How do I arrange an appointment?


If you do not have private medical insurance you can fill in the no-obligation, no-cost booking form on this website. This is a great way to get in touch if you are unsure if seeing a psychiatrist is the right thing for you or if you want to clarify some things. If you have private medical insurance and would like your assessment and treatment to be paid for by your insurance provider, you will need a referral from your GP. Please ask your GP to post the letter to the Private Patients Unit at the Royal National Orthopaedic Hospital (address on the Contacts Page), or email it to: p.ramanuj@nhs.net. You will need to email me your private insurance details prior to the appointment. If you are already seeing a consultant at the Royal National Orthopaedic Hospital and as emotional problems can often complicate severe or long-term musculoskeletal problems, you may also ask to be referredto me. I will require a referral letter from your consultant or GP in this case.




What happens before our first appointment?


Once we have made initial contact and you are happy to proceed with the appointment, we will arrange a mutually convenient time and place to meet. I usually see clients in the Private Patient Unit at the Royal National Orthopaedic Hospital but can also see you at 58 South Molton Street, Mayfair by prior arrangement. Depending on what you have sent me, I may want to clarify a few things about your symptoms before we meet. If you are paying through private health insurance I will ask for the authorisation number or your membership reference number. I will then send you my Terms and Conditions for you to read through and sign. The appointment is only confirmed when you have emailed this back to me.




What will the first appointment be like?


The first appointment will last one hour. At this appointment I will want to get to know a little about the things that matter to you. We will then talk you about your symptoms and how they are affecting you. I will ask you about any past psychiatric problems you may have had and also any physical condition you have had or are living with now. I will write any what medications you are on and if you have any allergies. If you are willing to, we will then discuss any relevant personal problems, if they have an impact on you now. We do not have to talk about these problems but they can help build up a picture of why you may be feeling the way you are, and can sometimes help to guide treatment also. I will then suggest a diagnosis, explain what that means and explore treatment options together.




Will I have to take medications?


Medications can be useful in situations where the symptoms of mental illness are severe, or long-standing or if other treatments have not worked. In some cases, the scientific evidence suggests that medications should be started at the same time or before talking therapies. However in most cases I will explore other treatment options with you, including ways to understand and manage your symptoms better, talking therapies and lifestyle changes. All interventions (including talking therapies) can have side-effects, so I will discuss these with you and we will come to a decision together about whether medications are right for you. If we agree that you should have a course of medications I can provide you with a private prescription that you can fill out at any pharmacy, or if you prefer I can write to your GP advising on a course of medications. After starting medication if you decided you did not want to carry on taking them it is best to speak with me first so we can stop them safely. Sometimes stopping psychiatric medications abruptly can have side effects and in rare cases can be dangerous.




Do you offer talking therapy?


I do not offer therapy myself although I have experience in a range of therapeutic techniques including cognitive behavior therapy, cognitive analytical therapy, psychodynamic psychotherapy, systemic couples and family therapy. I use these in my consultations to identify topics for therapy or types of therapy that could help you. If we then agree that talking therapies would be useful in your treatment I would refer you on to a selection of experienced and certified therapists. I do offer psychological formulations [hyperlink to “what is psychological formulation”] which can provide a deeper understanding of your emotional state (see below).




What happens after the initial consultation?


I will write you a letter within one week of our meeting summarizing what we had discussed and the treatment we had agreed. I encourage you to feedback to me if there is anything you do not agree with in the letter. With your permission only I will copy your GP into the letter as well. If we have agreed to meet again, I will offer you another appointment. How regularly we meet will depend on the treatment plan we have agreed.




How long will my treatment go on for?


Some people will want to see me to clarify what is wrong, find out if they meet any psychiatric diagnoses and get some ideas on what can help them. IN these situations, an initial consultation is often all that is needed. Many people will want or need to have further follow-up consultations, for example if you were started on medications that require monitoring or if it requires more than just one appointment to get to the root of your problem. Symptoms can also change over time and you may wish to have these thought about. It is therefore difficult to put a number on how long follow-up will last. You can of course at any point choose to stop seeing me, although you would need to tell me this so that I can arrange for your care to be followed-up appropriately. It is not advisable to stop taking psychiatric medications abruptly so I would need to ensure that these can be monitored or withdrawn by a trained professional.




What is the process for a psychological formulation?


A psychological formulation is not essential to your assessment or treatment but can help you understand your symptoms better. It is an evolving process so can be done at any point. After the initial consultation it can help guide treatment, or if we have had a number of follow-ups it can help build up a picture of the things we have discussed. As it takes time to build up a formulation it would require a second consultation (usually lasting 50 minutes) and you would need to feel comfortable discussing relevant information about your childhood, relationships and personal difficulties. For this reason, some people choose to have a formulation once they feel comfortable with me. I would then write you a letter (usually a size of A4) reflecting on why you may have developed some of the difficulties you have, based on my understanding of psychological science. I would actively seek your feedback on what I have written to see if it makes sense to you and we would spend part of our next follow-up consultation discussing your formulation.




Is everything I say confidential?


Generally everything you tell me, from the initial email contact to all subsequent consultations will be kept confidential. The only exceptions to that is if in exploring your symptoms, I think you are a risk to yourself or to others and this risk cannot be managed without me telling someone else. In most cases this will be your GP but I will always discuss this with you first.




Does my GP have to be informed?


GPs are often the professionals who have the most complete medical history on you and it can help to have them involved in your care; however I would not contact your GP without your permission (except for the caveat outlined above under the question on confidentiality). Alternatively if you were happy for me to write to your GP, but wanted me to leave anything we have discussed out I would be happy to do that also. For ethical and professional reasons it is important for me to have the contact details of your GP even if I do not contact him/her.




What is your cancellation policy?


Please contact me as soon as possible if you will not be able to make an appointment to allow for it to be rescheduled. Unfortunately, due to room bookings, I will need at least 48 hours’ notice to reschedule. Appointments cancelled with less than 48 hours’ notice will be charged the full price.




How do I pay if I don’t have private health insurance?


You can either pay by BACS or with a cheque. If paying by BACS I will send you an invoice with my consultation letter and expect the money to be transferred within a week of receipt. Alternatively you can pay by cheque at the end of the consultation.




What if you do not accept my specific health insurance?


I am registered with the four biggest health insurers in the UK but there is an ever growing number of independent insurers. If you do not see your insurer on the list of companies I am registered please contact me. I can then register with your company before we meet. Registration can take up to four weeks.





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