Shirah Vollmer MD

The Musings of Dr. Vollmer

Mental Health Specialists

Posted by Dr. Vollmer on June 4, 2018


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The future of psychiatry involves less direct patient care, or so says James Phelps MD of the Samaritan Health System in Oregon. MHS, or mental health specialists, an un-licensed position takes the history, reports to the psychiatrist who then makes suggestions to the primary care physician. Am I missing something? The nuance of the narrative is lost without a skilled listener. Medicine, not just psychiatry, is losing this narrative and replacing it with symptom checklists which right now can be done by college graduates, but in the future, is likely to be done by computer. Large systems of care such as Kaiser or UCLA are going to absorb the liability making doctors less fearful about making recommendations without taking  their own history. No license means no regulation, no specific training and no mandate for continuing education.  I have said on this blog many times how appalled I am that the listening skills of a psychiatrist are no longer valued, but the creation of this new position is a new low for me.  The listening bar has been lowered such that diagnosis and treatment is based solely on symptoms, without any room for, dare I say, intuition. Listening, I trust, will always be valued by patients, but clearly it is not valued by health care delivery systems. Medicine has gone corporate. I know this is not all bad, but for those who have mental suffering, it certainly is bad. Patients with difficult feelings need to be heard. They need to control their narrative. They need to understand themselves. Being evaluated by a mental health specialist will not accomplish that, and for that, I am very sad.

3 Responses to “Mental Health Specialists”

  1. Jon said

    Sadly, we have an update to the wonderful quote of Robert Frost, “Poetry is what is lost in translation,” into the modern Vollmerian potential quote “Psychiatry is what is lost in transcription of the narrative without a skilled listener.” Yours is you want it.

    • Well, hello Jon….yes…the art, the poetry in medicine is eroding rapidly and, as you know, for that I am very sad for both patients and practitioners.

  2. Coralie Le Coguic said

    Hi, I just discovered your blog today, and am voraciously reading because I feel like someone both took the words right out of my mouth and wrote them down & am finding gold clinical nuggets that will certainly help my practice. I have a request… in this post you talk about the importance of intuition for diagnosis and treatment, while in another you warn of diagnosing from our own counter-transference. I would love to see a post comparing/contrasting these two ideas. Thank you in advance for considering this idea, and thank you for this thoughtful blog! Very excited to keep reading!

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