Can Psychiatry scale up? Mildred, sixty-one, went to her insurance company because she thought she might need medication for her poor focus and “lousy” mood. She found a Dr. Lolli who had what she considered to be excellent credentials. Upon arriving at Dr. Lolli’s office, named ‘Lolli Psychiatry’ she was told that her appointment was with Dr. Edwards. Surprised that this information was not disclosed when she made the appointment, the office manager told her that ‘Lolli Psychiatry’ meant people who work for ‘Lolli Psychiatry’ and although this was not clear from the website, this is how the office worked. Mildred, not sure what to do, decided to see Dr. Edwards. She was content with the visit, but at the end, he told her to take Prozac, specifying a particular generic and to call him “whenever she felt like it.” There was no mandate for follow-up. Mildred thought this was a bit strange, but she took the prescription, did not fill it, and decided to forget the endeavor of pursuing medication. So, the trend, as I see it, continues. The personal part of psychiatry is dwindling away, while the interchangeable psychiatrist replaces it, for the vast majority of folks who use insurance to seek medical care. Those, like with hospitality, who are willing and wanting to pay for personalization, can get their physician to remember their name, but, for most patients, there will be a deep impersonal quality to medical care, at least medical care administered by a physician. Although I understand this trend, and I have blogged about it for years now, I still find myself quite sad and dismayed at this change. Mostly, I wonder what motivates the physician to set up such a practice. Does Dr. Lolli charge more to see ‘Dr. Lolli’? I wonder. Does Dr. Lolli, recruit young psychiatrists to be the Dr. Edwards of his practice, knowing that eventually Dr. Edwards will be a competitor? Is. Dr. Lolli going to franchise and create multiple locations? Will the name ‘Lolli Psychiatry’ have a brand meaning? Confusion sets in for me. Dr. Lolli needs to create a business, while at the same time, create a model of care which generates patient satisfaction and improved well-being. Compare that to my idea that the physician/patient dyad is unique, creating a sense of care, and love, and in that relationship, along with deep insights and understanding of human motivation, the healing journey begins. Perhaps, Dr. Lolli creates a bench of psychiatrists who can provide this personal care. More likely, though, Dr. Lolli sees his ‘bench’ as interchangeable widgets, giving patients availability, but also, anonymity. I am in the psychiatry business, but I struggle to understand the business of psychiatry.