Is Bad Care Better Than No Care?
Posted by Dr. Vollmer on January 28, 2015
If the choice is bad care or no care, what do we choose? This sums up my current focus on the changing nature of mental health delivery. Today I am reminded that psychiatrists are asked to do paper reviews of prescribing practices. This means that there will be psychiatrists employed to review charts to determine the kind of care the patient needs. Whatever is documented is valued as being “true” since the psychiatrists will never interview the patient, and in terms of children, he/she will not interview the parents either. Like teachers who are forced to teach to a test, rather than help each child learn to the best of his ability, physicians are now looking at data, and this data is what is entered into the computer, and this data is used to evaluate the appropriateness of the care. Garbage in, garbage out, as computer engineers would say. We rely on the input to make determinations, but we are not questioning the input. This results in big data which is determining reimbursement and program development. Measuring cholesterol may help determine the overall health of a population, but there is no corresponding measure in psychiatry. There is no short-cut for assessing mental health. The long-cut is a trained professional doing a painstaking interview, along with review of previous evaluations, talking to collateral historians and then formulating a hypothesis which is tested over time, through interventions such as psychopharmacology, psychotherapy, and environmental manipulations. This is my rant. I will keep saying it, as long as I keep hearing about the future of medical care, and in particular, the future of mental health intervention. Bad care is not necessarily better than no care, but bad care breeds statistics and big data. No care seems like neglect, but picking an option which only gives data, but does not address the state of mental health assessment is not wise. “There is no money” I keep hearing as to why the system is stuck. “You mean that it is not a priority,” I reply. And so the dilemma continues.