Psychiatry in Fifteen Minutes Isn’t Psychiatry
The nurse cuffs the arm. “Any side effects?” A nod, a shrug, the clock. Thirteen minutes later the portal pings: refill sent. If this feels like psychiatry, it’s only because we’ve lowered the bar.
Short psychiatry appointments—“15-minute med checks”—didn’t happen by accident. They’re the predictable output of billing codes that reward speed. Managed care prized throughput; clinics scaled; providers adapted. The stopwatch became policy. Efficiency matters—access matters—but when every visit is compressed, psychiatry turns into medication management with a stethoscope cameo.
On paper, the 15-minute psychiatry appointment looks tidy. You confirm the medication, scan for side effects, nudge a dose, and move on. In reality, the model strips out the parts of care that actually change outcomes: time to understand where symptoms come from, space to notice the pattern behind the complaints, room to earn enough trust that patients will tell you the thing they’ve never said out loud. Rushed psychiatry care meets a schedule; it rarely meets a person.
This is where errors creep in. A “new depression” turns out to be untreated hypothyroidism once someone finally orders labs and listens to the timeline. “Anxiety” worsens because the stimulant dose is too high—easy to catch if you map panic to when the pill peaks, easy to miss if the visit ends at minute fifteen. Sleep apnea drives mood swings that no SSRI will fix; one careful history plus a sleep screen changes everything. None of this surfaces when the conversation is squeezed into a quarter hour and dominated by a prescription pad.
There’s also the human cost that never shows up on a superbill. Patients learn to edit themselves. They skip the awkward details, the shame, the relapse they’re afraid to name. They bring a curated version of their lives to the clinic because there isn’t time for the whole story. They start to believe that psychiatry is a refill lane, not a place to think. When people leave with more questions than answers—again—their expectations fall to the level of the system. “This is just how it is.” It isn’t. It’s just common.
Real psychiatric care requires patience and curiosity, not just prescriptions. It asks for silence long enough for someone to find the right words. It asks for questions that don’t fit neatly into yes/no boxes. It asks for a provider to hold multiple possibilities at once—bereavement or major depression, trauma response or bipolar spectrum, substance effect or primary anxiety—without rushing to close the case. That work has a pace. The pace isn’t fifteen minutes.
How long is a psychiatry appointment supposed to be? The honest answer is: long enough to do the job. Sometimes that’s a focused follow-up when things are stable. Often it’s 30–45 minutes, occasionally 60, especially when the picture is tangled—comorbid medical issues, multiple medications, unclear diagnosis, safety questions, family dynamics, work stress, sleep problems. Psychiatry visit length should match complexity, not a spreadsheet.
Picture a real follow-up, not a med check. You start by anchoring the timeline: when did symptoms spike, and what else moved at the same time—med changes, life events, substance use, shifts in sleep. You pull up the list of past trials and look at doses and durations (not just drug names). You ask what the medication actually does at different hours of the day. You screen sleep with three concrete questions. You look for medical flags worth testing—TSH, B12, iron panel when appropriate. You do one focused piece of psychotherapy in the room—behavioral activation for a week ahead, a worry exposure plan, sleep compression with strict wake time. You make a plan with contingencies: “If X by week two, we do Y. If not, here’s the next move.” The patient leaves with a map, not just a bottle.
There’s a popular defense of short psychiatry appointments: more, shorter visits mean more people can be “seen.” Access is not a trivial goal, and no one should pretend it is. But access without adequacy is a mirage. Ten quick touches will never equal one thoughtful visit when the problem is misframed from the start. The right answer isn’t maximal compression; it’s a tiered approach—longer when the story is unclear, shorter once the course is set and stable, periodic deep dives to prevent drift. Throughput matters; correctness matters more.
If you’ve only ever known the fast version, it can be hard to imagine the alternative. It feels different the moment you sit down. There isn’t a rush to the refill. The questions land in places that don’t usually get airtime: what mornings feel like, how you actually fall asleep, why Sundays are worse, which side effect you were quietly tolerating because you didn’t want to complain. There’s enough room to admit that you’re taking a friend’s leftover benzos sometimes, enough room to say you stopped therapy because the waiting room made you feel watched, enough room to say you’re worried the diagnosis is wrong. In that kind of visit, people tell the truth. Treatment gets better because the data get better.
This is not a plea for endless appointments or romanticized “talk.” It’s an argument for precision. Precision requires time. If a plan changes, it changes for a reason you can explain to the patient and defend to yourself. If a diagnosis stands, it stands on evidence you actually gathered. If medication is used, it’s used with a rationale, not momentum. The quality of psychiatric care rises with the quality of the reasoning—and reasoning is allergic to hurry.
At Zellig, we built our model around that premise. We don’t pretend psychiatry fits in a quarter hour. Our visits are longer by design. We use the time to do the simple things that somehow became rare: take a thorough history, connect symptoms to a lived timeline, review past trials with doses and durations, check the medical pieces that masquerade as psychiatric ones, and add one concrete therapeutic step you can practice this week. We talk about sleep and substances and stress, about relationships and work and meaning, because those are not side issues. They are the terrain treatment has to cross.
Medication matters—often a lot. It just shouldn’t be the only instrument we play. The difference patients feel isn’t just that their plan looks more complete; it’s that the care makes sense. When the care makes sense, adherence improves, side effects are caught sooner, and the path forward doesn’t have to be reinvented at every visit. That’s not indulgence. That’s efficiency properly defined.
None of this denies the real constraints providers face. Schedules are tight. Systems are rigid. But some choices belong to the clinic. We can decide that first evaluations aren’t rushed. We can decide that ambiguous cases get time. We can decide to schedule periodic longer reviews even in maintenance care, to make sure the plan still fits the person living it. We can decide to protect thinking time. Protecting thinking time is protecting outcomes.
The field doesn’t need slogans; it needs better defaults. Default to enough minutes to hear the story the first time. Default to checking the obvious medical confounders. Default to writing the plan in language a patient can use at home. Default to setting contingencies so both of you know what happens next and when. Default to visits that are long enough to make good decisions and short enough to respect a life. If we get the defaults right, the exceptions can be exceptions again.
Fifteen minutes keeps a clinic moving. It does not move lives forward. If your experience of psychiatry has been all speed and no depth, it’s reasonable to ask for something else. Ask for a visit length that matches the complexity of your situation. Ask for a plan you can repeat back without notes. Ask why the medication change makes sense, and what would make you and your clinician change course. Ask for care that thinks with you, not at you.
Psychiatry isn’t a refill lane. It’s careful listening, measured change, and time to think together. When the clock stops running the visit, everything else—accuracy, adherence, relief—has room to start.
