Like other docs, psychiatrists receive email surveys now and then asking about different aspects of life as a psychiatrist– about the medications favored for treating depression or anxiety, the fees charged for different types of patient visits, and the amount of time spent at work versus home.
I received such a survey last week, in multiple choice format. Much of it was the same as usual, asking the things I described above and similar questions. But one question made me pause for a moment, and to re-read the question and the choice of answers.
The question: What is the average amount of time spent with each patient?
I looked for my answer among those listed: a. 3 minutes; b. 6 minutes; c. 9 minutes; d. 13 minutes; or e. 20 minutes or longer.
That’s it? No ’30 minute’ choice? No 60 minutes? I wondered if the survey was intended for a different specialty– perhaps for… for what, exactly? I checked the survey email and sure enough, it was for psychiatrists. And I wondered– how the heck can ANYONE take care of patients, based on appointments that last 9 minutes– let alone 3 minutes?!
I wondered if the answer template was chosen from a different survey; one that was used for a different medical specialty. But when one thinks about it, is there ANY medical specialty, where the doctor can do a good job by seeing people for an average of 9 minutes? I realize that the specialty of medicine has changed. Doctors have ceased to be the friendly confidant, and are now ‘care gatekeepers.’ Somewhere, some doctor agreed to work for the insurer’s interest, accepting extra payment from the insurer in return for agreeing to keep the patient from seeing specialists– and now the role is taken for granted. Isn’t that something? Doctors being paid, by insurers, to prevent access to care. The term for that, by the way, is ‘managed care.’ Funny how nice it sounds; managed care. managed care. Almost sounds like a good thing!
As a solo-practice psychiatrist, I am more connected to the cost/value equation of my services than the typical system-employed physician. I’ve also written in prior posts about my concerns with modern psychiatry. I have worked in a variety of settings over the course of my career, and I realize that coming to an understanding of something as complicated as another person’s subjective life experience is a very difficult endeavor. At the very least, such an understanding takes time. It also takes a willingness to maintain the constant recognition that my perception may be wrong, and may be the result of my own bias. Finally, it takes a certain amount of intelligence. Over time, certain patterns of thought become apparent and easier to recognize– but these patterns are extremely complex, and trying to provide insight into such patterns, without causing a person to take offense, requires intelligence, patience, and tact.
I have come to the realization (a somewhat surprising realization, frankly) that psychiatry works, when practiced properly. I’ve come to realize that the ten-minute med check is worse than worthless, as a ten-minute glimpse of a person’s day is more likely to lead to the prescribing of a harmful medication than a helpful one.
On the other hand, if one has the time to sit and share small talk, then review the important issues occuring in a person’s life, and then discuss the problematic symptoms that the patient is experiencing…. then ask questions that provide context for the symptoms, and perhaps make a small suggestion or two in order to provide outside insight into the cause of the symptoms…then present the different medications sometimes used for the person’s symptoms, after first discussing whether the person would prefer medication over working on the problem through more ‘mindful’ approaches… then discuss the different side effects possible with each medication, and the likelihood that the medication chosen would be helpful…
Today on my radio show I mentioned my frustration with being ‘in my 50′s’, and the injury to my knee that happened while stowing stuff in the garage last night. She sent me the video below– and I got a kick out of it!
