Tuesday, November 5, 2019

Why are Some Psychiatrists Such Wimps?

“Most psychiatrists are working in toxic practice environments that were designed by business administrators and politicians. As a result, psychiatrists are expected to see large numbers of patients for limited periods of time and spend additional hours performing tasks that are basically designed by business administration politicians and have no clinical value.” ~ George Dawson, MD

With the exception of those who are in “concierge” practices who do not take insurance and treat only those who can pay significant fees, very few psychiatrists—even in private practice—are doing any psychotherapy at all—other than being supportive with their patients. As mentioned in Dr. Dawson’s quote, some don’t do it because, simply put, they aren’t given the necessary time. They have to see several patients per hour, and are also too busy filling out completely useless symptom checklists on electronic medical records. 

Others are not interested in psychosocial issues and see everything in the DSM, the profession’s diagnostic manual, as a brain disease in need of medication – even “adjustment disorders,” which by their very definition have strictly psychological and social etiologies and do not require medication. Still others won’t do therapy because it doesn’t pay well. (Even psychologists are doing less and less long-term psychotherapy because insurance companies will not authorize it and keep ratcheting down fees, and they have been advocating for prescribing privileges. However, that is not the subject of this particular post).

Medical and psychiatric newspapers are filled with stories of physician “burnout” - being exhausted or depressed over their unpleasant work situation. Business and insurance companies work hard to convince these cases that the problem resides with their stress tolerance, rather than with their stressful working situation, and that they need to practice more mindfulness.

Meanwhile, hospital beds for the chronically mentally ill – those who do have actual brain diseases and are in desperate need of medication – have started to disappear. Along with that, the Community Mental Health Centers which once treated them with close follow up have been defunded by the states and the federal government. These two developments have resulted in many of these people living on the streets or languishing in jails, which have become de facto mental hospitals.

So who’s to blame for all this? Surely tax phobic politicians and greedy business interests share the lion’s share of the responsibility. Dr. Dawkins in his blog, from which the quote at the start of the post comes, seems to think that psychiatrists have no responsibility here, because they have all been forced to conform to the whims of businessmen with zero knowledge of medicine dictating how they should practice. But don't they really?

I think one of the main problems with the psychiatrists is that many of them are really a bunch of wimps who are too friggin’ chicken to band together and say “no” to their task masters. Of course, a lone doctor who tries to do that by himself or herself can be fired or made an example of. I recall my own experience at the VA when I had the nerve to protest in the patient’s chart that I had to prescribe a drug I knew would not work for a patient with both chronic pain and depression, before I could prescribe the more expensive medication which had been shown to be the most effective for that (while the rheumatologists could use the more expensive drug first line). I was offered an “anger management” seminar to treat me because I was angry that veterans were being screwed!

But can the business interests fire every one of their docs if they all refused to go along? Hell no!

There is a national shortage of psychiatrists. When you are in demand like that, they need you way more than you need them. In fact, as a member of the professional networking site LinkedIn, I have been asked to be part of their network by 22 different recruiters in just the last two months alone! And that was pretty much representative of the numbers of recruiters trying to snag me for a position every two months for the last several years. BTW, my profile clearly states that I am retired.

What a bunch of wimps these doctors are. You’d think it would take a lot of willpower and self esteem to get into and through medical school and residency training, and it does.  But doctors-in-training are also bullied, hazed, and forced to submit to the medical school hierarchy even when they know that their superiors are in the wrong. 

Until it was prohibited a few years ago, medical interns routinely worked 36 hours straight several times per month. (This was justified by the powers that be as being necessary because, they said, if there is an epidemic, doctors have to be able to work until they drop. The only problem with this rationalization was that the last major epidemic in the United States was the flu epidemic of 1918. By the time the next one rolls around, the doctors will be out of practice for 36 hour shifts, not to mention out of shape. No, this practice was hazing, pure and simple).

In other words, doctors are trained to act like sheep, and after they finish training many still act like sheep. Psychiatrists are no exception. How irritating. So my answer is yes, we psychiatrists are indeed part of the problem.