As I joined in yet another debate over the extent of the tragedy of psychiatrists who have relegated psychotherapy to non-physician professionals and restricted their practices to the now infamous "med check," an analogy occurred to me. The spork represents the combination of two perfectly good eating implements, the spoon and the fork. Each of these does its job quite well, but by combining them you can achieve one-stop-shopping, at least a small advantage.
The spork compromise, however, leaves you with an inferior spoon and an inferior fork, not to mention that you can't take along a 3-tine vs. a 4-tine fork, or a smaller or larger spoon. You are stuck with the design of the implement. If you lose the spork, you've lost both implements, while if you had brought separate tools, you might still have one. You are not likely to ever need to use a spoon and fork simultaneously, but those tines make for a leaky spoon, and their stubbiness makes for a decidedly inferior fork.
And so it goes with psychiatry. Some patients and their psychiatrists will find the combined approach suits them best. For the rest, independent professionals offer decided advantages.
More ad nauseum:
The Sporkiatrist Tries to Do Psychotherapy
The Real Reasons Psychiatrists Want to Provide Psychotherapy
Unhinging Dr. Carlat
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The issue, in my opinion, is how someone could possibly do a good job assessing mood and other issues in a 10-15 minute med check every month or two. This is simply ridiculous to me. So, fine, don't have the psychiatrists do psychotherapy if they'd be so awful at it - but have them spend enough time to get to know their patients well enough to have some claim to professional pride.
ReplyDeleteThe patient should get what is needed, but for many that means a visit to their primary care once a year for refills. For others 50' weekly isn't enough.
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