On the front page of Sunday’s, New York Times (3/6/2011) was an article about the state of psychiatry in America; it was so painful to read that I lost my appetite.
There are 48,000 psychiatrists in America, and 90% of them no longer talk to their patients. Instead, they see patients for 15 minutes to monitor their medications. Psychiatrists stopped talking to patients because managed healthcare no longer pays for talk therapy.
There is no evidence that a psychiatrist’s talk therapy is of any higher quality than that of a psychologist or social worker, so managed care may pay you $90 for a 45″ session. If you see three people for 15 minutes each for medication checks, you will be paid$150 for those 45″ It doesn’t take an accountant to figure out that if you see 30 people a day you make a living.
Until recently psychiatry was the only specialty left where doctors spent time listening and talking to patients. I had hoped that the practice of medicine would become more like psychiatry, but alas, psychiatry has joined the rest of medicine in practicing brief, impersonal care.
When doctors minimize their relationships with patients, they lose any expectation of building intimacy with them, and it will steal their spirit as healers.
In 15″ I can’t know anything about the lives of my patients. I don’t care how important medication is; it’s relationships that get people better, listening to their stories so that they can hear mine. Nowadays, if patients want to talk about something, they are told to wait and talk about it when they see their primary therapist.
For the first time in my life I am ashamed to call myself a psychiatrist, without adding this proviso “not of the pill-pushing kind”.