Saturday, July 17, 2010

The pitfalls of psychiatry

Earlier in the week, I heard a snippet on NPR's Fresh Air about the pitfalls of psychiatry. Dave Davies who filled in for host Terry Gross interviewed Dr. Daniel Carlat, psychiatrist and author of the new book Unhinged: the trouble with psychiatry.

Dr. Carlat touched on a number of different topics, but the one that has always troubled me was that so many psychiatrists typically do not do any counseling at all. Instead, it's literally a 15-20 minute med check where only questions of whether you had any side effects are asked, a decision of med adjustment is made, and then you are on your way. There are never questions of what is going on in your life, how you are truly feeling, etc., because that is left up to the therapist whom hopefully you are also seeing.

Now, I know this is not always the case, and there are psychiatrists who also counsel, but in reality, the number is few and far between. (1 in 10 or a measly 11 % is cited in his new book based on a Columbia University survey who give counseling to all their patients) I think psychiatrists are missing out a lot in not looking at the whole patient. They miss that the patient may be drinking alcohol while also taking a sleeping medication. Or the patient may be purging their medication or not eating enough to make the medication effective, etc. How does that help the patient in the end? Why is it difficult to ask the right questions that would enable the most amount of information? Even more so, if you are seeing a therapist, there is rarely communication between the two.

Just think how much better the off the patient would be if there was more collaborative efforts between professionals. This is not to say this never happens, but the majority of time, everything must be separate, at least in the case of outpatient care.

I realize with the way insurance us set up, the idea for most psychiatrists is to see as many patients as possible, and if they were to do an hour long session with each one, they would have less patients. Still though, as many psychiatrists are seeing hundreds of patients a week, how are they even to remember who you are in the first place?

Maybe I'm slightly biased here, because I never had great relationships with the psychiatrists whom I saw versus my therapists. They just did not have the time, and there was always a feeling of a rush to get you out the door. Even years ago when I had wanted to go to medical school, I had decided that if I were to be a psychiatrist, I would not become a pill pusher but rather do a combination of both meds and therapy.

It's funny how this issue is still at the forefront and probably even more so. It'll be interesting to see what will happen in the field of psychiatry.

What are your thoughts and experiences with psychiatrists? Have yours offered therapy and should they?

Links to listen to the story: "A psychiatrist's prescription for his profession" or to read the transcript.

1 comment:

Kara said...

I've had a psychiatrist that literally had to look up my name on the chart when I came into his office - every time. Lame!