Psychiatric Services COLLEAGUE INTERVIEW
A Conversation With
George Dawson, M.D.
G
eorge Dawson, M.D. received his medical degree from the Medical College of Wisconsin, Milwaukee, WI. His postgraduate training included an internship at St. Paul-Ramsey Medical Center, followed by a residency in psychiatry at the University of Minnesota Hospitals and Clinics and the University of Wisconsin Hospitals and Clinics. He is board certified by the American Board of Psychiatry and Neurology, and has added qualifications in geriatric psychiatry and addiction psychiatry. Dr. Dawson is an assistant professor, Department of Psychiatry, University of Minnesota Hospitals and Clinics, and a staff psychiatrist at Hazelden, Center City, MN. Questions were provided by: Renee Koronkowski, M.D., Peter Dehnel, M.D., Marvin Segal, M.D, and Lee Beecher, M.D.
What attracted you to psychiatry when you first made that career decision? I had a lot of exposure to people with severe mental illnesses as a child growing up in a small town. I had a five block walk to school every day and on that walk I went past the homes of many people who were afflicted with mental illness. Additional motivation occurs when you have affected family members. You realize that this is something that is very real and that you have to do something about it. When you move away, the effects of the illness haunt you and your family for decades. In medical school, I had the good fortune to encounter psychiatrists who had strong identities as physicians and they were confident that they could help people with these problems. I could talk directly with patients without any pretense that I was different from them. I was interested in everything about medicine but it was a perfect time to be a psychiatrist.
In your 25 years of experience as a psychiatrist, what are the greatest advances you have seen in the field? What are the biggest setbacks you have witnessed? The biggest advance has been the accumulation of information over the past 25 years. Much of the information has been compiled into treatment guidelines. I was an early adopter of the National Library of Medicine as a resource for medical practice and other informatics based approaches. This probably is the best example of how the government can impact 8
November/December 2011
quality in medical practice. Every day tens of thousands of physicians check Medline looking for the best scientific solutions for their patients. There has been an explosion in how information is processed in biological systems to include cell signaling, genomics and proteomics, and brain based models that attempt to integrate diagnoses and more specific behaviors. A major clinical advance was the start of the community-based treatment for people with severe chronic mental illnesses in Madison, Wisconsin by Len Stein, M.D. and others. Today in Minnesota, Assertive Community Treatment based on that model is one of the few modalities offering comprehensive community based care to persons with severe mental disorders. The biggest setback for psychiatry has been managed care and using both utilization review and prior authorization to ration care to patients needing psychiatric care. The evolution of this process is lost on people who did not witness it happening and only see the end result — severely compromised psychiatric care. I was at a meeting in 1994 when a managed care consultant addressed a large crowd of psychiatrists and told us all that we were highly paid specialists. According to him, managed care was going to buy up all of the high priced specialists, put them out of business, and greatly expand primary care. Instead we find that managed care has expanded specialty care and promotes their own specialty care and imaging facilities. Primary care access may be at an all time low. Access to psychiatric care and addiction treatment is far worse and in many cases nonexistent. Most significantly, costs have not been MetroDoctors
The Journal of the Twin Cities Medical Society