"The best way to predict the future is to create it." - Peter Drucker
The annual convention is approaching and the American Psychiatric Association (APA) has decided to train a few psychiatrists from each district branch to teach about the new DSM5. They think that is sufficient to fill the demand from organizations and groups who want assistance with DSM5 training and implementation. They also think that the threat of litigation is enough to protect the DSM copyright and prevent other self declared trainers from going around the country and training people about the DSM5. That is more critical than you might think. Let me explain why both of these thoughts are problematic wrong and describe a more optimal course of action that could still be implemented before the May convention.
First of all let me say that the ideas I am posting here are
not new. I have inquired directly from the APA as a member both at their
Washington Offices and through my District Branch (DB). The lack of response prompted the “Crickets”
title from the APA because cricket chirping is about all I am hearing about any
initiative other than the APA’s original plan.
There are many sources of failure possible by restricting the
training. The obvious one is that
psychiatrists are busy. The failed
billing and coding system generally means that psychiatrists are seeing a lot
of patients and spending even more time on billing, coding, and
documentation. That leaves very little
time each week to study for recertification exams, train future psychiatrists
and medical students, and participate in other professional activities. Given how thin psychiatrists and other
physicians find themselves spread, it might be reasonable to have a bureau of
trained DSM5 experts at each DB to cover the potential demand.
I first got interested in this issue when a large health care
organization asked me about the availability of consultants to assist them in
their nationwide implementation. The DSM
IV is currently implemented in their electronic medical record (EMR). Several calls directly to the APA did not
produce any results. I identified myself
as a member and that did not make a difference.
I contacted my excellent DB Executive who I had worked with during my
term of being the DB President. She is
extremely knowledgeable and widely networked within the organization. The question I proposed was whether the APA
would consider opening up the convention session to all psychiatrists through
the DB and certifying anyone who has taken the course. Still no response.
Absent the response I have the following suggestions about
how to train DSM5 trainers in the interest of the APA and its mission and
preserve the copyright integrity of the DSM5:
1. Expand the
training in May to all DBs and to as many psychiatrists as want to take the training.
2. Provide password
access to all of these psychiatrists to the DSM5 web site for the purpose of
ongoing learning. The DSM5 site was
quite good in providing the rationale for suggested changes and prospective
trainers could benefit from ongoing access to this material.
3. Provide
educational materials (PowerPoints) to all of the trainers through access to a
training web site.
4. Develop a course
specific to administrators and companies who need IT implementation information
and have that readily available.
5. License DSM5 to
corporations in the same way that psychiatrists with online subscriptions can
access it. UpToDate has provided a good example of the continuously updated online
reference rather than serial textbooks being the direction forward. There should be no need for update cycles and
massive political events to herald updates.
The DSM and all psychiatric guidelines need to be systematically
reviewed and updated if APA technology is to be seen as the definitive
reference for the biomedical diagnosis and treatment of major mental disorders. Updating every 10-20 years will not survive
in the day of Internet technology. There is also a lot less drama involved when UpToDate updates its content. That is consistent with being a resource for physicians and by physicians.
All of these recommendations can be done and anything less
than following through on these recommendations leaves the APA seriously
compromised and not competitive in the future.
George Dawson, MD, DFAPA
