tag:blogger.com,1999:blog-7772182113499451603.post60192161010582878..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: An Excursion into the Psychiatric News - Blurred Lines Between Business and Professional OrganizationsGeorge Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-7772182113499451603.post-45881808435067630842016-09-26T09:55:56.760-05:002016-09-26T09:55:56.760-05:00BTW the Oquendo article is a perfect illustration ...BTW the Oquendo article is a perfect illustration of academic-in-power seemingly oblivious to the increasing impotence of the hoi polloi. That is, maximum responsibility and minimal control. There's nothing to wonder about, physicians have been talking about it for decades. PHQ-9s? If you want to focus on acronyms, start with EHRs and ACOs and MOCs. Alcohol abuse? In some cases, but that doesn't explain the larger trend. I'm not confused about the larger metadiagnosis at all and it lies firmly on Axis 4.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-87734558444561850642016-09-25T22:46:20.389-05:002016-09-25T22:46:20.389-05:00Collabo-Care renders doctors to the role of an alg...Collabo-Care renders doctors to the role of an algorithm and as such, we are guaranteed in time to be replaced by software that will have a lower error rate by an ACO model. <br /><br />The Disney IT workers who were forced to train their own replacements or lose their pension at least had the dignity and self-awareness to be upset about it. APA leadership are lemmings in cheerleading costumes. And some of us keep paying them to do it.<br /><br />https://www.youtube.com/watch?v=Z8Kx0GxSle0James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-24437366008106060162016-09-25T22:14:12.396-05:002016-09-25T22:14:12.396-05:00Agree completely on the collaborative care issue, ...Agree completely on the collaborative care issue, especially since the "health care reform" is an administrative/managerial house of cards. There is absolutely no evidence for the way that physicians and psychiatrists are managed these days. There is no reason for the APA or the AMA to go along with anything.<br /><br />I gave it my best effort in trying the get the point across as a district branch president, but physicians in general and psychiatrists in particular never want to rock the boat - especially if even a small part of the membership might be alienated. <br /><br />In that case, that small minority prevents the kind of assertiveness and initiatives that would benefit the majority of front line clinicians and their patients.<br /><br />Instead of saying the system of mental health care is thoroughly dilapidated and needs to be run by psychiatrists who know what they are doing - we are playing along with strategies that marginalize psychiatry. That will kill psychiatry as we know it - replaced by a PHQ-9 and a "prescriber". George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-39274816522651146612016-09-25T20:35:31.050-05:002016-09-25T20:35:31.050-05:00In "Changing the Face of American Psychiatry,...In "Changing the Face of American Psychiatry," Mel Sabshin, Medical Director of the APA wrote of the lead up to the DSM-III, "How could a professional organization engineer a scientific revolution that changed its core? According to conventional wisdom, organizations respond; they do not initiate." He was explaining why the APA took control in those days. Most still think that was a correct move. <br /><br />But after that, the APA never let go of that power. Rather than going back to being responsive to the membership, they continued to tell, rather than ask. I dropped out early around the very issues George is talking about now. The current APA and its collaboration with "Collaborative Care" is an example of of an organization participating in its own demise.Mickey Nardohttp://1boringoldman.comnoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-56188951821327101742016-09-25T19:11:17.789-05:002016-09-25T19:11:17.789-05:00With the money I have saved in thirty years of not...With the money I have saved in thirty years of not belonging to AMA or APA or their local chapters, basically paid for my last two cars (bought 12 years apart, which btw is how you really leave a small footprint). I have never regretted giving them the heave ho after residency. AMA rolled over on Obamacare and APA is an ineffective ceremonial guild.<br /><br />Also getting out of the bubble has made me more objective and critical in a good way.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-10286273009404995882016-09-25T14:36:32.600-05:002016-09-25T14:36:32.600-05:00Agree completely - the entire "evidence-basis...Agree completely - the entire "evidence-basis" for ACOs and the elaborate rationing scheme in place by the federal government is not valid. The other issue is the continuous kowtowing to administrators and managers by an endless stream of opinion and perspective pieces on "reform" and the next great idea in management and administration in some of our top journals. It not only contradicts science and evidence based medicine but it also mimics the real life process of working in these places and being subjected to the next great idea by whoever your not-so-bright administrator is.<br /><br />I hope to post a piece on a researcher who I think has done the most to totally debunk ACOs and what supposedly supports them.<br /><br />And let's get blogging out of medical journals and get back to the facts. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-26891808615255631542016-09-25T14:06:33.654-05:002016-09-25T14:06:33.654-05:00The AMA, as far as I can tell, is just as bad or w...The AMA, as far as I can tell, is just as bad or worse at protecting the interests of both physicians and their patients as the APA. The metrics suggested for Medicare to assess "merit-based" payment reforms are anything but merit-based, and will have the effect on many doctors of causing them to only take the cases with the best prognosis so they can look good. What has either organization done to counter this bull in the minds of the public? I'll tell you. Not one damned thing.David M. Allen M.D.https://www.blogger.com/profile/06280912088483192599noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-34538149049619948442016-09-24T22:44:01.794-05:002016-09-24T22:44:01.794-05:00Not to mention the incessant articles conceptualiz...Not to mention the incessant articles conceptualizing burnout as an Axis I disease rather than an Axis 4 problem.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.com