Primary Care Docs: I Am Looking At You!

West Annual Conference

Anaheim, CA | May 10-13, 2017

Anaheim Convention Center

The Worried Well: Anxiety Disorders in Primary Care

• Thursday, May 11
• 10:45 AM – 11:45 AM

Description

This talk will cover the assessment and treatment of anxiety disorders in a primary care setting, incorporating new diagnostic issues as a result of D5M5

Learning Objectives

The clinician will learn how to classify anxiety disorders

The clinician will learn how to choose a psychopharmacological agent to treat anxiety disorders

The clinician will learn how to manage patient anxiety in a busy clinical practice

The clinician will learn how to take patients off anti-anxiety medication

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Speakers

Shirah Vollmer, MD

Shirah Vollmer, MD is a Clinical Professor of Psychiatry at the David Geffen UCLA School of Medicine. She is a board certified child and adult psychiatrist and she is a psychoanalyst. She is on faculty at Loyala Marymount University, The New Center f…

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I return to my mission of teaching primary care doctors about anxiety disorders, as a way of sensitizing them to the suffering of mental distress. Today, I spoke at the 44th Annual UCLA Family Medicine Refresher Course, a conference I have participated in for over 25 years. My slides have been updated to include DSM 5 diagnostic system. A few new medications, but not many, have been added to my presentation. Mostly, my talk has changed in form and not in substance, meaning that I make a deeper plea for taking time with patients to determine why they are anxious, along with a plea to give anti-anxiety medications with caution, but at the same time, not withhold them from those who are temporarily overwhelmed with their circumstances. In two months, I give a similar talk at Prime-Med, a larger audience of primary care, but my message will be the same. Anxiety is a starting point, not an end-point. Stay curious and help the patient understand himself and what meaning the anxiety has for his life. Yes, this takes time, I say, and yes, I know you are not reimbursed for that time, I say, but that time is essential to helping the patient cope with the stressors, both internal and external, that he faces. At the end of my presentation, the questions are predictable. “What do I do with a patient who won’t come in because he does not want to pay his co-pay?” An audience member asked, knowing that I had no answer for that. “Tell him that management of his issues requires time and patience, and that you cannot short-change him of that, while at the same time understanding that co-payments can be a burden”. I say, knowing that this will not convince the patient to come in, but it might help the physician stand her ground. As with all of my presentations, I review the history of psychiatry, those wonderful days before we had medications, where we offered deep listening and thoughtfulness, and I sadly state that those days created a field in which thinking was valued, and time with patients was essential. This contrasts with today, where algorithms rule the evaluation, and time is crunched for “efficiency” which in my mind means poor care. So, all you primary care docs out there, wanna come to the happiest place on earth on May 11, 2017 and hear me say this one more time? I would welcome your questions.

Is Psychiatry As Bad Off As I Say It Is?

Check out Kelly Brogan MD…http://kellybroganmd.com/, a psychiatrist, similar to my thinking, advocates for mental health without medication. Now, I do not completely agree that medications are hurting patients, although sometimes that is true, but I do agree that we as psychiatrists have gotten trigger happy, which means we are too eager to prescribe, and too reluctant to listen and put symptoms in context. I have recently taught second-year psychiatry residents (UCLA-15 total), psychodynamic psychotherapy students (New Center for Psychoanalysis-9 total) and I am about to teach primary care doctors .https://www.cme.ucla.edu/courses/event-description?registration_id=146702 about the diagnosis and treatment of anxiety disorders.  In each of these very different audiences I lament the loss of history taking in psychiatry, associated with the rush to prescribe and the consequences being unrealistic expectations and poor understanding of one’s personal dynamics. Associated with this are tremendous health care disparities in psychiatry where those without means are given care which is significantly lower quality than care given to those with discretionary income. Further associated with this are training programs where students learn to read checklists as opposed to asking and listening to open-ended questions. The patient’s narrative is lost and with that comes the loss of the excitement and joy of self-discovery; this loss being for both patient and provider. Burn-out seems like an inevitable consequence of our new model of care, but it will take many years to document this and so we must wait for evidence to validate our suspicions. Meanwhile patient care is suffering, and those with means can seek out care that makes sense, while those dependent on public funds are left to focus on symptom relief and not bigger picture understanding of what is killing their vitality. “I make students depressed” I say frequently, always to laughter, which goes with the grain of truth this gloomy picture represents. Exposing the problem remains the first step. Hence, I will repeat myself until this broken system starts to mend.