Why Most Psychiatric Evaluations Miss the Full Picture

In my 35+ years of treating patients in Cincinnati and Northern Kentucky, I have seen one pattern repeat itself more than any other: people come to me after years of struggling, not because they never sought help, but because the help they received was incomplete. They sat in an office for 15 minutes, answered a handful of questions, received a single diagnosis, and were handed a prescription. And then they wondered why they still felt terrible six months later.

This is the problem with how psychiatric evaluations are typically done in this country, and it is something I have spent my entire career trying to fix.

The standard model in many psychiatric practices today looks something like this: a patient calls, gets an appointment within a few weeks, sits down with a psychiatrist for 15 to 20 minutes, describes their main complaint, and leaves with a diagnosis and a medication. The psychiatrist is not being careless or lazy. They are working within a system that rewards speed over thoroughness. Insurance reimbursement rates push clinicians to see as many patients as possible. The result is that millions of people are walking around with incomplete diagnoses.

Here is what I have learned after treating thousands of patients across 35+ years: most people who come to a psychiatrist do not have just one condition. The research supports this overwhelmingly. Studies published in the Journal of Clinical Psychiatry have consistently shown that psychiatric comorbidity is the rule, not the exception. A person with ADHD very often also has anxiety. A teenager with depression frequently has an undiagnosed learning difference or OCD. An adult who has been treated for depression for years may actually have bipolar disorder that was never properly identified.

When you miss one of those conditions, the treatment plan falls apart. You can prescribe the best antidepressant in the world, but if the patient also has untreated ADHD, they are still going to struggle with focus, organization, and follow-through. You can give a child a stimulant for ADHD, but if you miss the underlying anxiety disorder, that medication might actually make the anxiety worse.

This is exactly why we built our practice around a three-part evaluation system. It is not the fastest approach, and I will be honest with you, it is not the cheapest approach either. But it is thorough, and thoroughness is what leads to accurate diagnosis and effective treatment.

For adults, our evaluation takes approximately two hours spread across multiple interactions. The process begins with a one-hour session with our licensed professional counselor, Kari. She conducts a comprehensive clinical interview that covers your current symptoms, your history, your family background, your relationships, your work life, and your daily functioning. She is not just checking boxes on a form. She is listening carefully, asking follow-up questions, and building a complete picture of who you are and what you are experiencing.

After that session, Kari and I sit down together and she reviews everything with me in detail. I take pages of notes. We discuss patterns, possibilities, and areas that need further exploration. Then you meet with me for approximately one hour. By the time we sit down together, I already know a great deal about you. But I am not just going through the motions. I ask my own questions, I clarify things that stood out, and I share my diagnostic findings with you in plain language.

For children and teenagers, the process is even more thorough, taking approximately three hours total. We meet separately with the parents and with the child. We collect rating scales from parents, teachers, and sometimes the child themselves. We look at the whole picture because children are developing rapidly and their symptoms can be complex and overlapping.

Here is the part that most practices skip entirely: we do not just look for whatever condition you think you might have. If you come to me saying you think you have ADHD, I do not simply run an ADHD checklist and call it a day. I evaluate for everything. Anxiety, depression, OCD, bipolar disorder, learning differences, trauma, sleep disorders, and more. Because in my experience, when you find the complete picture, the treatment plan changes dramatically, and so do the results.

I have lost count of how many patients have told me some version of this story: they were diagnosed with depression five years ago, tried three different antidepressants, and none of them worked well enough. When we did our comprehensive evaluation, we discovered that yes, they had depression, but they also had ADHD and generalized anxiety disorder. Once we addressed all three conditions with an integrated treatment plan, they described the change as life-altering.

I want to be clear about something. I am not criticizing other psychiatrists. Many of them are excellent clinicians who are doing their best within a broken system. The problem is structural. When insurance companies reimburse a psychiatrist the same amount for a 15-minute visit as they would for a thorough evaluation, there is no financial incentive to spend more time with each patient. Our practice is out-of-network specifically because we refuse to let insurance dictate how we practice medicine.

If you are reading this and you have been struggling despite receiving treatment, I want you to consider the possibility that your evaluation may have missed something. It is not your fault. It is not necessarily your previous doctor's fault either. But it is something that can be corrected with a thorough, comprehensive assessment.

My commitment to every patient is the same: we keep working together until you are not just stable, but dramatically better. That journey starts with getting the diagnosis right, and getting the diagnosis right starts with an evaluation that does not cut corners.

If you would like to schedule a comprehensive evaluation at our Cincinnati or Fort Wright office, please call us at (859) 341-7453. We respond to inquiries almost always the same day.