On the front page of Sunday’s, New York Times (3/6/2011) was an article about the state of psychiatry in America; it was so painful to read that I lost my appetite.
There are 48,000 psychiatrists in America, and 90% of them no longer talk to their patients. Instead, they see patients for 15 minutes to monitor their medications. Psychiatrists stopped talking to patients because managed healthcare no longer pays for talk therapy.
There is no evidence that a psychiatrist’s talk therapy is of any higher quality than that of a psychologist or social worker, so managed care may pay you $90 for a 45″ session. If you see three people for 15 minutes each for medication checks, you will be paid$150 for those 45″ It doesn’t take an accountant to figure out that if you see 30 people a day you make a living.
Until recently psychiatry was the only specialty left where doctors spent time listening and talking to patients. I had hoped that the practice of medicine would become more like psychiatry, but alas, psychiatry has joined the rest of medicine in practicing brief, impersonal care.
When doctors minimize their relationships with patients, they lose any expectation of building intimacy with them, and it will steal their spirit as healers.
In 15″ I can’t know anything about the lives of my patients. I don’t care how important medication is; it’s relationships that get people better, listening to their stories so that they can hear mine. Nowadays, if patients want to talk about something, they are told to wait and talk about it when they see their primary therapist.
For the first time in my life I am ashamed to call myself a psychiatrist, without adding this proviso “not of the pill-pushing kind”.
Sad, so sad. I read the same article. So how many of these medicated patients really, truly NEED the medication? How many could just be reassured, guided through some alternatives or taught life skills to help them through a tough time????
There is a small cadre of dentists, who spent time with Wilson Southham developing what he called “Volitional Practice”. I practice because I choose to, team members work with us because they choose to, and clients/patients have no dentistry done until they choose to have it.
We offer a “New Person Interview” where together, we decide to begin a healing relationship, or, not. We are not psychological therapists, but we often become trusted counselors because of our long term relationships.
It is a model that could work for MDs also, but it would require giving up organized medicine’s attachment to insurance and how it has created expensive insurance, but cheap care for those insured.
Sweet Bro; It’s a great idea but you’re right in medicine it means we’d have to change the whole reimbursement structure. In the meantime I send to you my birthday greetings to you and always my love and blessings
Several years ago I read your book Theft of the Spirit……..it was truly a gift. I shared it frequently when treating impaired addicted professionals..thank you……Here in Wisconsin regulations continue to change….the long term residential treatment program I worked in for many many years is no longer in existence..I had been blessed to witness so many human beings share from the depths of their soul……and now I am a displaced worker, fortunate to have a job providing me a living but it is missing that soul connection…..I AM so very thankful there are people like you who continue to walk the path and carry the message….love and light Wendy
It is difficult enough to accomplish healing in therapy as it is, but to be ‘medicated only’ is almost like going about ‘untreated’ plus not only does the patient have to become balanced using a drug, they eventually should go off of it which is a roller coaster ride itself. The sweat lodge rules! What the world needs now is love sweet love. Peace