mortiz095

This is from an email I recently sent to a colleague. It also relates to the comment on my last blog by Dr. Dawson, and the new assembly line psychiatry. I can't begin to count the number of patients of mine who complain that they've been to other psychiatrists who never talked to them, spent 10 mins and prescribed drugs. This, in my view, results in gross overtreatment with medications, poor decision-making regarding medication management, poor patient outcomes, lack of patient participation in treatment decision-making, as well as patient and family dissatisfaction. I don't think it's possible to properly evaluate a patient in that amount of time. If the patient is so stable they don't really need an evaluation, just a prescription, then they don't need a psychiatrist, their primary care doctor can do that. There is now a terrible shortage of psychiatrists, and it will reach truly crisis proportions in the next 10 years as the aging workforce retires or dies. ...

One major lesson I have learned is that the gap between academia/NIH and the real world of practice in large private health care organizations is so vast that it's almost hard to believe. Even though I have always had a significant clinical involvement, I was shocked at how little I understood about how the real world works. It's taken more than two years to figure out how it works, and very humbling. (Example: Hospitalist: Hi, haven't met you before, nice to meet you. I need some help with this patient with opioid addiction and pain. Me: Hi Dr. Jones, happy to help. Hospitalist: Have you been in this area for a long time? Me: I worked at the VA and the University for many years, then was at NIH for 5 years, then recently moved back here. Hospitalist: NIH? That's very nice. Now, can you help me get this patient out of the hospital?) MW