Disjointed Care

An article I recently read in the New York Times by Gardiner Harris confirms what so many people already know: You talk to your therapist and you get your drugs from your psychiatrist. The article, which I highly recommend reading, sheds some light on how this disconnected treatment evolved. The bottom line, not surprisingly, is that it is all about  money and our failing health care system. It is just not cost-effective for psychiatrists to spend forty-five minutes to an hour  talking about a patient’s problems when they can spend fifteen minutes with them, prescribe meds, and refer them back to their therapist. They can see a lot more patients in a day this way.  According to Harris, “No specialty has suffered this loss [of intimacy between doctors and patients] more profoundly than psychiatry.”

Well, I could’ve told you that. I didn’t understand it when I was shuffling Dan between his psychiatrist and his therapist, and I don’t understand it now.  What are the benefits to the patient to have this disjointed care? If you have a therapist who knows you, understands you, and talks with you an hour a week, shouldn’t they be able to prescribe medication for you?  The meds we are talking about are all trial and error anyway, so doesn’t someone who knows you well have at least as good a chance of getting it right as a psychiatrist who hardly knows you at all? I know. I know. Therapists aren’t MD’s. But neither are optometrists, podiatrists,or nurse practitioners, to name a few professionals who are licensed to prescribe (certain) medications in most states.

I am so thankful that Dan has been off of medication completely for almost two years. He has now been seeing the same therapist twice a month for almost three years. It is ludicrous to think that if Dan needs to go back on medication at some point, we would need to shop around for a psychiatrist. It’s like already having a doctor who has examined you and diagnosed you with an infection.  He/she then proceeds to send you into the world to find another doctor who will prescribe you an antibiotic.

Am I missing something? If this system benefits the patient at all, I would love to hear how…

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2 Responses to Disjointed Care

  1. Deb says:

    Yes.Yes. Yes. I had no idea that is they way psychiatry works. I have a further stretch of this in that my son’s depression is being seen by a local therapist. His exposure therapy is with someone an hour away. His medication is with a Dr who simply suggests pill after pill after pill on top of pills. She gets a glazed look when we talk about symptoms.

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