4
P SY CH I AT R I C T I M ES www.psy c h i a t r i c t i m e s. c o m
Awaken Continued from page 2
don’t. This is their principle, and they stand by it. And in doing so, they help countless patients receive quality treatment. It is also not the case that these Ronin care only for the “worried well.” The Times piece notes that in “New York City . . . a select group of psychiatrists charges $600 or more per hour.”3 But the rarified atmosphere of a top dollar Manhattan psychiatrist’s office is hardly a realistic assessment of the state of private practice in psychiatry. There is much truth to the statement that “medicine is rapidly changing in the United States,” and that these changes have been associated with a “loss of intimacy between doctors and patients.”3 This is simply a fact for all of medicine, and so let’s examine this trend a little more closely. Trends in health care, generally, could be said to proceed in this fashion: • Te c h n o l o g y n e v e r s t o p s progressing. • As technology progresses, much of the evaluation/treatment process becomes more rapid, and just as importantly . . . • It becomes easier for people without specialized training to do. Again, a simple fact because the computer/new technology/etc can do the job more quickly, more consistently, and without a salary and health care benefits. • Thus, the business of health care becomes progressively segmented and compartmentalized • No area of health care is immune to the above process. Psychotherapy does not escape this sequence. Already, virtual psychotherapy is being developed and used. Soon, “avatar therapists” may be implemented.8 But until we develop true artificial intelligence, human beings will still be needed somewhere in the process. So in the interim, psychotherapy, too, will be distilled down to what “researchers” believe is its practical “essence.” Anything that cannot be accomplished in the 10- to 15-minute session can be given as a take-home assignment to the patient. At some point, third-party payers may decide that it is no longer feasible to pay even psychologists or social workers for what anyone with a bachelor’s degree can do. Does this sound familiar? If so, it is because some of it is already happening. But the question still remains: if we are not satisfied with this, must we accept it? Are we so genteel and apathetic as a profession that we will
M AY 2011
simply acquiesce? Will we passively assent to a lowering of what we believe is an acceptable standard of care for the patients we took an oath to treat? Some may argue that my points here are too idealistic. Others may quarrel: “It is easy to proclaim such ideals when one does not have to live with the restrictions of my position.” To them I would say—who is it that is keeping you imprisoned by these restrictions? Ultimately, this type of thinking provides no solutions and nurtures discontent. All that really matters are the answers to these questions: • Are your patients’ best interests being served? • Are you content practicing medicine according to the oath you took? If the answer to either of these questions is no, then it may be time to change your situation. If we still wish to pursue our medical calling, then we must seek out the set of circumstances that brings us closer to what matters, and settle for nothing less. Such circumstances do exist (albeit maybe not in a particular desired location), and it is still possible to practice this amazing profession provided one is willing to adapt, stand by one’s principles, and stick to the path. Psychiatry—it is time for you to awaken and return to your calling. If you went into psychiatry for the money, well . . . perhaps it is time to reevaluate that decision. If you went into psychiatry because you wanted to relieve suffering and explore the mystery of the human condition with (Please see Awaken, page 6)
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