tag:blogger.com,1999:blog-7772182113499451603.post5081405481449968872..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: The Model of Psychiatric Care for the FutureGeorge Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-7772182113499451603.post-17488929769028886122013-05-13T22:27:00.625-05:002013-05-13T22:27:00.625-05:00There is no better example of the negative impact ...There is no better example of the negative impact of managed care on the provision of psychiatric care than child and adolescent psychiatry. One of my best training experiences as a medical student was a course in infant and toddler psychotherapy for children at risk in Milwaukee. It occurred in a day hospital run by two psychiatrists, a fellow, and three medical students. We saw children and their parents individually, in groups, and in their homes in the case of parents who were too disabled to come out to the county grounds. This was all psychotherapy and we had a seminar once a week where we reviewed the latest information in scientific journals. We saw kids who were diagnosed with "autism" completely change their behavior. I haven't treated any children in over 20 years at this point but my guess is that nothing like this exists anymore. And anyone espousing the managed care model will tell you why and tell you how things are supposed to be done.<br /><br />No therapy, no detailed assessments, and no good residential treatment for the kids that need it. The state where I work had a solution where doctors prescribing antipsychotic prescriptions to kids could get a second opinion from a child psychiatrist. I guess that is more "cost effective" than a rich clinical atmosphere and a comprehensive approach to children and their families.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-41845663715635517952013-05-13T14:02:45.347-05:002013-05-13T14:02:45.347-05:00Dr. Dawson, thank you for writing about this impor...Dr. Dawson, thank you for writing about this important topic. As a child psychiatrist, I really worry about the impact of managed care on my profession, given the relative shortage of child psychiatrists around the country.<br /><br />While I don't agree with everything you write, I'm glad to have found a blog with a different perspective from the usual ones (including <a href="http://www.psycritic.com/" rel="nofollow">my own</a>) that are fairly critical of mainstream psychiatry.Psycritichttps://www.blogger.com/profile/05279225254350525266noreply@blogger.com