Med Managers

In this month's issue of Archives of General Psychiatry, an article documents a decline of visits to psychiatrists involving psychotherapy, from 44.4% in 1996-97 to 28.9% in 2004-05. To anyone in the field this is about as surprising as the weather forecast in August (as of last evening, "It's going to be another hot one").

There are three issues pertaining here, and two of them--the overall continuity and quality of care delivered to patients, and the economics involved (some argue that treatment split between therapist and prescriber leads to more overall visits and therefore more expense)--receive the most attention, properly so. But the third issue, hardly trivial, is the satisfaction or lack thereof of being a psychiatrist. It is hard for me to imagine that undiluted medication management, particularly done at the q 15 minute pace that is increasingly standard, could be anything but a mind-numbing grind, an evil necessary only for paying the bills (particularly the ever larger student debt burdens of new physicians). Think about it--at this point, and for the foreseeable future, psychiatry enjoys neither the scientific specificity nor the treatment efficacy (except maybe in the case of ECT) of other specialties. If there is no time to engage with patients' stories, how many people realistically would want to do this?