith: Exactly. That's great. And, what is it that got you interested in becoming a psychiatrist?
Peter Reiss: So, I didn't start out in medical school wanting to be a psychiatrist. I did keep my options open. I was leaning more towards primary care, internal medicine, possibly emergency medicine. I always knew that psychiatry and mental health is important, and that it's kind of very ubiquitous anywhere you go in medicine.
I didn't think about psychiatry a whole lot until my third year in medical school when I had my real introduction to psychiatry, where I went to the psych ward and other psych facilities for my medical school rotation. And, I just immediately loved it. I liked how it's just slightly different than other fields of medicine. It kind of forces you to think more outside of the box. It doesn't necessarily follow the standard algorithms that we have in medicine. There's a lot more nuance and room for interpretation, and it's probably the least well-understood specialty in medicine as well. So, I did the fact that there's just so much more that potential will change in the specialty in the near future hopefully.
Jennifer Smith: That's fantastic. One question that we're often asked is, "Should I see a therapist or should I see a psychiatrist, or both?" And, can you explain the difference to our audience why should someone see either of these two professions?
Peter Reiss: Mm-hmm. Yeah. So, we do have quite a good variety of mental health specialists for anyone wanting to see treatment for any mental health problems. The two options, generally, are to see a medical doctor, so a psychiatrist, or see somebody who'll focus more on non-pharmaceutical management, which would be a therapist, which would typically be clinical social workers or psychologists by training. And, it sometimes comes down to personal choice what people prefer.
I would say, if somebody's psychiatric symptoms are fairly mild, they might need to see a psychiatrist. So, not everybody would be necessarily a candidate for psychiatric medications.
Psychiatrists themselves rarely practice psychotherapy anymore. It used to be different. We are trained in psychotherapy. We do go through all these different didactical trainings, how to provide different modalities of psychotherapy, and it used to be much more prevalent back, really, back in the seventies, eighties, up to nineties, where many psychiatrists were still offering psychotherapy. But, mostly due to our insurance landscape, it really has changed that that responsibility has fallen more to clinical social workers and psychologists who are very, very qualified to provide that training. And, they're really specialized in all these different training modalities, since there's just so many of them. So, somebody who has PTSD is getting different psychotherapy than somebody who has an anxiety disorder or depression.
And, it's really hard for a therapist to be very good at all of these therapy modalities. So, I think sort of the specialization among the different therapies works very well, and it's great to just share that professional space with all these very qualified therapists that we work with.
Jennifer Smith: Wow. Have there been times when a patient will come to you and you realize this person probably doesn't need medication - do you refer them to therapy? Does that ever happen?
Peter Reiss: Oh yeah. That is quite common.
I mean, I would say, in the majority of cases, probably at least a trial of medication might be helpful, just for the patient to engage better in psychotherapy if symptoms are just a little bit too severe at that time. But, for a lot of mild cases of the anxiety and depressive disorders, often starting with therapy alone might be a good option.
Jennifer Smith: Okay, fantastic. In what ways can someone's mental health impact their physical health?
Peter Reiss: So, that's actually a really good question. I think most people do understand the connection between chronic medical conditions causing psychiatric symptoms to worsen, but it's really also the other way around. So, I mean, for example, most psychiatric disorders, whether it's anxiety disorders, whether it's depressive disorders, trauma, excessive trauma responses, they typically cause physiological changes as well. Things like, for example, chronically increased stress hormones, like cortisol. And, that can have an impact on immune function, it can increase somebody's risk for cardiovascular issues.
And then also, indirectly, somebody who has low executive functioning, low motivation due do psychiatric issues, is less likely to take care of themselves and engage in these kind of activating behaviors that tend to improve one's mental and physical health.
If somebody, for example, is less likely to engage in things that are good for social connections, that leads to loneliness. And that, in itself, leads to worsening mental health and physical health as well just due to increasing chronic stress and things like that.
Jennifer Smith: Oh, wow. So, when they say, "Mental health IS health," it really is true.
Peter Reiss: Oh, it is absolutely true. I mean the two... It's not only that it's just in your head, right? It does cause real physiological changes, whether those are directly caused by mental health issues or indirectly.
Jennifer Smith: Right. Can you talk a little bit about your treatment approach?
Peter Reiss: So, I emphasize a lot of psychoeducation, making sure that I meet my patients where they're at, and also give them as clear information about what's going on for them to make the best informed decision.
Sometimes, maybe, they have a particular treatment modality in mind, particular medications or whatnot. Just, trying to understand what their idea is, where they're coming from. So, our treatment goals might be different; we might not always agree, and that's not necessarily wrong. But, giving them as much information as I can for them to make the most informed decisions, that's very important to me.
Then also, I tend to put a big emphasis on always reassessing... Just, speaking specifically about medication management, to reevaluate the need for a particular medication. Sometimes, patients come to me having been on one medication for 10 years. We don't know if they still need to be on that. We don't need... Maybe they need to be on something different. We need to reevaluate what, really, each component of their treatment is really doing, if it still has any effect on their mental health. Sometimes, less is more with psychopharmacology.
I do always want to do check-ins, even with patients who have been on a long-term medication, "Is that really necessary, and what can we do about it?"
Jennifer Smith: That's really great that you work with a patient. And, it sounds like you strive to just get the optimal dose and really not put things that are not... Meaning that you don't do unnecessary things.
Peter Reiss: Right, because each medication could not have side effects; it could have unwanted side effects; or, something else that the patient might not know about. So, they're still... Psychiatric medication's still among the safest medication in medications in general, but we shouldn't take it lightly to have somebody on long-term medications generally.
Usually, it's not a problem. We just have to do it the right way.
Jennifer Smith: Right. And, what type of disorders do you specialize in?
Peter Reiss: So, the disorders that I see here in the clinic are fairly standard, the average psychiatric disorders, including the depressive disorders, wide variety of anxiety disorders, including OCD and different kinds of phobia. We do see ADHD patients here in our clinic as well, patients with PTSD and more trauma-related issues, and also different levels of functioning. So, there's many of my patients who are really doing well, especially on the surface. They're able to do their day-to-day activities. And then, there's patients who are not doing well at this time, who might not be able to have a job right now. So, it's a big variety of different psychiatric issues that we're dealing with, but also, different, wide variety of patient needs.
Jennifer Smith: And, let's say that I was going to sign up for an appointment with you. You are a medical doctor, so of course, I would have to complete the intake paperwork so you have an idea of where I'm coming from, what medications I'm on, my past history. So that's, I think, pretty standard. But, after that, I have no idea what to expect. So, what can I expect in the first session with you? What would we do? What would we talk about?
Peter Reiss: Mm-hmm. Yeah.
So, after a patient signs up for an appointment, there's the initial intake. That can be done either here in my office, in person, or it could be done remotely. There's always those two options. On most days during the week, I have those two options available.
The first session is just gathering a lot of information, getting to know the patient. And, that typically takes at least 45 minutes to an hour so we are clear on establishing a diagnosis, getting enough information about the patient's medical background, mental health background, social background. And, the last part of the initial meeting... Well, there's initially the psychiatric interview, and then, we kind of talk about what we're going to do.
And, if there's any disagreements, or the patient might need a little more time to think about these different options, we might talk about... Besides different medication options, we might talk about potential referrals for therapy as well to see if there's somebody who might have that particular therapy skillset that the patient needs, whether that's in our office or outside of our office.
And then. If the patient decides to be a patient with us, there would be a follow-up appointment to check in, within usually two to four weeks or so. Depending on the acuity, really, and if there's any problems.
Jennifer Smith: Okay. And, that actually leads to my next question regarding follow-ups. So, at our practice, we have a form of concierge care. Can you explain what that is to the audience? And, how does it differ from a traditional practice, and what are the benefits that our patients may have?
Peter Reiss: Mm-hmm. So, the main difference with concierge care is really that it's a subscription-based access to our services.
In a traditional setting, patients would have their appointment and then schedule follow-ups, and then, essentially, the difference in payment would just be that they would pay for each follow-up appointment. But, a subscription-based model of concierge care, it's really that patients pay a monthly subscription for, essentially, unlimited access. So, they can have one appointment, they can have two appointments; they have access to their psychiatrist via messaging system or email. It just makes it easier for us to respond in real-time to any issues that might come up.
It also helps us to see who is continuing care at a regular interval. So, sometimes in outpatient psychiatry, it becomes a little tricky, because patients might be partially lost to follow up. They might not show up for an appointment, so we're not sure is that patient still patient with us, right? But, with a subscription model, we at least know, "Oh, that patient actually wants to continue, and that patient will continue with their follow-up appointments."
So, I think it helps with patient retention in the outpatient setting.
Jennifer Smith: Great. And, I think one thing that I've noticed from the administrative end is that, because we essentially cap the number of patients that our psychiatrists will see, and you've kind of alluded to this, that our patients really can have unlimited access, to a degree, because you're seeing X amount of patients and not thousands of patients. So, there's just more time that you can give each of your patients, which I really think makes more specialized care as well.
Peter Reiss: Mm-hmm. Yeah. So, our overall patient numbers are lower than you would see in a typical outpatient clinics, which helps with just the time that we give each patient. We're not necessarily back-to-back.
I mean, there's some days where we see more patients than other days, but it just feels a little bit more... It feels a little more less time pressure, to give that extra time as well, whether it's directly during the appointment or to communicate with the patient through our messaging system and hone in their treatment that way.
Jennifer Smith: Wonderful. So, our final question, do you have any words of advice, or anything else that you would like to say to our listeners today?
Peter Reiss: So, the main thing that I probably would say is that, to somebody who's starting out with their mental health recovery, really seeing that they want to get treatment, it initially seems very daunting, but I do want to say that it does get easier when somebody is actually establishing care and is getting the help that they need.
And, oftentimes, we often forget to check in with ourselves, especially when we're in treatment, making sure that we're really doing well, that we're not just doing okay, that we're really thriving and flourishing. And, that can mean different things to many people, obviously. But, often, what suffering from a lot of mental disorders and mental illness does to us, we're losing the sense of self-worth and almost like forgetting what our normal... We're getting used to this normal baseline of functioning and being. And, sometimes, it becomes difficult to keep track of what our purpose is in life and what we can do to thrive.
So, don't settle for any less when it comes to your mental health. That would be my main advice.
Jennifer Smith: That's great. Thank you so much for your time today.
If anyone is interested in scheduling an in-person or a telehealth appointment with Dr. Reiss to discuss psychiatric care and medication management, you can self-schedule at seattleanxiety.com
Thank you again, Dr. Reiss, we appreciate your time.
Peter Reiss: Thank you, Jennifer. Good seeing you.
Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.
Editor: Jennifer (Ghahari) Smith, Ph.D.