a response…

Posted on Sunday 6 March 2011

Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy
“I had to train myself not to get too interested in their problems, and not to get sidetracked trying to be a semi-therapist.”
The New York Times
March 5, 2011

Alone with his psychiatrist, the patient confided that his newborn had serious health problems, his distraught wife was screaming at him and he had started drinking again. With his life and second marriage falling apart, the man said he needed help. But the psychiatrist, Dr. Donald Levin, stopped him and said: “Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate.”

Like many of the nation’s 48,000 psychiatrists, Dr. Levin, in large part because of changes in how much insurance will pay, no longer provides talk therapy, the form of psychiatry popularized by Sigmund Freud that dominated the profession for decades. Instead, he prescribes medication, usually after a brief consultation with each patient. So Dr. Levin sent the man away with a referral to a less costly therapist and a personal crisis unexplored and unresolved.

Medicine is rapidly changing in the United States from a cottage industry to one dominated by large hospital groups and corporations, but the new efficiencies can be accompanied by a telling loss of intimacy between doctors and patients. And no specialty has suffered this loss more profoundly than psychiatry…
I’m responding to this because so many people have sent me links to this article that I guess to only thing to do is write something.
When he started in psychiatry, Dr. Levin kept his own schedule in a spiral notebook and paid college students to spend four hours a month sending out bills. But in 1985, he started a series of jobs in hospitals and did not return to full-time private practice until 2000, when he and more than a dozen other psychiatrists with whom he had worked were shocked to learn that insurers would no longer pay what they had planned to charge for talk therapy.

“At first, all of us held steadfast, saying we spent years learning the craft of psychotherapy and weren’t relinquishing it because of parsimonious policies by managed care,” Dr. Levin said. “But one by one, we accepted that that craft was no longer economically viable. Most of us had kids in college. And to have your income reduced that dramatically was a shock to all of us. It took me at least five years to emotionally accept that I was never going back to doing what I did before and what I loved.”

He could have accepted less money and could have provided time to patients even when insurers did not pay, but, he said, “I want to retire with the lifestyle that my wife and I have been living for the last 40 years.” “Nobody wants to go backwards, moneywise, in their career,” he said. “Would you?”
What happened is exactly as it is described in this article. I kept going on doing what I knew how to do anyway – just kept "doing what I did before and what I loved." I was a late arriver, having had another career first, so I was never around for the days of wine and roses to "go backwards, moneywise, in [my] career." I’m retired with "the lifestyle that my wife and I have been living for the last 40 years." I live in a log cabin. We travel and buy the things we want. It was a modest life with a modest retirement. I wouldn’t have had it be much different. I get calls from Therapist friends often who want me to help them find a "good Psychiatrist" who will do their "meds." I don’t even know what to say. Good Psychiatrists don’t "do meds," they treat people. Days like Dr. Levin describes change you into a machine, and you become kind of brain dead. I have no idea how to solve the current situation where Psychiatry is a "Med" Specialty. As is apparent from my recent blog posts, I think turning Psychiatry into a "Med" Specialty is one of the worst ideas anyone ever had – capitulation to the greedy Pharmaceutical Industry. Medication by Primary Care Physicians is even worse. I just wish the patients luck. Maybe Psychiatry can some day evolve into a rational "Med" Specialty in the future, but right now that’s certainly not what it is. I do hope Dr. Levin enjoys his retirement more than he enjoys his current life. I’d suggest he might start by downgrading his financial expectations…
    March 7, 2011 | 12:26 AM

    Do you think psychiatry of today has stopped for even a moment to self reflect upon the damage they are inflicting: or have they realized that patients have lost trust in not just the practice of “Psychiatry”, but this disturbing phenomena has extended across all of medicine with increasing consumer skepticism …

    When I walk into any doctor’s office, my suspicions are now always on high alert questioning each and every move they make. How can you provide sufficient care under those circumstances.

    This is very sad state of affairs that medicine has brought upon itself by becoming a business for profit first & foremost, and then a servant of their ethical creed a distance second.

    March 7, 2011 | 1:52 PM

    The fatal first step for the profession was crossing the line from profession to business. The bottom line for the profession was quality patient care and building a good reputation; the bottom line for business is profit. Those are vastly different basic motives.

    The shift became clear to me way back when psychiatrists began putting ads in the yellow pages, instead of just having their address/phone listed. I was shocked, having been brought up to consider advertising to be unseemly, if not outright unethical.

    Once that line was crossed, the rest was inevitable. And I don’t know how it can ever go back. We may have to just accept the fact that psychotherapy is a “non-medical” procedure, done either by other types of therapists who expect less compensation, or by psychiatrists willing to make far less than their friends in other specialties. At least that’s where we are now.

    March 11, 2011 | 7:57 PM

    And if Dr Levin were your patient would you suggest he “downgrade his financial expectations” without knowing a little something about his financial situation? How about a little empathy?

    Michael Scott
    March 18, 2011 | 11:50 AM

    “Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate.”

    Now comes the question: Did Dr. Levin charge his non-patient for that piece of wisdom?

    If I were to go to Al & Arnie’s garage and ask if they could fix my banged-up fender and Al told me, “Nope. We don’t do fenders.” would Al bill me for telling me he wouldn’t work for me? Would I pay the bill if he did? Would you?

    So again my question: Did Dr. Levin charge his patient for telling his patient that he would not treat his patient?

    If he didn’t – good. If he did (and most Doctors I’ve encountered would), why wasn’t that small detail included in this piece? And what part of “shooting yourself in the foot” are health care providers not grasping?

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