Shirah Vollmer MD

The Musings of Dr. Vollmer

Primary Care Docs: I Am Looking At You!

Posted by Dr. Vollmer on March 10, 2017

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West Annual Conference

Anaheim, CA | May 10-13, 2017

Anaheim Convention Center

The Worried Well: Anxiety Disorders in Primary Care

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


Speakers

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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.

4 Responses to “Primary Care Docs: I Am Looking At You!”

  1. Shelly said

    Are you saying that patients expect medications from their primary care physicians for anxiety without expecting to pay a co-pay for an office visit? Why would patients expect that, unless that is something that they had previously discussed with their physician? Are they talking about refills or first time prescriptions? What would happen to medicine if primary care physicians weren’t able to prescribe any anti-anxiety medications and only psychiatrists could? Wouldn’t that be better for you?

    • Yes. Patients expect to get refills without being monitored and this expectation needs to change. The co-pay makes people reluctant to come in, and as such, they hope they can get refills quickly over the telephone. Sadly, when this does not happen, they can threaten to write a bad yelp review and thus bully the MD into prescribing without monitoring. I think primary care docs should prescribe anti-anxiety meds but they should be limited to 10 pills at once, with no refills allowed. Thanks, as always.

  2. essemdee said

    I’m surprised that you’ve used the term “worried well,” which is often used as a term of contempt for people seeking treatment. A quick Google of the term turns up this: “One of my least favourite types of patient is the worried well. Treating them seems to me like a bottomless pit of meaningless medicine, with little progress or reward. They convince themselves they’re acutely moribund, and it’s our job to prove that they’re perfectly healthy. It’s a Sisyphean task and it’s excruciatingly frustrating. – See more at: http://www.cfpc.ca/ProjectAssets/Templates/Resource.aspx?id=4489#sthash.0r28ow3z.dpuf. It’s true that anxiety can be frustratingly long and difficult to work through, but I’d hate to think that my therapist feels this way about me. I’ve read your blog long enough to know that you don’t think of people who seek help this way, so what does the term mean to you?

    Thanks, as always, for your writing.

    • Hello Essemdee,,Thank you for chiming in. You are absolutely right that “worried well” is a contemptuous term, and I use it in my lectures as a way of trying to persuade primary care doctors NOT to see these patients as a “waste of time” but rather to see them as people with deep suffering that need time and attention to get better. My audience is primary care, as most therapists welcome anxiety as a symptom which deserves further exploration. In essence, the term is a launch pad for this discussion. Please let me know if you have any further questions. SV

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