Sunday, March 6, 2011

Talk Isn't as Cheap as Drugs

This article in today's NY Times has generated considerable discussion.

Here's my take:
  • 39 patients in a day: too many for me
  • Dr. Levin has a right to practice as he chooses
  • Dr. Levin's wife's role counts. She's appears to do things many psychiatrists would incorporate into their own roles. This makes the 39 patient count more reasonable.
  • Dr. Levin must be doing something right to attract so many patients.
  • Dr. Levin may be a lot better at psychopharmacotherapy now that he is doing so much of it.
  • Dr. Levin needs to get a... blog. Or maybe tweets would suit his practice better.
  • Sometimes 15' is more than enough time.
  • Sometimes 50' is not enough time.
  • Dr. Levin should have told his drinking patient to stop, if only because of potential interaction with prescribed drugs, and recommended appropriate help if needed. He could even have prescribed a drug to help him stop drinking.
  • Many patients just don't want psychotherapy and shouldn't be forced into it.
It's not all about the money:
  • Dr. Levin's patients get to choose their psychotherapist. They are not stuck with him.
  • Dr. Levin's patients can get the type of psychotherapy best suited to their diagnosis, not just the kind that he happens to practice.
  • Dr. Levin's patients don't have to get psychotherapy at all unless they want it.
  • Dr. Levin's patients get to start and stop psychotherapy independently of medication.
  • Dr. Levin's patients get to start and stop medication independently of psychotherapy.
My related posts:


  1. Yes, his wife really did an amazing role. I don't know what to feel about this article. At one point he looks like a gold digger but in the end he still has compassion for his patients.

  2. Compassion for his patients? Not enough to practice up to his own standards by his own admission. The guy sold his soul and he has no right to sit there and moan about it. He's the one who did it.

  3. Movie Doc,

    With all due respect, it is about the money when you stop a patient who says he needs help, by saying you aren't his therapist.

    This also resulted in missing a relevant fact about his patient who had started drinking. How many other relevant medical facts is he missing because of his McDonald's style practice?

    Contrast that with Dr. Carlat, who when his patient reported at the end of her med session that she was cheating on her husband, took the extra time to speak with her.

    I realize that if all your patients god forbid, had these types of problems, you would be in a bind. But blowing them off doesn't seem like the answer to me.

    You said,

    ""Dr. Levin's patients get to start and stop medication independently of psychotherapy.""

    Hmm, if he is missing relevant facts such as a patient's drinking, what makes you think he is going to be able to help his patients successfully taper off of meds? Even many psychiatrists who aren't as money hungry as Dr. Levin seem to be clueless about withdrawal so that is why I have little faith that he would be helpful.

  4. Anon: we all get to -- have to -- make decisions about what we feel comfortable doing, and what we refer or defer to someone else. For example, I don't detox alcoholics even tho in theory I could. Dr. L gets to call those shots. But I agree he should have followed up on the drinking issue, not because he should jump into psychotherapy, but because it bears directly on med management. Good for Carlat for taking extra time. Maybe his next patient didn't show. Even in a psychoanalytic practice the "time is up" statement is a standing joke. No matter how you practice you have to decide how much time in needed, and sometimes, like I said, even 50' is not enough. If "all your patients" have those kinds of problems, you may need to schedule fewer patients or screen out the ones that you can't help adequately.

    Would you be as critical of a gastronenterologist who "blew off" a patient who brought up cheating on her husband? Why not?

  5. Movie Doc,

    As an FYI, Carlat kept his next patient waiting.

    Yeah, I would be critical of the gastronenterologist who blew of a patient who brought up cheating on her husband. The stress of that situation could be contributing to the medical problems.

    I wouldn't expect him/her to offer psychotherapy on the spot but perhaps some brief empathy and asking whether the patient is seeing a therapist might be helpful.