Pill Mills

 

Most employed psychiatrists are hired to prescribe medication to the many folks who are thought to suffer from mental illness, while another practitioner provides psychotherapy and/or case management. At first glance, this seems appropriate. The psychiatrist is the only one in the mental health food chain who can prescribe, and hence, maximizing psychiatrist time, means having them do the most prescriptions possible. On the other hand, this narrows and denies the scope of psychiatric training, and in particular, it denies the value of the psychiatrist-patient relationship. For example, Sally, a fictional psychiatrist patient of mine, works for a social service agency, where she spends thirty minutes with each patient, ten hours per week, prescribing medication, but she feels, and I agree, that those thirty minutes are cherished moments in these severely ill patients’ lives. In this time, there is a frank discussion of their psychosis, their internal struggles, and their present worries, along with a prescription refill. This time is valued by both the psychiatrist and the patient as the healing relationship. The prescription is, in some secret way, almost an excuse for the psychiatrist and the patient to get together. In point of fact, the prescription could be written by a nurse practitioner, or more refills could be given, but the need for the prescriptions allows for quality time together. Sally reminds me that because our health care system is devaluing the doctor-patient relationship, the ‘work-around’ is to say the visit is for medication, but in fact, to use the time to build rapport. In my wishful life, I would like psychiatrists, like Sally, to come out of the closet and say that we need time with patients because our relationship with them matters, whether we prescribe medication or not. We represent a professional who can listen, understand and care about their internal and external struggles. We can also supplement our listening skills with psychopharmacology. Both are important. It is time to go public with our healing relationship with patients. We offer this to those who have hit tough times in their lives. We, as psychiatrists, should be proud, and not ashamed, of our bonds with those who seek us out. We are not, and should not be, pill-mills!