Shirah Vollmer MD

The Musings of Dr. Vollmer

Is Psychiatry As Bad Off As I Say It Is?

Posted by Dr. Vollmer on March 6, 2017

Image result for psychiatry

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.

2 Responses to “Is Psychiatry As Bad Off As I Say It Is?”

  1. Shelly said

    I think that both patients with discretionary income and those without want quick relief, however those with the income have the means to look at the whys and self discover whereas those without don’t. If the government were to get involved and were to allow a certain amount of sessions on their dollar to those without the income to understand their repeat patterns that bring about their downward spirals and triggers, perhaps in the long run it might make patients happier and less dependent on alcohol, drugs, or other destructive behaviors.

    • Yes, indeed. In fact, there are programs called FSP-full service programs, which give the “high utilizers” those who have used services frequently (ie cost the government a lot of money) are being seen in their home and given intensive attention to prevent costlier care. So, for the very ill, they do get continuity of care, but as usual, the vast majority who fall in the middle, get inadequate care which lacks continuity, and since that is the most important part of mental health care, that is very sad to me. Thanks.

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