By Dr. Alan Koenigsberg
My name is Alan Koenigsberg, M.D. This is a question-and-answer forum for those readers who have wanted to ask questions of a psychiatrist, and you now have that opportunity.
For those who don’t know me, I have a solo private practice in Plano, and have been in practice here since 1985. I am also a clinical professor of psychiatry at UTSW Medical School in Dallas, where I have been teaching medical students and residents since 1990.
My practice consists of both psychotherapy and medication treatments, so those are the areas with which I am most familiar.
I have been active on some websites that ask questions; one question that has come up repeatedly is about the training of a psychiatrist. Aren’t we just like psychologists but we can prescribe medications? Many are surprised we went to medical school and that we obtain the exact same education and training as all other physicians. So here is one Q&A: What is the training of a psychiatrist?
All psychiatrists are physicians. We graduate college, usually with a major in biology or chemistry, apply to, attend and complete traditional medical school, and earn an M.D. or a D.O. We attend and complete all of the courses and clinical rotations as all other physicians. A psychiatrist is first a physician. As an example, I did rotations in internal medicine, surgery, obstetrics (and delivered babies), surgery (and assisted in many surgeries), ophthalmology, endocrinology, clinical laboratory medicine, pediatrics, dermatology and so on.
I then did a one-year internship in general medicine, and then a three-year residency in psychiatry, which included child psychiatry, geriatric psychiatry, extensive training in psychotherapy and hospital psychiatry for the treatment of inpatients.
Some psychiatrists do additional specialization, such as child psychiatry, geriatric psychiatry, consultation liaison psychiatry (inpatient hospital consultation in medical and surgical wards) or forensic psychiatry.
In the past, psychiatrists were well trained and well versed in psychotherapy, as I was and am. My practice is about half psychotherapy. That has gradually shifted to psychiatrists mostly doing medication treatment, and referring out to psychologists for psychotherapy.
Many of my patients have complicated medical illnesses, such as lupus, cancer, diabetes, low thyroid, autoimmune disorders or COVID-19. As a physician, I understand these conditions, and work well with my physician colleagues in their treatments. The value in working with a psychiatrist is the background of medical information, as these examples show:
I saw a patient for whom I prescribe medication for anxiety and insomnia, and who had routine dental work. I asked her if she had been prescribed any narcotics for the pain, which she had forgotten to mention. I then explained the potential dangers of mixing narcotics with sleeping pills.
Another patient talked about a new boyfriend who has herpes, and told me they would use protection. When I explained that condoms would not prevent the spread of herpes, as the lesions are not contained within the condom, she was surprised.
Many patients have asked me about vaccinations, and appreciate my explaining how the new mRNA vaccines work.
These are but a few examples of questions I get from patients. Please email all questions directly to the TJP, and Sharon Wisch-Ray(firstname.lastname@example.org) will forward them to me. I’ll sort through the questions, and answer those that I believe will have relevance to the most readers.
Please keep in mind that as a physician, I cannot offer specific or personal medical advice to people who are not my patients, so my answers will be more general, or what I have done in my practice.