Personal relationships in Concierge Psychiatry: The power of truly knowing your provider

The quality of the therapeutic relationship fundamentally shapes treatment outcomes in psychiatry. Yet in traditional practice settings, time constraints make it nearly impossible to develop the depth of understanding necessary for truly personalized care. In my concierge practice, I’ve structured everything around a simple principle: We can only provide excellent care if we actually know our patients.

One Hour Means One Hour

In traditional psychiatry, follow-up appointments typically last 15 to 30 minutes, with some medication management visits reduced to just 15 minutes. Research shows the average medication management appointment lasts only 22 minutes, barely enough time to review medications, and discuss side effects — let alone explore what's actually happening in a patient's life.

At our practice, one hour means one hour. Every appointment. No rushing, no cutting sessions short, no feeling like you need to condense complex emotions into sound bites. This time allows us to notice subtleties that would be missed in shorter visits—the hesitation before answering a question, the pattern of symptoms that only emerges with careful exploration, the life context that transforms our understanding of what medication adjustments are actually needed.

With adequate time, medication changes become more specific and nuanced. Instead of making broad adjustments based on symptom checklists, we can explore exactly how a medication is affecting your energy at different times of day, how it interacts with your work demands, whether side effects are truly intolerable or just require better timing. This level of precision simply isn't possible in 15-minute visits.

A Caseload That Allows Deep Thinking

We maintain a maximum of 50 patients. This is not arbitrary—it's the number that allows us to truly know each person we treat.

Traditional outpatient psychiatrists managing medication typically carry caseloads of 100 to 300+ patients, with some psychiatrists reporting active panels of 500 to 700 patients. At that scale, psychiatrists see patients every few months for brief medication checks, relying heavily on notes from previous visits to remember who patients are and what's happening in their lives.

With 50 patients, we can think about you between sessions. When research about a new medication approach crosses my desk, I consider which patients might benefit. When I'm reviewing labs or reading about a drug interaction, I'm thinking about specific individuals in my practice. This isn't just good practice—it's possible because we're not drowning in hundreds of patients.

I know your job situation, your family dynamics, your sleep patterns, your stressors. I remember what we discussed last time without frantically reviewing notes. When you call with a concern, I don't need to spend the first five minutes of our conversation figuring out who you are and what medications you're taking. I already know.

Continuity That Builds Trust

The therapeutic relationship itself becomes medicine. When you're not rushed, you're more honest. When you trust that your psychiatrist genuinely knows and remembers you, you share the details that matter.

You might tell me that a medication is "fine" in a rushed 15-minute visit. But, in an hour-long appointment where you feel heard, you tell me that it's fine except you've stopped exercising because you're exhausted by 3 PM, and that's actually a significant problem because exercise was how you managed stress before.

That's the kind of information that changes everything. And it only emerges when there's time, trust, and a relationship built on actually knowing each other.

Complex Understanding for Complex Lives

This depth of relationship allows us to manage complexity that would be impossible in fragmented care. We understand how your work travel affects medication adherence. We know which family situations trigger symptoms and can adjust treatment proactively.

When you're facing a major life transition—a job change, a divorce, a health crisis—we don't need to play catch-up. We're already embedded in your life context and can adapt treatment immediately.

This is what psychiatry should be: a relationship built on time, attention, and genuine understanding. Not a series of rushed medication checks where you're one of hundreds. Not a fragmented system where nobody really knows you. But actual, sustained, thoughtful care from someone who takes the time to truly understand who you are and what you need.