Talk Doesn’t Pay, So Psychiatry Turns to Drug Therapy
Any internist or family physician will find this report explanatory, but have significant concerns about this paragraph:
Brief consultations have become common in psychiatry, said Dr. Steven S. Sharfstein, a former president of the American Psychiatric Association and the president and chief executive of Sheppard Pratt Health System, Maryland’s largest behavioral health system.
“It’s a practice that’s very reminiscent of primary care,” Dr. Sharfstein said. “They check up on people; they pull out the prescription pad; they order tests.”
Excuse me. I work with internists and family physicians. They actually talk with their patients. They writes prescriptions when indicated, but first they talk.
This article is very discouraging. Once again we see the perverse contortions that our payment system renders. You know my mantra. Our payment system is hurting patients. Just look at the number of psych meds and their side effects. Just look at the lack of understanding of their patients that this article mentions.
Shame on psychiatry, but a bigger shame on Medicare and private insurance.
{ 7 comments… read them below or add one }
The practice of psychopharmacology is entirely unlike primary care. What other specialty in medicine elevates the related pharmacology component to subspecialty status? The Psychiatry field truly needs to regroup.
Quote was incorrect, but in the context of the article, sentiment is close. What he should have said was “It’s a practice that’s very reminiscent of primary care HAS BECOME, WHERE INSTEAD OF BEING ALLOWED TO SPEND TIME TALKING TO PATIENTS, They check up on people; they pull out the prescription pad; they order tests.”
See my guest post on this issue relating psychiatry and primary care on KevinMD back from 2008. The bottom line is that insurance companies do not pay for cognitive services. Psychiatrists pulled out of the insurance business some time ago, so those that remain push patients through in quick appointments, filling scripts like the doc profiled in the article. The same thing is happening to primary care.
http://www.kevinmd.com/blog/2008/08/matthew-mintz-as-psychiatry-goes-so.html
Most primary care docs can take care of basic depression, Bipolar disorder, ADHD, and other psychiatric illnesses. Unfortunately, if I bill a psychiatric diagnosis as a primary care doctor, the insurance companies usually hit the patient with a deductible.
Agree with the above, especially MG's comment about psychopharmacology being a "subspecialty." Shouldn't all psychiatrists be able to prescribe meds and know what they're prescribing? If not, that's scary.
Dr Sharfstein's ill-advised quote sounds, to me, like a way of saying "Look at us! We can be doctors too, just like the rest of you!" [I agree that Dr Mintz's interpretation is more likely his real sentiment.] But for me, one reason I'm a psychiatrist is so that I don't have to be like other doctors. I have great respect for my fellow physicians of all specialties, but I chose psychiatry because of the unique relationships I can have with patients and the rather distinct body of knowledge I must master in order to truly heal a fellow human being. Unfortunately, financial pressures may turn me into a prescribing machine like Dr. Levin, and psychiatry (today, at least) just does not lend itself to that approach.
Yes, if it weren't for the twisted Medicare and Insurance policies, the doctors would really spend time with their patients. But with a high cost of living and the standards of life they are living… we can see more and more of this practice.
no matter the domain, after a while, the doctor gets used to not asking more questions and not spending a lot of time with the patients
DIY Health
You can DIY your Health, but I have to DIY student loan payments that equal the mortgage on my small rambler.
However, I have chosen not to completely pull out of therapy or insurance and have a mix of self pay and insurance patients. This is an ethical decision which works financially as well. I have taken on the care of patients whose last psychiatrist were apparently uncomfortable prescribing or simply stopped learning about new medications 15 years ago. That said, I am a trained analyst and family systems psychotherapist. Psychopharmacologic expertise versus psychotherapy is a false dichotomy.
Finally, I have cleaned up the life shattering eruptions into mania and the ensuing hospitalization that has happened when a primary care doc has given an SSRI to a patient presenting with depression without taking the time in that 8 minute visit to ask about a family history of bipolar disorder or to ask about the patient's own symptoms of mania (which they may not remember and so it takes a subtle, long interview to suss out any such symptoms). So please, don't say that family practice docs can treat psychiatric conditions just because the downward pressure on reimbursement due to the stigmatization of the mentally ill has forced primary care to treat mental illness due to the lack of access to psychiatric providers. The mean and median ages of psychiatrists is 62 and 64. That is AMA data. I hope you feel competent….