tag:blogger.com,1999:blog-7772182113499451603.post6921883591077423265..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: There Is No Identity Crisis in PsychiatryGeorge Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-7772182113499451603.post-84637067000077089352019-11-02T13:25:36.141-05:002019-11-02T13:25:36.141-05:00You and I also disagree on exactly how many psychi...You and I also disagree on exactly how many psychiatrists practice like you or I do.<br /><br />I think we also disagree on the idea that high throughput medicine has something to do with medicine. I seem to recall every excruciating step in that takeover.<br /><br />And not circling the wagons is how managed care and their friends in the government took over in the first place. <br /><br />Believe that unchecked - it can get a lot worse. The NEJM piece is just a sign of the next wave.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-47940385695529268382019-11-02T11:25:55.574-05:002019-11-02T11:25:55.574-05:00"In the meantime, psychiatry finds itself pla..."In the meantime, psychiatry finds itself plagued by overprescription of psychiatric medication for a large segment of the population; abandonment and incarceration of people with chronic, severe mental illness; and an increasingly unwieldy diagnostic system of overlapping symptom checklists.<br /><br />In addition, medicine’s “era of high throughput” has promoted a one-size-fits-all approach to diagnosis and treatment, and time with patients has dwindled in all specialties. For psychiatry, which still faces substantial diagnostic and therapeutic uncertainty, these trends have been especially deforming."<br /><br />Frankly, this sounds exactly like something you or I would say and I find very little to disagree with in the article. This was very much like your criticism of collaborative care or the PHQ-9 or treatment of psychosis in jails and prisons.<br /><br />Let's not confuse how we practice with how psychiatry is widely practiced, especially in systems like HMOs or Medicare or not practiced at all because of legal obstacles. <br /><br />I find no need to circle the wagons on this one with one exception. I disagree with the authors' idea that academics are going to reform this. They can't because they are the source of the problem and have no skin in the game. James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.com